Showing papers in "Academic Psychiatry in 1999"
TL;DR: The perception of psychiatry among medical students has improved, compared with a similar study done in the 1980s, but the decline in recruitment continues.
Abstract: Medical students’ views and attitudes of psychiatry may influence recruitment. A 39-item questionnaire assessing demographic characteristics and balanced positive and negative views of psychiatry was answered by 479 students from four medical schools at the end of their third-year psychiatric clerkship during the 1993–1994 academic year. The students’ attitudes and views of psychiatry were mostly positive. Exceptions were the perceived low respect of psychiatry by other medical disciplines and low salary. The perception of psychiatry among medical students has improved, compared with a similar study done in the 1980s, but the decline in recruitment continues. Students’ views and attitudes of psychiatry do not explain the decline in recruitment into psychiatry.
105 citations
TL;DR: Problem-based learning (PBL) as discussed by the authors is a method of teaching that uses hypothetical clinical cases, individual investigation, and group process to teach forensic psychiatry to psychiatric residents, and the residents' level of comfort with the educational issues of testimony, liability, and competence, as well as subjective ratings of their forensic knowledge base, improved significantly.
Abstract: Problem-based learning (PBL) is a method of teaching that uses hypothetical clinical cases, individual investigation, and group process. This pilot project used a PBL approach to teach forensic psychiatry to psychiatric residents. The change in the residents’ level of comfort with five major domains of forensic psychiatry were evaluated at pre- and posttraining stages. The residents’ level of comfort with the educational issues of testimony, liability, and competence, as well as subjective ratings of their forensic knowledge base, improved significantly. Postcourse satisfaction with the PBL method was moderately high.
34 citations
TL;DR: Residents were very confident that such an examination could discriminate between incompetent and competent medical students, but the residents were less certain of the OSCE’s power to do so between competent and incompetent residents.
Abstract: Although interest is increasing in the use of Objective Structured Clinical Examinations (OSCEs) for the assessment of psychiatry residents, there are very few reports of the experiences and attitudes of residents to this form of evaluation. Eighteen residents in psychiatry participated in an OSCE consisting of eight 12-minute standardized patient interviews. Of the 15 who completed a postexamination survey, 93% rated the scenarios as very realistic and 80% considered the scenarios reflective of clinical situations they had experienced. The residents were very confident that such an examination could discriminate between incompetent and competent medical students, but the residents were less certain of the OSCE’s power to do so between competent and incompetent residents. While residents rejected the idea of such an OSCE for board certification, many felt they would like the experience to be a formative part of their training.
27 citations
TL;DR: In this paper, the authors examined the effectiveness of a journal club for teaching critical appraisal skills to residents in psychiatry and their transfer of those skills to clinical scenarios and found no difference in performance between the two groups, although two-thirds of the journal club residents did show an improvement or no change.
Abstract: This study examined the effectiveness of a journal club for teaching critical appraisal skills to residents in psychiatry and their transfer of those skills to clinical scenarios. Twelve residents participated in a 12-week journal club, and 12 residents were matched control subjects. Following the journal club, there remained no difference in performance between the two groups, although two-thirds of the journal club residents did show an improvement or no change, compared with one-third of the control residents. Furthermore, there was a trend for the journal club residents to require less time to review an article. This format of a journal club may not be an effective method for teaching critical appraisal skills to residents in psychiatry.
27 citations
TL;DR: In this article, a method is discussed for teaching many of the principles and techniques of psychodynamic psychotherapy with adolescents, including transference and resistance, neutrality and the real object, slips of the tongue and the observing ego; unconscious conflict expressed somatically, and making it conscious; the role of education; open and closed-ended interpretations and gratifying or frustrating patients; and multiple determination of symptoms and the working-through process.
Abstract: Most movies provide rich examples of bad psychotherapy. A few movie psychotherapies are so accurate and well done that they can be used, like process notes, to teach psychiatric residents and other students the major principles and techniques of psychodynamic psychotherapy. Ordinary People is one such movie, in which the treatment of a severely depressed adolescent boy is portrayed. By using a summary of the “patient’s” background and the transcript of one vignette from the movie “psychotherapy,” a method is discussed for teaching many of the principles and techniques of psychodynamic psychotherapy with adolescents, including 1) transference and resistance; 2) neutrality and the real object; 3) slips of the tongue and the observing ego; 4) unconscious conflict expressed somatically, and making it conscious; 5) the role of education; 6) open- and closed-ended interpretations and gratifying or frustrating patients; and 7) multiple determination of symptoms and the working-through process.
26 citations
TL;DR: The author summarizes the findings of naturalistic, longitudinal, and population-based studies conducted over the last 30 years that provide compelling evidence that exposure of media violence to children plays a major role in the etiology of aggressive behavior.
Abstract: This column reviews the literature on violence in the media and its effects on youth. The author summarizes the findings of naturalistic, longitudinal, and population-based studies conducted over the last 30 years. The literature provides compelling evidence that exposure of media violence to children plays a major role in the etiology of aggressive behavior. Psychiatrists can facilitate primary prevention of violence in our society by discussing the problem of media violence with parents, medical students, residents, and allied health and school professionals.
24 citations
TL;DR: The Psychiatry Institute for Medical Students (PIMS) as discussed by the authors is a weeklong summer program for 15 first- or second-year medical students, organized into theme days and an active social program.
Abstract: In response to decreasing numbers of applicants to the authors’ psychiatry residency program, the University of Toronto initiated a novel recruitment strategy in 1994: The Psychiatry Institute for Medical Students. The institute is a weeklong summer program for 15 first- or second-year medical students. The institute provides exposure to a wide variety of subspecialties in psychiatry organized into theme days and an active social program. Evaluations by the attendees have been uniformly positive. In the past 3 years, 50% of the attendees have entered a psychiatric residency program.
16 citations
TL;DR: To prepare psychiatric residents to function effectively as practicing psychiatrists in this new medium, an introductory three-module curriculum has been developed at the University of South Dakota School of Medicine and McKennan Hospital in Sioux Falls, South Dakota.
Abstract: TO THE EDITOR: There has been interest in the potential efficiencies of remote psychiatric consultation through two-way interactive audiovisual linkages since the first use of a microwave link to provide consultations between Omaha’s Nebraska Psychiatric Institute and a state psychiatric hospital 112 miles away in 1961 (1). Recent advances in technology have made telepsychiatry a reality. This technology is particularly valuable in making specialty consultation available in remote rural areas without the inefficiencies, costs, and inconveniences of travel to both consultant and patients (2, 4). The psychiatric disorders of childhood are amenable to telemedicine evaluation (5), and children may be particularly comfortable with interactive audiovisual transmissions (6). To prepare psychiatric residents to function effectively as practicing psychiatrists in this new medium, an introductory three-module curriculum has been developed at the University of South Dakota School of Medicine and McKennan Hospital in Sioux Falls, South Dakota.
14 citations
TL;DR: For example, this article found that one out of six psychiatrists did not even know that the APA's guidelines even existed, and about one-half did not have a copy of the guideline, while 34% had read "some" or "thoroughly".
Abstract: Seventy-eight psychiatrists attending an American Psychiatric Association (APA) district branch continuing education meeting were surveyed about their awareness and acceptance of the APA’s practice guideline for bipolar disorder. Assessments were conducted immediately before and again immediately following an educational intervention, which consisted of a 3-hour slide-show and lecture presentation on these guidelines. Before the presentation, one out of six of these psychiatrists did not know that practice guidelines even existed, and about one-half did not have (or did not know that they had) a copy, and they did not know that guidelines were published in the American Journal of Psychiatry. Almost half had not read any of the bipolar guideline, whereas 34% had read “some” or “thoroughly.” Responses before and following the intervention showed that a large majority of the psychiatrists felt that this specific guideline generally validated the manner in which they treated patients with bipolar disorders, and almost half felt that knowledge obtained from the guideline had changed, or would change, their treatment of bipolar disorders in the future. High levels of acceptability for the guideline were reported both by those who had previously read the guideline and those who first became familiar with it during the presentation. Presentations at APA district branches may aid in dissemination of practice guidelines, but additional interventions and dissemination techniques are required as well. Since questions based on the APA’s practice guidelines will be increasingly influential in American Board of Psychiatry and Neurology recertification examinations, more comprehensive dissemination methods are needed to assure that practitioners are well acquainted with these guidelines.
14 citations
TL;DR: There has been a recent decline in the use of personal psychotherapy during residency training and a concomitant lower value assigned to psychodynamic therapy by trainees, suggesting that this lower utilization may be the cause and/or the effect of the lower valuation.
Abstract: The authors tested the following hypotheses: 1) that current psychiatry residents engage in personal psychotherapy less frequently than did former residents; 2) that there are interprogram differences with respect to engagement in personal psychotherapy among current residents; and 3) that attitudes about the professional utility of personal psychotherapy and toward psychodynamic therapy as a form of treatment are related to participation in personal psychotherapy. A 66-item anonymous questionnaire was sent to 119 current residents at three local residency training programs and 209 former residents of one of the training programs. The questionnaire gathered information on the residents’ participation in insight-oriented personal psychotherapy and attitudes toward personal therapy and toward psychotherapy as a treatment for patients. Current residents (20%) partake less frequently in personal psychotherapy during training than did former residents (70%) (P<0.0001). Among those in therapy, current residents have less frequent sessions than former residents. There are differences in participation in personal psychotherapy among current residents of different programs, ranging from 6% to 60% (P<0.0001). Residents in personal psychotherapy are more likely to acknowledge professional utility in personal therapy and to believe that residents should learn how to deliver insight-oriented therapy. These findings suggest that there has been a recent decline in the use of personal psychotherapy during residency training and a concomitant lower value assigned to psychodynamic therapy by trainees. This lower utilization may be the cause and/or the effect of the lower valuation. If confirmed, these findings reflect significant changes in the training experience of psychiatrists and have implications for the delivery of psychiatric care.
13 citations
TL;DR: The authors report a statistically significant increase in trainee self-confidence beginning and maintained after Module 4, which shows promise as a standard introduction to psychotherapy for psychiatric residents.
Abstract: Psychotherapy training programs require a uniform introduction to psychotherapy that presents the basic, generic concepts common to the major schools in a time-efficient manner. The program described in this article fits these criteria. The program has been initiated at seven residency training programs in the United States. The authors describe the six modules comprising the program—verbal response modes and intentions, working alliance, inducing patterns, change, resistance, and transference and countertransference. The authors also report preliminary results of the program evaluation (N = 15) from the University of Missouri-Columbia. By using a well-researched measure of trainee self-confidence as psychotherapist (The Counselor Self-Estimate Inventory), the authors report a statistically significant increase in trainee self-confidence beginning and maintained after Module 4. The authors conclude that this training shows promise as a standard introduction to psychotherapy for psychiatric residents.
TL;DR: A model seminar is described used in a psychiatric residency training program providing residents with skills in effective communication through the mass media to prepare residents for an important role in public health psychiatry.
Abstract: Psychiatric residency training programs rarely prepare residents for exposure to the media. Increasingly, however, physicians are called upon to disseminate current knowledge about a wide range of topics pertinent to mental health and illness. The authors describe a model seminar used in a psychiatric residency training program providing residents with skills in effective communication through the mass media. The goal of the seminar is to prepare residents for an important role in public health psychiatry.
TL;DR: Recommendations for the inclusion of psychiatric disability assessment training in residency programs are outlined and practical suggestions are provided for psychiatrists on how to approach a psychiatric disability evaluation.
Abstract: Psychiatric disability determination is a complicated task for the psychiatrist. With filings for disability benefits increasing, the task is becoming unavoidable. The increasing social cost of disability requires that psychiatrists learn how to respond appropriately to petitions for psychiatric disability benefits. However, there is a significant dearth of education on psychiatric disability assessment. The various disability programs are reviewed; criteria of disability determination and difficulties involved in making an assessment are examined. Characteristics of disability petitioners are reviewed, and practical suggestions are provided for psychiatrists on how to approach a psychiatric disability evaluation. Finally, recommendations for the inclusion of psychiatric disability assessment training in residency programs are outlined.
TL;DR: Male subjects were featured in case vignettes significantly more often than female subjects in the five texts combined; significantly different gender disparities were obtained in three of theFive texts examined.
Abstract: Prior research examining gender bias in textbooks used by medical students demonstrated that male models are used significantly more often than female models, raising concerns about the messages conveyed to trainees about patient care. By using a similar paradigm, this study assessed introductory psychiatric texts for gender bias. Five texts were selected for their use by medical students and based upon the presence of illustrative case vignettes. Frequencies with which vignettes featured male or female subjects were obtained. Two earlier versions of the DSM Casebooks were also reviewed for comparison with the most recent edition, to look for longitudinal trends. Male subjects were featured in case vignettes significantly more often than female subjects in the five texts combined; significantly different gender disparities were obtained in three of the five texts examined. The number of vignettes featuring female subjects exceeded those featuring males in one text. Despite repeated revision, each of the three versions of the DSM Casebooks retained a statistically significant predominance of male subjects. The observed gender discrepancies were not an artifact of use of vignettes illustrating disorders with higher prevalence rates among men. In fact, women were featured as subjects in vignettes illustrating disorders with higher prevalence rates among women. The use of predominantly male subjects was incongruent with trends in psychiatric service utilization by men and women. The potential impact of gender bias on medical trainees is discussed.
TL;DR: Overage from clinical activities driven by faculty may provide sufficient funding for resident services that provide an opportunity for longitudinal patient experiences and strategies for political action and for better collaborations with primary care faculty are discussed.
Abstract: Psychiatric educators must prepare to teach in an era in which funding for education is more difficult to obtain, all forms of treatment are shorter, patients are discharged from the hospital while they are still acutely ill, the burden of paperwork and other administrative tasks is greater, psychiatrists provide less psychotherapy, and residents are no longer able to play a primary role in the treatment of patients covered by third-party payment schemes. A surcharge on a national insurance plan could make up for funding deficits, but this is not likely to occur in the near future. A more realistic model involves billing for services of faculty who integrate direct participation in patient care with teaching and better definitions of the role that residents can play in modern patient care. Overage from clinical activities driven by faculty may provide sufficient funding for resident services that provide an opportunity for longitudinal patient experiences. Strategies for political action and for better collaborations with primary care faculty are discussed.
TL;DR: The authors review the emergence of geriatrics in general residency training and present recommendations for further evolution.
Abstract: As the number of older Americans increased in the twentieth century, training programs added geriatrics to their teaching and clinical experiences. The advent of added qualifications in geriatrics through board examination and the accreditation of geriatric residency (fellowship) programs brought further recognition of the geriatric imperative. Yet curricular requirements for experience with old age mental illness remain minimal. Reduced support for graduate medical education dictates that general—rather than geriatric—psychiatrists will continue to provide the majority of specialty mental health services to older adults. The authors review the emergence of geriatrics in general residency training and present recommendations for further evolution.
TL;DR: Core values that are proposed include the privilege of being a psychiatrist, the evolving knowledge base of the field, a focus upon the patient’s story, and the significance of adversity in life and in practice.
Abstract: The process of supervision includes the transmission of values. Although the professional values of supervisors may not be discussed openly, they are clearly perceived by trainees and may be an enduring legacy. Core values that are proposed include the privilege of being a psychiatrist, the evolving knowledge base of the field, a focus upon the patient’s story, and the significance of adversity in life and in practice.
TL;DR: The resident scores on the PRITE correlated well with the faculty evaluations the same year, which reinforces the concurrent criterion validity of the PRite and its value as an additional assessment of resident performance.
Abstract: The Psychiatry Resident In-Training Examination (PRITE) is given annually in a majority of accredited psychiatry residency training programs. The reliability and validity of the examination has been established. This study compared faculty evaluations of resident performance and professional knowledge with the performance on the PRITE for 7 consecutive years (1990–1996). The resident scores on the PRITE correlated well with the faculty evaluations the same year. This study reinforces the concurrent criterion validity of the PRITE and its value as an additional assessment of resident performance.
TL;DR: It is concluded that small-group, brief, intensive but comprehensive, and diverse learning experiences in AD had favorable effects on the self-reported knowledge base of the course participants.
Abstract: Outcomes of an annual 1-week intensive course, entitled “Dementia With Focus on Alzheimer Disease (AD),” were studied. The Division of Geriatric Psychiatry created this “selective” in 1990 for third-year medical students of the State University of New York at Buffalo School of Medicine and Biomedical Sciences in an effort to enhance geriatric education. In 1997, a survey was mailed to all participants of the past 6 years whose addresses were available (N = 50). Fifty nonparticipants, matched by graduation year, received a similar survey. The respondent participants in the course (N = 25) reported significantly more confidence in their assessment and diagnosis of dementia, awareness of community resources for demented patients, and familiarity with issues of caregiver burden than the control subjects (N = 27). The authors conclude that small-group, brief, intensive but comprehensive, and diverse learning experiences in AD had favorable effects on the self-reported knowledge base of the course participants.
TL;DR: Self-confidence for treating neurological disorders declined with the progression of training; however, neurology PRITE scores improved significantly and psychiatric self-confidence also improved over time.
Abstract: Keeping pace with advances in neurosciences is, in part, predicated upon an adequate knowledge of neurology obtained during the psychiatrist’s residency training. Results from a questionnaire assessing resident abiliities in neurology and psychiatry were compared with Psychiatry Resident In-Training Examination (PRITE) scores. Self-confidence for treating neurological disorders declined with the progression of training; however, neurology PRITE scores improved significantly. Psychiatric PRITE scores and psychiatric self-confidence also improved over time. These findings have implications for current residency training criteria and education.
TL;DR: In this article, the authors assess psychiatry residency training directors' perceptions of the training needs of psychiatry residents about ethnic and gender issues and examine training program characteristics associated with appraisals of greater adequacy of training in these areas.
Abstract: The goal of this study was to assess psychiatry residency training directors’ perceptions of the training needs of psychiatry residents about ethnic and gender issues and to examine training program characteristics associated with appraisals of greater adequacy of training in these areas. A questionnaire designed to assess perceptions of training needs in ethnicity and gender was developed and completed by 142 psychiatry residency training directors. The training directors’ ratings of their residents’ adequacy of training about ethnic issues in psychiatric practice was significantly related to the residents’ contact with patients of diverse ethnic backgrounds, having coursework addressing ethnic issues included in the residency program, and the percentage of residents of minority ethnic backgrounds included in the program. The training directors’ ratings of their residents’ adequacy of training about gender issues in psychiatric practice was significantly and positively related to having course-work addressing gender issues included in the residency program and was appraised more negatively by the younger residency directors than by the older ones. The residents in psychiatry who are appraised as having the most adequate training in ethnicity and gender issues of their patients are those who received residency course-work on these subjects and are in psychiatry training programs including substantial numbers of minority residents and ample opportunities to work with minority patients.
TL;DR: The Task Force’s considerations and recommendations concerning how the least damaging and most effective decisions could be made regarding the distribution of residency positions, program size, and the future funding of training stipends are described.
Abstract: Recent health care reform initiatives proposed training fewer medical specialists, including psychiatrists, and determining the size and location of training programs via centralized regulatory mechanisms. Facing such potential future developments, the American Association of Directors of Psychiatric Residency Training appointed a Task Force on the Quality of Residency Programs to develop informed recommendations for the field. This paper describes the Task Force's considerations and recommendations concerning how the least damaging and most effective decisions could be made regarding the distribution of residency positions, program size, and the future funding of training stipends. The recommendations emphasize voluntary decisions, feedback from local and regional stakeholders regarding perceived needs and demands for psychiatrists, and Federal or regional funding of postgraduate training stipends that are not primarily tied to providing clinical services.
TL;DR: Fellowship awards were perceived as helpful to professional development, and certain fellowship-related experiences were seen as more important than others, and these varied as a function of the awarding organization and by gender.
Abstract: Honorary fellowship awards are given each year by professional organizations in recognition of the achievements and future promise of psychiatric trainees. No data have been published to evaluate the characteristics of, or effects on, awardees. A 50-item instrument was developed to test four hypotheses. The confidential survey was mailed to award recipients identified by six major professional psychiatric associations. Data were analyzed by comparing responses with χ2 statistics and repeated measures multivariate analyses of variance. Responses from the award recipients from five of the organizations (N = 182, response rate = 55%) were analyzed. Fellowship awards were perceived as helpful to professional development. Certain fellowship-related experiences were seen as more important than others, and these varied as a function of the awarding organization and by gender. The awards had less importance than the recipients expected. Meeting with colleagues and leaders or mentors, prestige associated with the awards, networking, and learning about academic and organizational psychiatry were valued by the recipients. Enrichment of mentoring opportunities was identified as an area for improvement. The recipients described later involvement with professional organizations. Honorary fellowship award recipients represent a widely accomplished group of psychiatrists, who report their fellowship award experiences overall as beneficial to their career development. Perceived differences in fellowship programs should be interpreted in light of their varying goals, composition, and structures. Greater efforts to mentor awardees should be considered by fellowship programs.
TL;DR: The psychotherapy skills of psychiatry residents were assessed by using a structured-response supervisor inventory, the Supervisor Report (SR), and mixed cross-sectional and longitudinal comparisons demonstrated a significant, but small, increase in skill over the course of outpatient training.
Abstract: The psychotherapy skills of psychiatry residents were assessed by using a structured-response supervisor inventory, the Supervisor Report (SR). Longitudinal data on the same resident across time showed a small but positive trend toward the acquisition of skill in doing psychodynamic psychotherapy. Mixed cross-sectional and longitudinal comparisons between ratings of the beginning residents and advanced residents demonstrated a significant, but small, increase in skill over the course of outpatient training. SR score changes also corroborated observational data on individual residents. While these findings suggest the utility of the SR in measuring changes in psychotherapy skill, the results must be considered in light of the relatively poor interrater reliability and only somewhat better test-retest reliability.
TL;DR: This issue, the authors have invited Carlyle H. Chan, MD, to be a guest columnist for their "Educational Computing" column.
Abstract: This issue, we have invited Carlyle H. Chan, MD., to be a guest columnist for our \"Educational Computing\" column. Dr. Chan is Professor and Vice Chair for Education and Informatics in the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin, where he directs residency education and continuing medical education. We hope you enjoy his column. -Tom Kramer, MD., and Robert Kennedy, M.A. (Academic Psychiatry 1999; 23:107-109)
TL;DR: The authors contend that academic psychiatry will only survive in the future if it helps to fulfill the crucial requirement of academic medicine in the new health care era and proposed strategies for departments of psychiatry to help meet the requirements.
Abstract: The authors contend that academic psychiatry will only survive in the future if it helps to fulfill the crucial requirement of academic medicine in the new health care era. They present six basic requirements of academic medicine: 1) effective, efficient, and responsible organizations; 2) quality educational programs of appropriate type and size; 3) linkage to health care networks; 4) primary care capacity and services; 5) restructured systems for research; and 6) effective leadership. Specific strategies for departments of psychiatry to help meet the requirements of academic medicine are outlined. The authors present major implications of these proposed strategies for psychiatric chairs, faculty, and the professional organizations that serve them.
TL;DR: The notion that psychiatric teaching hospitals provided more care to low-income and underinsured persons than the nonteaching hospitals and that they offer more services and more psychiatric oversight is supported.
Abstract: Because funding for teaching hospitals is threatened in the cost-conscious era of managed care, teaching hospitals must demonstrate their value. To examine the clinical and community-service activities of teaching hospitals, this study compared academic medical centers (AMCs) and other hospitals operating psychiatric residency programs with nonteaching hospitals. Data for the study are from the National Mental Health Facilities Survey, a national survey of providers of inpatient psychiatric care in the United States conducted at the beginning of the current managed care era. When compared with nonteaching hospitals, both types of teaching hospitals offered a larger number of specialized services and had a higher psychiatrist-to-patient ratio. The AMCs received a higher proportion of their revenues from Medicaid than did the nonteaching hospitals. Other teaching hospitals collected a lower percentage of their inpatient charges than the nonteaching hospitals. This study supports the notion that psychiatric teaching hospitals provided more care to low-income and underinsured persons than the nonteaching hospitals and that they offer more services and more psychiatric oversight. The authors find justification for supporting psychiatric teaching hospitals for their clinical and community-service activities.
TL;DR: Where the authors' PGY-3 cohort was in their professional development may have encouraged us to preserve their group, but this also clarified the importance of personality factors for selecting partners for subsequent practice relationships.
Abstract: ConclusionAlthough not its original intention, Timberlawn prepared us well to practice psychiatry in a tumultuous time. We all agreed that if we had it to do over again, even knowing the residency program would burn, we would still train there. This realization not only speaks to Timberlawn’s training program, but also to the special bonds we developed with each other before and during Timberlawn’s demise. Where our PGY-3 cohort was in our professional development may have encouraged us to preserve our group, but this also clarified the importance of personality factors for selecting partners for subsequent practice relationships. This early opportunity to negotiate time-limited arrangements beneficial for multiple parties, with collective rather than individual efforts, prepared us to think creatively about “win-win” scenarios when facing other grim circumstances. Residents facing similar circumstances may benefit from adopting professional “adult” roles, allying with trustworthy others, collectively addressing needs of the institution and each resident, and remembering seemingly imposed “decisions” may only reflect initial oversimplified plans that are actually amenable to creative improvements and solutions.