Showing papers in "Academic Psychiatry in 2000"

Skills for Mentors and Protégés Applicable to Psychiatry

Abstract: The authors address the elements and dynamics involved in the life cycle of mentoring relationships applicable to psychiatry, including a proposed model for explicating the developmental stages experienced by participants in the process. They provide a review of the mentoring literature for use in psychiatric education, research, and practice and offer various perspectives, describing skills for mentors, skills for proteges, the dynamics of the mentoring relationship, benefits and barriers, and issues related to gender, race, and culture.

Psychosocial Formulation Training Using Commercial Films

Abstract: With the explosion of neurobiology research in psychiatry, the ability of psychiatry residents to construct psychosocial formulations for their patients appears to have declined. Although the traditional methods of teaching psychosocial case formulation (written references, individual psychotherapy supervision, clinical case conferences) remain important and effective, the changing orientation of academic psychiatry as well as the decreasing time allotted to psychotherapy suggest that psychosocial formulation training must increasingly compete with the myriad other aspects of psychiatry to which residents are exposed. Over the past 5 years, we have complemented the traditional psychosocial formulation curriculum with a highly structured teaching venue in which psychiatry residents regularly observe commercial films and then, as a group, construct psychosocial formulations for the principal characters. In this article, the author reviews the opportunities, advantages, and success of this complementary approach.

Process and Product

Abstract: The authors describe a group effort to devise objective and measurable standards for assessing competency of psychiatric residents in a number of domains, using techniques of brainstorming, affinity grouping, and priority matrices. Results from each step were used to refine the next step. A checklist of minimum skill competencies was successfully devised and implemented. Skills were allocated to five domains: Assessment and Presentation, Diagnosis, Somatic Treatment, Side-Effect Management, Consultation-Liaison and Medical Psychiatry, and Psychotherapy. They concluded that competency-based measures can be formulated for psychiatric residency training. Although the set of competencies derived for the authors’ institution may be particular to local goals and values, the general structure and the process of development are transferable.

The Junior-Year Psychiatric Clerkship and Medical Students’ Interest in Psychiatry

Abstract: The authors present results for a 5-year period, from 1994 to 1998, of medical students’ interest in specializing in psychiatry after the junior-year psychiatric clerkship and their actual decisions to specialize in psychiatry. The student-reported survey results, NRMP matching data, and internal house-staff records showed that students rotating through an outpatient setting for their psychiatric clerkship reported significantly greater interest in specializing in psychiatry than students rotating through the emergency room, a children’s hospital, or inpatient or consultation/liaison setting. Of the factors examined in this study, the site of the clerkship and the rotation time-of-year were not associated with the choice of psychiatry as a specialty, whereas the strongest predictor of eventual specialization in psychiatry was post-clerkship attitudes.

Quality in Psychiatric Training Development of a Resident Satisfaction Questionnaire

Abstract: The authors describe the development of an instrument to measure resident satisfaction with training, the Resident Satisfaction Questionnaire (RSQ). A national sample of 180 residents rated 41 items regarding the relative importance of each item in determining resident satisfaction with training. The five items rated most important in determining resident satisfaction with psychiatric training were 1) quality of supervision; 2) respect of faculty for residents; 3) responsiveness of the program to feedback from residents; 4) balance of training between psychosocial and biomedical aspects of psychiatry; and 5) departmental morale. Authors discuss differences among resident subgroups. The 10-item RSQ included items rated most important by the overall group of residents and by resident subgroups. Authors present recommendations for use of the questionnaire.

Lying in Psychotherapy Supervision

Abstract: Despite expectations of accuracy and truthfulness, psychotherapy trainees may deliberately distort accounts of patient interactions presented in supervision. The author presents interviews with four psychiatry residents, detailing specific misrepresentations made to supervisors. Aspects of the literature on lying and on the supervisory setting are reviewed to help explain this phenomenon and suggest interventions to help prevent it.

A Cultural Sensitivity Training Workshop for Psychiatry Residents

Abstract: Efforts have been made to develop a core curriculum for cultural sensitivity training for psychiatry residents. There is a lack of literature reporting effectiveness of various teaching modalities for such training. The authors report their experience with a 4-hour pilot workshop to teach psychiatry residents ethnic and cultural issues in patient care. Pretest and posttest questionnaires were designed to measure residents’ knowledge of cultural issues. There was statistically significant improvement in performance on questionnaires after the workshop (F = 30.6; P<0.001). Further studies are necessary to examine teaching modalities in residency education.

The Breakfast Club: Utilizing Popular Film to Teach Adolescent Development

Abstract: Under increasing pressures to teach an explosion of information, residency training programs need to look for effective and efficient ways to convey information. Utilizing films lends itself well to teaching about development and psychotherapy and has the advantage of being enjoyable to faculty and residents. In this article, the authors examine the film The Breakfast Club as a vehicle for teaching about multiple aspects of adolescent development, analyzing specific scenes of the film and their corresponding developmental themes.

Training Psychiatry Residents as Consultants in Primary Care Settings

Abstract: Patients seen in primary care medical settings often have psychiatric disorders that often go undetected by their primary care physicians. It is important that psychiatry residents be trained in the specific skills necessary to work as consultants in primary care settings. The authors describe 2 years of primary care consultation-liaison rotation experience for 4th-year psychiatry residents (16 rotations, one-half day per week for 12 months or 1 day per week for 6 months). Residents’ evaluations of their experience were generally positive. The presence of a supervising attending psychiatrist who worked in the same clinic resulted in higher satisfaction and effectiveness ratings. Other issues identified by residents included need for specific preparation for working in such settings, frequent misunderstanding of the psychiatry resident’s role by primary care providers, and the difficulty of establishing relationships and communicating with multiple clinic providers. Authors discuss modifications of this rotation and recommendations for the establishment of similar rotations elsewhere.

Vampires and Those Who Slay Them

Abstract: Psychodynamic concepts are frequent themes throughout popular culture. For this reason, movies, books, and even television shows offer rich opportunities for the examination of important psychological constructs. Given the current popularity of vampire stories within adolescent groups, the psychodynamic themes woven throughout the vampire myth deserve special attention. In particular, the television program Buffy the Vampire Slayer uniquely displays key adolescent developmental challenges. In discussing the psychodynamic significance of vampires, with special attention to the characteristics of Buffy the Vampire Slayer, this article demonstrates both the use of displacement in adolescent therapy, as well the utilization of the Buffy’s story as a means of teaching important psychodynamic concepts.

Transfer to a New Psychopharmacologist

Abstract: The authors surveyed 38 psychiatry residents to determine the effect of end-of-residency transfer of care on psychopharmacology patients. Senior residents reported that 19% of patients worsened after notification about the upcoming transfer, 32% required medication changes, and up to 9% became noncompliant. Junior residents reported that, after transfer, 10% of patients worsened, 7% required medication changes, and up to 12% became non-compliant. Approximately 29% of patients considered the change of residents a major treatment disruption. The authors propose a system for minimizing deleterious effects and improving outcome in the transfer of psychopharmacology patients.

The Life Stories of Children and Adolescents

Abstract: Commercial films have been used by educators as helpful components in the psychiatry training process. Professional literature describing cinema focusing on children, adolescents, and their families, however, has been conspicuous by its absence. A solicitation from child and adolescent psychiatry members of the Association for Academic Psychiatry resulted in a compilation of 97 substantial and relevant commercial films, with each accompanied by a single-sentence annotated description. The author proposes a teaching approach and suggests questions to assist educators in the utilization of these films during the training of residents about child and adolescent themes and issues. A description of this approach is illustrated using two representative films.

Psychiatric Residency An Analysis of Training Activities With Recommendations

Abstract: The authors sought to develop recommendations regarding the optimal balance of psychiatric residency training activities. University of Toronto residents completed a weeklong time-log of their daytime training activities. Staff and resident focus groups were asked to comment on the data from this survey and on the variables that affect successful introduction of new requirements into psychiatric residency. In a large multicenter training program, supervised clinical experience was found to be the most valuable training activity, especially when accurate and specific feedback is provided.

The Necessity of Continuing Education for Psychotherapy Supervisors

Abstract: Over the past decade, the practice of neurobiology has come to dominate hospital-based psychotherapy, and the teaching of psychotherapy has become marginalized in psychiatry residency programs across the country. As a result, psychotherapy supervisors must play an increasingly important role in maintaining the viability of this discipline. Moreover, because the supervisory relationship is the main way that trainees develop their identity as psychotherapists, supervisors’ development of knowledge and skill is critical to their role as mentor. The authors describe a symposium and lecture series for trainee supervisors that enabled them to come together and offer a forum for a lively exchange of ideas and information.

The Impact of Impaired Supervisors on Residents

Abstract: The author estimated the proportion of Canadian psychiatry residents who had ever worked with impaired supervisors and explored the residents’ reactions. A 22-item questionnaire was distributed to all 600 Canadian psychiatry residents; a total of 229 completed surveys were returned. Seven percent of surveyed residents reported working with an impaired supervisor. Female and senior residents were more likely to report such an experience. The most common reactions to working with supervisors perceived to be impaired were alterations in their work patterns (e.g., taking on more responsibilities, working without supervision), anger, conflict, and loss. Forty percent of residents in this situation recounted symptoms of depression and anxiety. Supervisors who are perceived as impaired seem to have a large impact, both professionally and personally, on the residents they supervise. Training programs need to actively address impairment in psychiatrists affiliated with their institution in order to aid both their colleague and the residents that they supervise.

The Cost of Residency Training in Psychiatry

Abstract: Graduate medical education (GME) in the United States is financed largely by the federal government through the Medicare program. Medicare regulations developed in 1997 resulted in cuts in the direct, indirect, and disproportionate-share components of GME funding. Given this situation, it is increasingly important for programs to understand what the true costs of residency training are and how they are allocated. Using a faculty time survey and the yearly residency budget, the authors report on such an analysis for their own training program (at Michigan State University) for the 1996–97academic year. Overall, the response rate for the faculty time survey was 77% (N = 28). The identified program costs of supporting 20 psychiatry residents, excluding donated time, were calculated at $1,563,193, or $78,159 per resident. Eighty-four percent of costs were for personnel. These costs are consistent with those derived from studies of family practice and internal medicine training programs. Awareness of the costs of training will assist training directors in budget negotiations with their institutions.

Ambulatory Care Teaching and the Psychiatric Clerkship

Abstract: The psychiatric clerkship is the educational center of the psychiatric curriculum and is a powerful influence in recruitment into psychiatry. Clerkships remain inpatient-based, although effective treatments and changes in reimbursement have moved the practice of psychiatry out of hospitals and into ambulatory settings. Despite dissatisfaction with inpatient teaching, psychiatry has lagged behind other specialties in creating outpatient teaching venues.

Teaching the Integration of Psychotherapy Paradigms in a Psychiatric Residency Seminar

Abstract: The authors describe methods used to approach the integration of competing psychotherapy paradigms within a resident psychotherapy seminar. They distributed a questionnaire developed to assess residents’ subjective feelings about the usefulness of the seminar and also surveyed a second program that teaches multiple perspectives without formal attempts at integration. Results indicate that a large majority of residents in both programs felt positively about their training experience from several perspectives. However, residents from the comparison program may have had a less uniformly positive experience in learning to compare and contrast psychotherapy paradigms.

So You Want to Train Psychiatry Residents in Ambulatory Primary Care Settings

Abstract: Providing mental health services in primary care surroundings has potential advantages for both patient care and resident education. On the basis of the growing understanding of learning issues in ambulatory settings and the few descriptions of ambulatory primary care (APC) psychiatry rotations in the literature, the author proposes practical guidelines for consultation/liaison rotations in APC settings. Recommendations and references are given for educational objectives, the role of the resident, supervision and teaching, the format and funding of the rotation, and evaluation. Program directors contemplating new rotations should plan to evaluate and publish their efforts in order to add to our evidence-base in this area.

A New Teaching Program

Abstract: The authors describe the utilization of telemedicine technology to provide psychiatry residents with a 10-week series of seminars on the subject of managed care. Residents at two schools of medicine participated in a series of interactive seminars with presenters at distant sites through the use of telemedicine technology. The authors describe a cost-effective approach to teaching managed-care concepts to residents, using telemedicine technology to allow experts to present from distant sites.

Balance in Psychiatric Education

Abstract: Applicants to psychiatry residencies often express a preference for balance between psychotherapy/psychology and biological approaches. It is not clear, however, that parity is an achievable or even desirable goal. The degree to which balance may be achieved is influenced by the phase of training, resident preferences, scientific advances, and the healthcare system. An overemphasis on maintenance of balance may be unduly restrictive.

Patient-Based Teaching

Abstract: Recently, medical schools have begun increasing the amount of problem-based teaching, which gives students the opportunity to apply a database in a simulated clinical setting. This exercise helps them incorporate principles of diagnosis and treatment into their procedural memory. Although problem-based teaching has great educational benefits, it poses a unique challenge. It is extremely labor-intensive, because until now it has been assumed that patient-based teaching can only be done in small groups, requiring a large number of faculty to moderate group seminars. In today’s economic climate, with difficulty in recruiting sufficient faculty, having an alternative to small-group teaching has potential advantages. Here, the authors describe the process of developing principles of problem-based teaching from small groups into an instructional method for a large-group setting for a large clinical neuroscience course using patient-based sessions.

The Current Status of Family Medicine—Psychiatry Combined Residency Programs

Abstract: The authors assessed the growth of the 12 approved family medicine-psychiatry programs since initiation of this option in 1995. In 1998, they conducted a two-stage survey of family medicine-psychiatry training directors and selected residents. Ten programs had enrolled a range of 1–7 residents in each of the 5-year programs, for a total of 41 residents. Of a possible 22 first-year positions, 17 first-year residents began training in July 1998 (77% fill rate), 12 of whom enrolled through the National Resident Matching Program, 4 through the military match, and 1 outside the match. The first participants graduated in 2000. Two approved programs have closed, and one new program has been approved. The number of applicants has increased each year. Training directors and residents are generally satisfied with their programs, but low medical student awareness of this option persists.

Preparation, Conduct, Follow-Up, and Evaluation of a Departmental Retreat on Residency Education

Abstract: Psychiatric residency training programs must continually respond to a changing graduate medical education environment. In the following, the authors discuss their use of an educational retreat as a mechanism to help faculty and residents analyze and plan responses to these challenges in a medical center located in an underserved inner-city area. Specific strategies for preparing for a retreat, such as evaluating attitudes of residents and faculty, conducting the retreat itself, following-up to incorporate recommendations into a course of action, and evaluating the success of the retreat, are presented. The results of the retreat are shared.

Teaching System-of-Care Principles in Child and Adolescent Psychiatry Clerkships

Abstract: The authors describe an approach for teaching system-of-care concepts to third-year medical students during their psychiatry clerkship. All students participated in a child and adolescent psychiatry seminar series highlighting these concepts, and four students per cohort were provided clinical exposure emphasizing this approach during patient care. Seventy-four of the 79 medical students completed pre- and post-clerkship questionnaires assessing their attitude toward four system-of-care concepts: the physician’s role working with the patient and family, the importance of the family’s participation in the process, the importance of interdisciplinary collaboration, and the use of the least restrictive treatment setting. Medical students who were exposed to the system-of-care concepts through seminars and clinical exposure showed a significant change in their attitudes regarding the first two concepts compared with their peers who only received didactic instruction.

An Internet-Based Survey of Academic Psychiatry and Managed-Care Readiness

Abstract: The authors surveyed the managed-care readiness of academic psychiatry to derive a baseline for comparison of future surveys. A 25-item Internet-based survey was used to assess the organizational structure and programs, quality- and performance-improvement initiatives, and information-systems capacity of academic psychiatry. A website (bstpractice.com) was created for potential respondents. Thirty-five departments participated; a majority indicated involvement in caring for managed-care patients, and some were managing care. The authors concluded that academic psychiatry is developing the infrastructure to assume risk in order to manage care in a contemporary environment.