Showing papers in "Academic Psychiatry in 1991"
TL;DR: The authors found that residents were provided with minimal training in aggression management during their residency, and there was no significant correlation between rates of threats or assaults and age, sex, or training sites.
Abstract: There are few studies of assaults against psychiatric residents. The only two domestic studies specifically investigating assaults against residents each surveyed a single residency program. In the present study, 333 psychiatric residents in 11 training programs in Pennsylvania were surveyed about assaults and threats on them during residency. One hundred fifty-five questionnaires (46%) were completed and returned. Of the respondents, 41 % experienced a physical assault and 48% were threatened at some time during their training. Ten percent of the respondents were assaulted more than once, and 30% of the respondents were threatened more than once. There was no significant correlation between rates of threats or assaults and age, sex, or training sites. The majority of threats and assaults occurred in either an inpatient setting (56%) or a psychiatric emergency service (31%). The authors found that residents were provided with minimal training in aggression management during their residency.
25 citations
TL;DR: An annotated bibliography of psychiatric medical ethics that includes both empirical and conceptual analyses of the ethical issues seen daily in the office, clinic, hospital, nursing home, and in society at large is offered.
Abstract: We offer an annotated bibliography of psychiatric medical ethics that we hope will be useful for psychiatrists and other mental health professionals who are interested in the moral dimensions of psychiatric care. We present the educational and clinical rationale for the bibliography, ways to use the bibliography, and the bibliography itself. Using the American Psychiatric Association’s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry as a principled framework, we selected references based primarily on educational and clinical relevance for physicians. We include both empirical and conceptual analyses of the ethical issues seen daily in the office, clinic, hospital, nursing home, and in society at large.
14 citations
TL;DR: It is believed that teaching residents to be better teachers can have an impact on recruitment of medical students into psychiatry and psychiatric residents into careers in academic psychiatry.
Abstract: Teaching other residents and medical students is one of the primary activities of psychiatric residents, yet most receive minimal or no formal training or supervision on how to teach. This report describes a Teaching Day Workshop, designed and implemented by residents at the Massachusetts General Hospital with the support of their faculty and an educational consultant, as one model to introduce the concepts and techniques of teaching to psychiatric residents. The participating residents were unanimous in their positive appraisal of the workshop, and they recommended that additional seminars on teaching be integrated into the residency's core curriculum. Ways that the Teaching Day Workshop can be adapted for use by other residency training programs are discussed. The authors believe that teaching residents to be better teachers can have an impact on recruitment of medical students into psychiatry and psychiatric residents into careers in academic psychiatry.
13 citations
TL;DR: These tensions are described as a set of dilemmas facing the training director when designing the psychotherapy curriculum for residents and the recently developed psychotherapy training program at the University of Washington in Seattle is described.
Abstract: The field of psychiatry is characterized by tensions and philosophical differences. These tensions are described as a set of dilemmas facing the training director when designing the psychotherapy curriculum for residents. A solution to these dilemmas is presented. As a concrete example, the recently developed psychotherapy training program at the University of Washington in Seattle is described.
10 citations
TL;DR: Two cases from the Asian Focus Unit illustrate how residents learn trans-cultural psychiatry during interactions with ethnic Asian patients and staff.
Abstract: The ethnic/minority psychiatric inpatient units (i.e., focus units) at the University of California, San Francisco, train residents in transcultural psychiatry. This article describes the history, goals, and educational program that comprise this unique training experience. Two cases from the Asian Focus Unit illustrate how residents learn trans-cultural psychiatry during interactions with ethnic Asian patients and staff. Educational perspectives and current program evaluation are discussed.
10 citations
TL;DR: The authors describe a program they have initiated that incorporates organized family support groups in such training efforts and indicates a wide variation in time allotted, activities, and participants insuch training among the respondents.
Abstract: In an attempt to assess the status of residency training in psychoeducational approaches for families of chronically ill patients, the authors conducted a national survey of U.S. residency training programs. Responses from 154 programs (75%) indicated a wide variation in time allotted, activities, and participants in such training among the respondents. Less than 50% of the programs indicated formal involvement of family support groups such as the National Alliance for the Mentally Ill (NAMI) and the National Depressive and Manie-Depressive Association (NDMDA). The authors describe a program they have initiated that incorporates organized family support groups in such training efforts.
8 citations
TL;DR: The extent and the barriers to expansion of geriatric psychiatry training in psychiatry training programs in the United States are determined and reported factors inhibiting the introduction of geriatrics into psychiatry residency programs are reported.
Abstract: The objective of this study was to determine the extent and the barriers to expansion of geriatric psychiatry training in psychiatry training programs in the United States We mailed a questionnaire to the training directors of all 216 psychiatry residency programs listed with the Accreditation Council for Graduate Medical Education We received and analyzed 127 responses Seventy-nine percent of the respondents reported having at least one geriatric specialist on their faculty, and almost half of all reported psychiatry residents take a geriatric rotation Rates in other medical specialties range from 71% of internal medicine departments to 13% of general surgery departments with any faculty geriatric specialists and from 62% in family practice residents to 3% of neurology residents who take a geriatric rotation Reported factors inhibiting the introduction of geriatrics into psychiatry residency programs include limited time, insufficient numbers of trained faculty, and insufficient funds More direct funding supporting the research of geriatric faculty may be needed to stimulate the development of geriatric training
7 citations
TL;DR: Higher effectiveness ratings were associated with journal clubs that had mandatory participation, met frequently, were held in a convenient location, reviewed articles on original research, emphasized and taught research methods, and had regular faculty participation.
Abstract: We surveyed the membership of the American Association of Directors of Psychiatric Residency Training (AADPRT) regarding the presence and characteristics of journal clubs in their general and child psychiatry residency training programs. Responses were obtained from 141 general residency programs and 76 child psychiatry programs. Eighty-six percent (N=180) offered at least one required and/or voluntary journal club, and many offered multiple journal clubs. Higher effectiveness ratings were associated with journal clubs that had mandatory participation, met frequently, were held in a convenient location, reviewed articles on original research, emphasized and taught research methods, and had regular faculty participation. Higher attendance ratings were associated with daytime meetings, smaller residency programs, required clubs, clubs that met more often and for shorter lengths of time within the hospital, and clubs that show continuity in faculty participation. Descriptions of various formats and inducements reported may be useful to other programs wishing to establish or improve journal clubs.
7 citations
TL;DR: There was a tendency for students on the consultation and acute services to enter psychiatry residencies at a higher rate and ratings were not significantly correlated with National Board of Medical Examiners examination scores, which were higher during years with 8-week rotations and case conferences.
Abstract: For over 14 years, students completing a psychiatry clerkship were asked to rate their educational experience. Comparisons were made across clinical assignment, length of rotation (6 vs. 8 weeks), and teaching modes. Consultation and acute services were rated higher than open adult or child/adolescent services. General units were rated higher than specialty units. Ratings were higher for 8-week rotations, and case conferences were preferred to lecture formats. Ratings were not significantly correlated with National Board of Medical Examiners examination scores, which were higher during years with 8-week rotations and case conferences. There was a tendency for students on the consultation and acute services to enter psychiatry residencies at a higher rate.
6 citations
TL;DR: The authors present data showing that between 1974 and 1984 University of Maryland Medical School graduates specializing in psychiatry were more than twice as likely to enter fellowships in child and adolescent psychiatry if they were participants in the Combined Accelerated Program in Psychiatry (CAPP) as medical students.
Abstract: Part of child psychiatry's recruitment problem stems from defections among medical students who were planning careers in child psychiatry when they entered medical school The authors present data showing that between 1974 and 1984 University of Maryland Medical School graduates specializing in psychiatry were more than twice as likely to enter fellowships in child and adolescent psychiatry if they were participants in the Combined Accelerated Program in Psychiatry (CAPP) as medical students. The CAPP, a 4-year medical school track that contains a strong child psychiatry component, appears to prevent the erosion of students' interest in child psychiatry.
5 citations
TL;DR: In 1989, the authors surveyed all general psychiatry residency programs to assess the availability, extent, and emphasis of administrative teaching currently being offered during residency training and proposed curricula for training in administration.
Abstract: In 1989, the authors surveyed all general psychiatry residency programs to assess the availability, extent, and emphasis of administrative teaching currently being offered during residency training. With a return rate of 74.5%, the results reveal that 69.5% of the respondents presently include administrative training within their curricula and 56% offer didactic teaching about administrative issues. These results are compared with a similar survey performed 10 years previously in which 85% of the respondents reported offering some administrative training but only 39% offered didactic instruction in this area. An analysis of these data and a review of proposed curricula for training in administration are provided.
TL;DR: A school-based program in which psychiatry residents educate adolescents about a variety of mental health topics responded positively to the program and were principally concerned about drugs, depression, suicide, and family problems.
Abstract: This paper describes a school-based program in which psychiatry residents educate adolescents about a variety of mental health topics. Adolescents responded positively to the program and were principally concerned about drugs, depression, suicide, and family problems. Residents also liked presenting in the schools. Participation in this program allowed residents to learn about agency consultation and secondary prevention. Possibilities for program expansion are discussed.
TL;DR: It was found that training directors use much the same criteria for evaluating FMGs as AMGs, and familiarity with, and confidence in, the evaluative methods used in American medical schools was seen as a more important criterion for evaluatingFMGs than AMGs.
Abstract: A survey of training directors in psychiatry was conducted to explore criterion areas in foreign medical graduate selection by comparing the perceived importance of 11 selection criteria between American medical graduates (AMGs) and foreign medical graduates (FMGs). Our study found that training directors use much the same criteria for evaluating FMGs as AMGs. For both groups, great emphasis was placed on personality factors, psychological mindedness, ability to communicate, and performance in the interview. Referrals by faculty received equal importance for both groups. The examination scores were seen as more important for FMGs and the transcripts and the reference letters marginally more important for AMGs. This is interpreted as a reflection of a lack of reliable sources of information about medical education received from abroad and a greater familiarity with, and confidence in, the evaluative methods used in American medical schools. Familiarity with American subcultures was seen as a more important criterion for evaluating FMGs than AMGs. The implications of these findings are discussed, and some suggestions are made regarding selection of FMGs.
TL;DR: Specific discussions with medical students about the dynamics of unequal relationships and sexual exploitation are recommended to help prepare them for some of the difficult ethical issues in medical training and practice.
Abstract: We surveyed 297 medical students regarding their attitudes toward sexual relations between physicians and patients and between physician supervisors and junior colleagues Significantly more female than male medical students would intervene in a situation involving sexual contact between a physician and a patient, and male students would intercede significantly more often in the circumstance of sexual contact between a colleague and physician supervisor Four percent of the students considered it acceptable to have sexual relations with patients Forty-two percent felt that sexual contact would be acceptable immediately after the professional relationship ended; 80% approved of sexual contact with ex-patients after two years The responses of both sexes indicated a naive understanding of the unequal power dynamics inherent in these types of relationships We recommend specific discussions with medical students about the dynamics of unequal relationships and sexual exploitation to help prepare them for some of the difficult ethical issues in medical training and practice
TL;DR: There is no simple answer to the question "Has academic psychiatry abandoned the community?", but I think it has incorporated the very best and most useful community psychiatry concepts and programmatic elements into mainstream general psychiatry.
Abstract: There is no simple answer to the question "Has academic psychiatry abandoned the community?" I think it has incorporated the very best and most useful community psychiatry concepts and programmatic elements into mainstream general psychiatry. I think academic psychiatry has gradually become involved with the chronic mentally ill wherever they are, not always because it wanted to and more slowly than many other voluntary community organizations, but more quickly than most government agencies. And I think, again perhaps faute demieux, it is now, more than ever, heavily involved with society's most difficult and perplexing public mental health problems. That does not mean that there is not more to do. Clearly, more must be done in those areas in which 1) there are manpower problems, e.g., rural areas, CMHCs, and state hospitals; 2) there is absent or abysmal care, e.g., prisons, nursing homes, and shelters; and 3) populations exist that still are largely ignored and underserved, e.g., the dually diagnosed and homeless mentally ill. It is, therefore, the time for neither self-congratulation nor self-condemnation. Rather, now is the time for continued self-examination of which areas academic psychiatry can appropriately contribute to community psychiatric activities by extending its research, training, and service energies.
TL;DR: Preliminary findings suggest that PGY-3 residents had more difficulty in acquiring inpatient diagnostic skills, in understanding the range of inpatient psychopathology, inUnderstanding therange of therapeutic interactions, and in development of professional psychiatric identity than PGY -2 residents on the same rotation.
Abstract: This article provides a preliminary report on the educational impact of scheduling inpatient rotations either before or after an out patient year. The inpatient psychiatry evaluations of a group of PGY-3 residents who had their inpatient training rotation after a psychodynamically focused outpatient PGY-2 were compared with those of a group of PGY-2 residents who had their initial psychiatry training at the same inpatient service with the same supervisors during the same academic year. The PGY-3 residents had more difficulty in acquiring inpatient diagnostic skills, in understanding the range of inpatient psychopathology, in understanding the range of therapeutic interactions, and in development of professional psychiatric identity than PGY-2 residents on the same rotation. The implications of these preliminary findings for educational planning and future research are discussed.
TL;DR: The Electric Resident System is an experimental arrangement of software for the personal computer designed to help residents in the educational cycle of patient interview, literature review, write-up, attending review, and patient treatment.
Abstract: The Electric Resident System is an experimental arrangement of software for the personal computer. It is designed to help residents in the educational cycle of patient interview, literature review, write-up, attending review, and patient treatment. The authors emphasize the system's immediate utility and ease of operation, using a graphical interface. Within a year of operation this system was in daily use on a consultation service with minimal formal instruction. Usage data show a positive correlation between the number of patients seen per month and the number of computer-assisted MEDLINE literature searches performed. Residents' comments indicate not only acceptance of the system but increased interest in computer applications in medical care. The Electric Resident System is meant to be the first step toward a computer-aided residency.
TL;DR: It is found that residents identify themselves more with the “frontline” mental health workers engaged in the strike than with the faculty/attending psychiatrists who serve as their professional role models.
Abstract: A study of the attitudes of psychiatry residents and attending psychiatrists toward a strike by nurses and mental health workers in a psychiatric teaching hospital was performed. All residents (n = 20) and 47 (83% of the attending psychiatrists) completed a questionnaire within 4 weeks after the strike. The responses to the questionnaire indicated that resident's behavior in response to the strike was significantly different from the behavior of the attendings: 20% of the residents volunteered service during the strike compared with 66% of the attendings (p ≤ 0.0001). The attending psychiatrists, when asked what action they would have taken if they were residents, indicated somewhat less of an inclination to volunteer; 16.7% changed their position about volunteering (NS). When asked what they would have done if they were attendings, 55% (p ≤ 0.008) of the residents indicated they would have volunteered service. The significance of these findings is that residents identify themselves more with the "frontline" mental health workers engaged in the strike than with the faculty/attending psychiatrists who serve as their professional role models.
TL;DR: Specific mechanisms for determining clinical faculty membership and duties are addressed and policies for appointment, reappointment, and promotion are suggested, including the creation of a departmental Clinical Faculty Committee and the consideration of quality assurance issues.
Abstract: A large number of psychiatrists have been, or are currently, unpaid, voluntary, or “clinical” faculty. In 1987-1988, in 127 medical schools, there were approximately 122,000 clinical faculty members, outnumbering regular faculty by approximately two to one. Yet, in contrast to primary faculty, administrative policies (e.g., appointment, reappointment, promotion) regarding clinical faculty are often ill-defined or absent entirely. We discovered in a survey of 8 departments of psychiatry that most departments do not have separate administrative guidelines or policies for these faculty. This article addresses specific mechanisms for determining clinical faculty membership and duties and suggests policies for appointment, reappointment, and promotion. The authors focus on administrative management strategies, such as the creation of a departmental Clinical Faculty Committee and the consideration of quality assurance issues.
TL;DR: Except for the finding that men were less moralistic about substance abuse than women, it is found that there are no significant attitudinal differences among these IMGs despite their diverse backgrounds.
Abstract: After developing a hypothesis that international medical graduates (IMGs)from different ethno-cultural backgrounds would have different attitudes toward substance abuse, we compared the attitudes of 79 IMG applicants to our psychiatry residency training program using Chappel’s Substance Abuse Attitude Survey. Except for the finding that men were less moralistic about substance abuse than women, we found no significant attitudinal differences among these IMGs despite their diverse backgrounds.
TL;DR: A review of 69 inpatient cases presented prior to discharge revealed that residents’ greatest deficiencies were in the following two areas: knowing indications for specific outpatient treatments and coordinating input from various clinical disciplines, both inpatient and outpatient.
Abstract: We devised a rating scale, the Resident Case Presentation Inventory (RCPI), to evaluate psychiatry residents’ case presentations at our hospital’s disposition conference. A review of 69 inpatient cases presented prior to discharge revealed that residents’ greatest deficiencies were in the following two areas: 1) knowing indications for specific outpatient treatments and 2) coordinating input from various clinical disciplines, both inpatient and outpatient. The RCPI allows early identification of residents’ educational needs and can give ongoing feedback on their progress.
TL;DR: The authors draw conclusions about the most efficient means of tracking the literature for various purposes and offer suggestions about improving resources.
Abstract: This paper reviews the various resources available to psychiatrists for keeping abreast of the current literature and research in the field and reports the results of a survey that assesses psychiatrists' current practices in tracking the literature. The respondents' knowledge of available resources, their usual searching practices, and their satisfaction with the resource network are presented. The authors draw conclusions about the most efficient means of tracking the literature for various purposes and offer suggestions about improving resources.
TL;DR: The case for systematic planning for part-time training in psychiatry is presented based on experience in a program and a survey of other programs and the practical issues of arranging inpatient and outpatient clinical experiences, on-call arrangements, didactic programs, funding dilemmas, supervision, and evaluation are addressed.
Abstract: Part-time training in psychiatry has largely remained informaland has been utilized only by about 1% of psychiatry residents. This is puzzling considering the large number of women who have children during residency. In addition to aiding residents with child care needs, part-time training is also of potential value to dual-career families, handicapped residents with mobility problems, physicians seeking mid-career changes, and as a solution to those with funding problems. In this article, we present the case for systematic planning for part-time training based on experience in our program and a survey of other programs. We address the practical issues of arranging inpatient and outpatient clinical experiences, on-call arrangements, didactic programs, funding dilemmas, supervision, and evaluation.
TL;DR: A token economy pilot program in which reinforcers were provided by a university outpatient child and adolescent psychiatry clinic to address two problems common to psychiatry training programs: psychiatric residents have insufficient opportunity to learn to use behavior modification techniques with outpatients and many patients and their parents seen in training clinics are poorly motivated and noncompliant with treatment.
Abstract: We developed a token economy pilot program in which reinforcers were provided by a university outpatient child and adolescent psychiatry clinic to address two problems common to psychiatry training programs: 1) psychiatric residents have insufficient opportunity to learn to use behavior modification techniques with outpatients, and 2) many patients and their parents seen in training clinics are poorly motivated and noncompliant with treatment, which leads to psychiatry resident discouragement and frustration. The rationale for the program is presented from the perspective of both the resident and the patient. The implementation of the program with 25 cases is described, including potential and actual difficulties. One case treated by a psychiatry resident is presented in more detail.