Let me start by offering a broad definition of a portfolio. The word portfolio is partly based on the Latin folium, meaning “leaf, sheet.” * A portfolio usually represents a showcase of an individual's abilities, skills, or professional accomplishments. It is created by someone who wants to visually demonstrate his qualifications for the position he is applying for. This usually consists of a selection of documents that illustrate education, training, experience, samples of work, etc. Nowadays, many choose to build a digital portfolio on a website, but in the 1990s, which is the period I am addressing in this writing, it was a physical portable object in a 3-ring binder or a similar holding device.
I can't remember how I came up with the idea of putting together a portfolio as part of the job application on the east coast. Perhaps I was inspired by an artist's portfolio that many budding visual artists must have when they apply for an art school or a job. They need to put the best examples of their finished work in a large dossier which is not easy to carry around. I saw them in the movies and in real life with my family of artists. But I knew it wasn't common in my line of work. Generally, medical professionals seeking a job submit an application, a curriculum vitae, and references. After that comes an invitation for an interview, and voilà, after the interviewers assess that you are a qualified, well-prepared, and friendly person, the job is yours. Piece of cake, right?
I didn't think the job I was interested in at Butler Hospital in Providence, Rhode Island, would be mine in the easy manner described above because this elite hospital never before employed anyone coming from North Dakota. Therefore, I decided to convince decision-makers from the hospital that I was the right person for the job. For that reason, among other things I was preparing for the job interview, I decided to create something unique and different than the other candidates, a portfolio. I found a 3-ring binder. That was easy. I chose to start with a personal statement. That was not as easy. It took time and effort, but I thought it would be relevant that anyone who opens the portfolio first encounters my professional biographical sketch. Right from the start, I wanted to let them know who I was. To illustrate my point, I provide here my full personal statement. It has never been published before. The following is what my interviewers read first when they opened the portfolio:
Personal Statement
“I would like to begin by stating that as far back as I can remember I have had a curiosity toward other human beings, a capacity for empathy and understanding of suffering, and a need and desire to help. I believe that these characteristics determined my early decision to become a doctor when I was 11 years old. I intuitively knew that my strengths (love for books, positive attitude towards school and studying, capacity to form harmonious relationships, emotional stability, goal-oriented motivation, and optimism) would help me to accomplish that goal.
I have always been an excellent student and direction toward excellence is a part of my identity and the reason for my frustrations if I do not meet my standards of performance. But I also had to learn to be tolerant and patient so that I can keep a balance between a wish to use the maximum of my capacities under the optimal external circumstances and limitations imposed by real situations and the diversity of my roles.
In my first year of medical school, I decided to become a psychiatrist after listening elective lecture delivered by a psychiatrist. I admired his knowledge and comprehensiveness of thinking. This happened at the time when, for a moment, I doubted my decision to enter medical school due to a lack of “personal touch” and “dry science” at the beginning year of medical school. But since that time, I have devoted the best part of myself to studying and preparing for a career in psychiatry.
During the years of training and education, I was exposed to different theories and influenced by the readings, mentors, colleagues, and patients. My beliefs about the basic principles of our profession have been evolving and changing because of expanding knowledge base and diversity of experiences.
I have tried to keep a dynamic balance between constant evolution and attempts of integration as a way of making sense and putting meaning into a rich and chaotic reality. This was based on scientific principles accepted by the psychiatric community, which have been frequently challenged by new “facts” and societal forces.
My current views about human behavior, mental health, psychiatric disorders, treatment, and the role of psychiatrists are the result of that process, and I flexibly apply them in my work. I believe that human behavior is determined by an interaction between genetic “makeup” and environmental circumstances. Human needs are always expressed in a social context and the form and content of that expression are determined by that context.
Early experiences with other human beings are crucial in neurodevelopment and adaptive functioning in modern society. Human beings have a biological need to seek and attach to others. The quality of the first attachment is an important factor in the development of a sense of security, confidence, and harmony between the individual and his environment. In modern society, the need for attachment and secure bonds is frequently suboptimally fulfilled which was responsible for the development of a predisposition for mental disturbances during a lifetime.
Specific environmental influence is necessary for adequate neurodevelopment during critical periods and if this influence is not present, the neurodevelopmental arrest will ensue. Categories of mental health and mental disturbances are relative and dependent on the particular developmental stage in the life of an individual. Successful completion of developmental tasks is necessary for the overall quality of mental health.
Brain activity is responsible for mental phenomena in health and disease, and it is determined by the brain’s structural elements, electrical and chemical events, as well as by the quality and quantity of stimuli from the external environment. Mental functions are dependent on the activity of multiple brain regions connected by discrete neural circuits.
The etiology of mental disorders is complex and at least includes these factors: (a) Predisposing (for example, genetic, temperamental, developmental, traumatic, interactive); (b) Precipitating (stressors, traumatic, physical, developmental); (c) Maintaining (chronic psychosocial stressors, substance abuse, chronic illnesses, disabilities); and (d) Protective (support system, adaptive coping strategies, “ego strength”, talents, education).
The relative strength of specific etiological factors differs in different mental disorders and in different patients with the same disorder, so a thorough assessment is necessary for the development of a diagnostic formulation that goes beyond symptoms and makes a tentative hypothesis that can be used in comprehensive treatment planning and prognosis.
Treatment of mental disorders consists of symptomatic and etiological therapies. The former treats symptoms without being concerned about their meaning or causes. The letter has as a general goal removal, modification, or decrease of predisposing, precipitating, and maintaining etiological factors, and/or enhancement, addition, or modification of protective factors, which can be accomplished using diverse biopsychosocial treatment modalities.
Because all etiological factors are expressed through brain malfunctioning in the form of symptoms, syndromes, and mental disorders, all therapeutic interventions affect brain functioning too. Important common elements necessary for successful treatments are therapeutic alliance, education, encouragement and hope, normalizing behavior and decreasing stigma, and elements of supportive psychotherapy.
The role of the psychiatrist is determined by society so cultural values and beliefs as well as economics are significant factors in the theory and practice of psychiatry. In this time and place, healthcare reform is underway, mostly driven by economic reasons and causing rapid changes in the professional identity and autonomy of psychiatrists. Managed-care companies and other third-party payers have increased the influence on the delivery of medical care.
Psychiatrists’ work has become a more “public” and less “private” agreement between doctor and patient. Medical necessity specifically defined, rather than quality-of-life enhancement is a guiding principle in reimbursement for services. This requires detailed documentation of the presence of DSM-IV diagnosis, severity, and functional impairment affecting the patient’s job, relations, etc. The establishment of definable goals, use of objective criteria, practice guidelines, and outcome measures are making the provision of care more uniform, quantifiable, and standardized, as well as subject to efficacy evaluation and market laws.
The psychiatrist is less “in control” of the patient’s pool and more in need to prove the quality and uniqueness of his work. He frequently must share patients with other mental health professionals and accept a limited role in the overall care of the patient. He is but one in the “network” of providers. Because of these changes, psychiatrists need to adaptively assert themselves and accept the new realities and remain focused on the provision of quality care to their patients. I believe that a contemporary psychiatrist is primarily a physician and clinician who ought to be an expert evaluator, psychopharmacologist, clinical neuroscientist, consultant, collaborative leader, educator, integrative provider, team member, and broadly knowledgeable person.” **
Letter of recommendation
When I reread what I wrote 27 years ago, I still adhere to many of the principles that I supported back then. Now let’s move on. When interviewers continued to turn pages of the portfolio, they saw a standardized version of my curriculum vitae. No surprises there, just the listing of information relevant to my education, training, academic and health care system appointments, memberships in professional organizations, publications, etc. After that, I included several letters of recommendation from my friends and colleagues. I was grateful for their generous support and comprehensive writing. All of them were high-quality individuals with reputable professional credentials. It is a humbling but at the same time rewarding experience to read what they wrote about my skills and capabilities. For instance, let me quote from a two-page letter written by university psychologist Stephen Wonderlich:
I consider Dr. Jocić to be one of the most well-rounded and competent psychiatrists with whom I have ever worked. He vigorously pursues competency in pharmacotherapy and a broad array of psychotherapies. He has recently been working on the construction of databases that are truly clinically useful and I have been impressed with the instrument that he has developed. Recently, he has been talking to me about identifying factors or issues which serve to maintain his patients’ mental disorders rather than focusing on broader theoretical issues about the etiology. I have found him to be a very passionate, caring, and sensitive individual. He acknowledges differences of opinion openly and comfortably and is able to assert himself directly and clearly in his relations with others. He is a secure man who is comfortable with his talents, abilities, and goals. **
The instrument Dr. Wonderlich was referring to was my attempt to translate just published DSM-IV diagnostic criteria into an easy-to-understand questionnaire, which could assist psychiatric residents and medical students, as well as practicing clinicians in making systematic diagnostic evaluations. I promised myself that I would complete this project before I left Fargo and dedicate it to the trainees in our program. I included it in my portfolio under the heading Selected Psychiatric Assessment Forms.
Academic record and other documents
Richard Olafson, interim chairman of our department, requested a 3-year evaluation of my academic record from Dennis Staton. Dr. Staton wrote a 3-page report in which he outlined my didactic teaching, clinical instruction, scholarly activity, and professional and community service. He concluded that I demonstrated a highly successful functioning during this period and recommended that I be promoted to the rank of Associate Professor. I included his report in the portfolio too.
My portfolio was getting filled with many other documents related to my performance, achievements, awards, publications, results from examinations, lectures, psychiatric reports, and others. At the end of the day, it became a 100-plus-page record that I had with me when I went to the Butler Hospital interview. More than 10 interviewers reviewed it with interest, some of them were impressed and suggested that I start collaborating with researchers from Brown University who were interested in the development of assessment forms. I don't know to what extent my portfolio contributed to the fact that I got a job, but it definitely didn't have a negative impact.
What guided me to use this novel but unusual approach in my application process in an environment I was not familiar with? I believe it was my intuition, gut feeling, that it was the right thing to do; build a portfolio that would show the strength of my desire to get the job. The portfolio was objective and tangible proof of my credentials, which was hard to ignore. It was a testament to my organizational skills and my ambitious and hardworking nature. I never used it again in my future job interviews. In what I saw as an opportunity in a lifetime, a portfolio fulfilled its purpose.
** Psychiatrist’s portfolio, by Željko Jocić, 1995
I agree that your inherent style has remained consistent while continuing to grow, love, and contribute to those around you.