Showing papers in "Academic Psychiatry in 2004"
TL;DR: Efforts to reduce resident burnout nationally would benefit from expanding beyond the work-hours regulation, as being single, personal stress, and dissatisfaction with faculty were independently associated with burnout.
Abstract: Objective: To investigate resident burnout in relation to work and home-related factors. Method: Maslach Burnout Inventory was mailed to residents in eight different medical specialties, with a response rate of 35%. Results: Overall, 50% of residents met burnout criteria, ranging from 75% (obstetrics/gynecology) to 27% (family medicine). The first year of residency, being single, personal stress, and dissatisfaction with faculty were independently associated with burnout. Conclusions: Efforts to reduce resident burnout nationally would benefit from expanding beyond the work-hours regulation.
274 citations
TL;DR: The impact was more severe when the patient suicide occurred during training than after graduation and was inversely correlated with clinicians’ perceived social integration into their relational professional network.
Abstract: Objective: The authors investigated the impact of patient suicides on trainees and psychiatrists and their utilization of supports. Methods: Graduates in practice and trainees of the residency program of the University of Toronto from 1980–1995 (N = 495) were surveyed, retrospectively, with 239/495responding (48%). Demographic and educational information, exposure to suicide, impact of the suicide(s), use of support systems, acute stress disorder and posttraumatic stress disorder symptoms, and impact of events and social relationship scores were collected. Results: One-half of the respondents (120/239) experienced at least one suicide of a patient, 62% of them (74/120) during postgraduate training. Biologically oriented psychiatrists in practice were more at risk for patient suicide. An important minority (one-quarter) among those who experienced patient suicide had substantially higher (morbid) scores than the overall group. They also scored higher on an acute stress disorder and a posttraumatic stress disorder symptom checklist. The impact was more severe when the patient suicide occurred during training than after graduation and was inversely correlated with clinicians’ perceived social integration into their relational professional network. Conclusions: The experience of patient suicide is common during training and in clinical practice. The majority of trainees and clinicians are able to cope normally with the trauma, but in an important minority the emotional impact approaches morbid levels. Training programs should prepare students for this occupational hazard and implement systematic protocols to support those trainees who are especially vulnerable to their patient’s suicide and reduce their social isolation from their peer group. Formal and informal professional networks should heighten awareness of the impact of patient suicide on practicing colleagues and take adequate measures to support them.
166 citations
TL;DR: Medical students and residents indicate support for professionalism and ethics educational initiatives, including diverse curricular topics and clinically-attuned assessments.
Abstract: Objective: To assess the perspectives and preferences of medical students and residents regarding professionalism and ethics education. Methods: A new written survey with 124 items (scale: “strongly disagree” = 1, “strongly agree” = 9) was sent to all medical students (n = 308) and PGY 1–3 residents (n = 233) at one academic center. Results: Of the 336 participants (200 students, 65% response; 136 residents 58% response), only 18% found current professionalism and ethics preparation sufficient. Respondents endorsed professionalism (means = 7.48 to 8.11) and ethics topics (means = 6.56 to 6.87), women more so than men (p<0.05). Respondents preferred clinically- and expert-oriented learning over formal, nontraditional, or independent approaches (p<0.0001). They preferred clinically-oriented assessment methods (p<0.0001), residents more so than medical students (p<0.0001). On several items, psychiatry residents expressed greater receptiveness to professionalism and ethics preparation. Conclusions: Medical students and residents indicate support for professionalism and ethics educational initiatives, including diverse curricular topics and clinically-attuned assessments.
113 citations
TL;DR: There is little evidence of a substantial link between exposure to violent interactive games and serious real-life violence or crime, according to media headlines and public perceptions.
Abstract: Objective: Contrary to media headlines and public perceptions, there is little evidence of a substantial link between exposure to violent interactive games and serious real-life violence or crime. Conclusion: Further research is needed on whether violent games may affect less dramatic but real concerns such as bullying, fighting, or attitudes and beliefs that support aggression, as well as how effects may vary by child characteristics and types of games. There is also a need for research on the potential benefits of violent games for some children and adults.
107 citations
TL;DR: The approval of subspecialty status for psychosomatic medicine will help promote the psychiatric care of patients with complex medical, surgical, obstetrical and neurological conditions, as well as foster further improvements in the quality of training and research in this important area.
Abstract: Objective: Psychosomatic medicine, also known as consultation-liaison psychiatry, received approval as a subspecialty field of psychiatry by the American Board of Medical Specialties in the spring of 2003. This represents a crucial step in the development of the field of psychosomatic medicine and recognition by leaders in the fields of medicine and psychiatry of its importance. Methods: The field was developed in response to evidence suggesting that a high prevalence of psychiatric disorders exists in patients with complex medical illnesses and that diagnosis and management of these disorders in this population is critical yet frequently complicated by the medical illnesses themselves. Results: Psychosomatic medicine psychiatrists have developed specialized expertise in addressing these issues. Conclusion: The approval of subspecialty status for psychosomatic medicine will help promote the psychiatric care of patients with complex medical, surgical, obstetrical and neurological conditions, as well as foster further improvements in the quality of training and research in this important area.
100 citations
TL;DR: Mentoring is still believed to be a vital component of a successful residency experience and specific components that warrant further research include boundaries within the relationship, ethnicity and gender factors, and potential need for resident and faculty curricula on the topic of mentoring.
Abstract: Objective: This study aimed to describe the state of mentoring in today’s academic environment. Methods: Resident focus groups from across the nation discussed their opinions about mentoring and experiences with mentoring, and individual faculty members were videotaped discussing the same. Results: Sixty-six residents and five faculty members participated in the project. There was consensus among residents and faculty regarding important qualities of a mentoring relationship, obstacles to forming a mentorship, and methods to improve the mentorship experience in psychiatric training. Conclusion: Mentoring is still believed to be a vital component of a successful residency experience. Specific components that warrant further research include boundaries within the relationship, ethnicity and gender factors, and potential need for resident and faculty curricula on the topic of mentoring.
73 citations
TL;DR: The difficulties of balancing family and medicine affect women’s choices of specialty, advancement in academic medicine, health, and decisions regarding whether to have children.
Abstract: Dr. Verlander is a former Child Psychiatry Fellow at the University of ColoradoHealth Sciences Center (UCHSC,Denver, Colorado. Address correspondence toDr. Verlander, GeneralDelivery, Silverthorne, CO 80498; gleseann@yahoo.com (E-mail). Copyright 2004 Academic Psychiatry. Finding an acceptable balance between career and family is a difficult challenge for many physicians. Medicine is a profession in which dedication to the wellbeing of others is of paramount importance. Careers in medicine historically demanded a selfless emphasis on caring for one’s patients, sometimes at the expense of one’s marriage, children, and personal life. Such a skewed focus worked more easily in the past when the vast majority of physicians were men. When male physicians spent long hours at work or traveling to meetings, their wives were home to run the household and care for the children. As women entered themedical field in increasing numbers, however, the tensions between career and family became more prominent. In trying to balance personal and professional responsibilities, female physicians face a difficult task in striving to “have it all.” As a physician and single mother of four children, I know that it can be done successfully, but there are many challenges that female physicians must confront in balancing their multiple roles as physician, mother, and spouse. The number of females pursuing careers in medicine is steadily increasing. In 1997, women constituted 43% of medical students in the United States and 22% of practicing physicians (1). In 2001, those numbers reached 45.8% for female medical students and 28% for female academic medical faculty (2). Women are expected to comprise 30% of practicing doctors by the year 2010 (3), and 50% by the year 2040 (4). Despite the dramatic surge in the number of female physicians, hospitals and medical centers have moved slowly to provide support for women who pursue medical careers while managing families and raising children (5–7). The difficulties of balancing family and medicine affect women’s choices of specialty (8), advancement in academic medicine (9), health (4, 10), and decisions regarding whether to have children. Professional women in many families remain responsible for the majority of domestic and child-related duties (11–13), which makes it difficult to devote the necessary hours at work to obtain promotions and tenure. Most medical institutions furthermore remain oriented toward traditional families of the past, rather than today’s dual-career parents, with rare availability of onsite daycare and little opportunity for creative scheduling or job-sharing.
70 citations
TL;DR: Evidence of construct validity of a psychiatry OSCE was obtained from multiple measures of performance, including the clinical skills examination, which lend support to the continued use of checklist and global process evaluations as part of OSCEs in psychiatry.
Abstract: Objective: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical Examiners (NBME) psychiatry subject examination. Methods: Archival data from two successive classes of third-year medical students (1999–2000, N=142; 2000–2001, N= 144) were aggregated and analyzed. Results: The pattern and magnitude of convergence and discrimination were indicative of adequate construct validity for both the psychiatry checklist scores and the global process score. Clinical skills examination scores for history taking, interpersonal skills, and physical examination were related to psychiatry OSCE scores that reflected the same skill set. Construct validity was fairly higher for the global process rating. Conclusion: Evidence of construct validity of a psychiatry OSCE was obtained from multiple measures of performance, including the clinical skills examination. Findings lend support to the continued use of checklist and global process evaluations as part of OSCEs in psychiatry.
56 citations
TL;DR: The aim of this short piece is to provide some “down-to-earth” guidance for early career faculty, prospective authors, and peer reviewers on how to write a manuscript review.
Abstract: Dr. Roberts is the Editor-in-Chief of Academic Psychiatry. Drs. Coverdale and Louie are the Associate Editors for Academic Psychiatry. Ms. Edenharder is the Assistant to the Editors. Copyright 2004 Academic Psychiatry. A thoughtful review of a manuscript is a gift. It is a gift of expertise, of time, and of careful consideration. It is a gift for authors, editors, and the field. Performing a thoughtful peer evaluation of a manuscript is an acquired skill, however, and one that may not be formally taught in many academic departments or postgraduate training programs. The aim of this short piece is to provide some “down-to-earth” guidance for early career faculty, prospective authors, and peer reviewers on how to write a manuscript review. This represents a fundamental skill in academics, and this paper is the first in a series that will appear in our journal providing “down-to-earth” guidance related to academic skills for our readers.
53 citations
TL;DR: It is concluded that small-group videotape training is an efficient psychotherapy training format that encourages self-monitoring and the exchange of supportive peer feedback.
Abstract: Objective: Psychotherapy instructors have used video technology to train residents for over 40 years Though it has met with some controversy, many will argue that videotape review is essential for self-directed learning and accurate psychotherapy supervision Methods: The author describes a technique of small-group videotape training as provided in a psychiatry residency training program Results: He reviews the merits and limitations of this format and suggests simple and inexpensive technical approaches to augment this training Conclusion: The author concludes that small-group videotape training is an efficient psychotherapy training format that encourages self-monitoring and the exchange of supportive peer feedback
52 citations
TL;DR: It is determined that portfolios, useable by any program, can provide needed evidence of resident performance within the ACGME general competencies and any combination of five entries reflects all competencies with the exception of practice-based learning.
Abstract: Objective: To determine that portfolios, useable by any program, can provide needed evidence of resident performance within the ACGME general competencies. Methods: Eighteen residents constructed portfolios with selected entries from thirteen psychiatric skills. Two raters assessed whether entries reflected resident performance within the general competencies. They indicated no (0), some (1), or definite evidence (2) for each competency. Median scores were reported by competency and psychiatric skill. Results: Eighty entries were rated: 100% of the psychiatric skills reflected some evidence for medical knowledge; 92% provided some evidence for patient care, communication and interpersonal skills, and professionalism; 77% provided some evidence for systems-based practice, and 31% provided some evidence for practice-based learning. Ten of the 13 skills reflected evidence for at least five of the competencies. Conclusions: Any combination of five entries reflects all competencies with the exception of practice-based learning. This deficit can be corrected with revision of portfolio guidelines.
TL;DR: Increasing the psychiatrist-researcher workforce will require interventions involving many institutions and the NPTC’s efforts may offer practical solutions for approaching complex and admittedly challenging difficulties.
Abstract: Objective: The National Institute of Mental Health (NIMH) determined that declines in the psychiatrist-researcher workforce are harming public needs and that significant steps are necessary to alter current trends. Method: The NIMH commissioned the Institute of Medicine (IOM) to examine the undersupply and recommend solutions. The NIMH subsequently appointed a National Psychiatry Training Council (NPTC) to facilitate implementation of the IOM’s recommendations. Results: The IOM recommendations and preliminary NPTC actions to address them are described. Conclusions: Increasing the psychiatrist-researcher workforce will require interventions involving many institutions. The NPTC’s efforts may offer practical solutions for approaching complex and admittedly challenging difficulties.
TL;DR: A curriculum for educating PGY-1s and residency program directors about physician impairment is described, which was rated highly by residents in the areas of program content and usefulness and receptive to education on physician impairment.
Abstract: Objective: Residents are at a higher risk than the general population for the development of stress-related problems, depression, or suicide. The authors describe a curriculum for educating PGY-1s and residency program directors about physician impairment. Methods: A resident wellness program was established with the goals of preventing resident suicide, encouraging acceptance of treatment where appropriate, preventing self-prescribing, and aiding in stress management. Results: The curriculum was rated highly by residents in the areas of program content and usefulness. Conclusions: Residents are receptive to education on physician impairment. Institutional support is necessary for effectively addressing these concerns with trainees.
TL;DR: A model for understanding covert elements of ethical decision making during psychiatric residency is proposed and strategies training programs can use to help residents navigate an ethical minefield are recommended.
Abstract: In addition to learning about confidentiality, civil commitment, informed consent, and other ethical issues, psychiatry residents must deal with less visible ethical dilemmas that arise from the training process itself. Residents grapple with three inherent conflicting duties between their dual roles as physician and learner, as physician and supervisee, and as physician and employee of a training institution. These conflicts must be negotiated at a time of high stress, when residents are plagued with self-doubt, fear, fatigue, and other vulnerabilities that can lead good doctors to make ethically dubious decisions. While such conflicts and stressors are common to residency training in most specialties, they may be heightened in psychiatric residency. This paper proposes a model for understanding covert elements of ethical decision making during psychiatric residency and recommends strategies training programs can use to help residents navigate an ethical minefield.
TL;DR: This pilot study indicates that the authors can improve resident competency in this area and indicates that an intervention could improve biopsychosocial formulation.
Abstract: Objective: Since Engel introduced the biopsychosocial model, it has been extensively examined. The authors expect psychiatrists to formulate cases using the biopsychosocial model. However, resident psychiatrists’ ability to generate formulations using this model has received little attention. Methods: The authors evaluated resident biopsychosocial formulations using biopsychosocial scores from trained, blinded raters across four institutions. Second, the authors determined if an intervention could improve biopsychosocial formulation. Design: This study included nonexperimental and pre-post components using resident portfolio scores to measure biopsychosocial. Participants/Setting: Residents from four postgraduate years (PGY) in four different programs participated. In one institution, faculty made a concerted effort to improve biopsychosocial formulation. There were 33 entries in 2000–2001 and 46 entries in 2001–2002. Results: Using the combined data from all institutions, no PGY level averaged a rating of 3.0 (competent) in either year. In the institution implementing an intervention, a significant improvement was noted. Conclusion: This pilot study indicates that we can improve resident competency in this area.
TL;DR: Women in departments of psychiatry 2,781 37 Associate professors 450 29 Full professors 217 15 Dr. Bickel is a Career Development and Executive Coach and a Faculty Career and Diversity Consultant.
Abstract: Women in departments of psychiatry 2,781 37 Associate professors 450 29 Full professors 217 15 Dr. Bickel is a Career Development and Executive Coach and a Faculty Career and Diversity Consultant. Address correspondence to Dr. Bickel, 7407 Venice St., Falls Church, VA 22043; janetbickel@cox.net (E-mail). Copyright 2004 Academic Psychiatry. Women constituted 50% of applicants and new entrants to U.S. medical schools in 2003. As shown in Table 1, the proportion of total fulltime, female medical school faculty was 29% in 2002. This proportion (37%) was considerably higher in psychiatry (1). Currently, the proportion of female medical school instructors has risen to 46%. Overall, however, only 24% of associate professors and 13% of full professors are women. In psychiatry, these proportions are 29% and 15%, respectively. Women constitute only 15% of tenured medical school faculty nationally (all ranks). Table 2 displays faculty data from another angle— that is, looking at the proportion of males and females who are full professors. In 2002, 11% of all female faculty, compared with 31% of all male faculty, were full professors. It has taken more than 15 years for this proportion of women to grow from 10% to 11%. Table 2 also shows that these proportions were 8% and 26% inmedical school departments of psychiatry, revealing a lower than average percentage of both female and male faculty at the rank of full professor. The Association of American Medical College’s Faculty Roster System data also reveal that the average annual rate of female faculty attrition (9.1%) exceeds that of males (7%) (2). The gender gap in attrition is even greater for psychiatry faculty, with the attrition rate for women being 9.5% and the rate for men being 7.8% With regard to academic administrative roles women chaired approximately 214 departments in 2002 (91 basic science departments and 123 clinical departments, including interim/actingChairs),which is about 8% of all medical school Chairs (1), and eight women chaired a medical school psychiatry department (which equals 6% of Chairs if all 125 schools have a department). Currently, no female psychiatrist is dean of a U.S. medical school.
TL;DR: An educational intervention that is planned and implemented by a multidisciplinary team can enhance an area of resident performance that affects patient care.
Abstract: Objective: This report describes an educational intervention designed to improve psychiatry residents’ inpatient charting skills. Methods: The residency training committee formed a multidisciplinary team to study the problem by using quality improvement principles. The team hypothesized that residents’ charting would improve with education about the purpose of the medical record and instruction on the specific components to document. The team designed an educational intervention to train residents to record five items in the chart of every inpatient: an admission note, an off-service note, descriptions of medication changes, daily progress notes, and the name and discipline of the individual recording these items. Prior to the educational intervention, a chart abstractor determined the frequency, with which residents charted the five items. Additional chart audits were conducted 1 month and 6 months following education. Results: Compliance in charting four of the five items improved significantly 1 month after education, and the improvement was maintained after 6 months. Conclusion: An educational intervention that is planned and implemented by a multidisciplinary team can enhance an area of resident performance that affects patient care.
TL;DR: These guidelines address all aspects of training including objectives, recommended training sites, rotation length, clinical supervision, curriculum content and evaluation, and hope that by implementing these guidelines, training programs will enable residents to become competent and comfortable working in a psychiatric emergency service.
Abstract: Objective: Describe training goals, objectives and requirements in emergency psychiatry to assist residency programs in developing comprehensive training programs to ensure psychiatric residents acquire the necessary skills and knowledge to competently assess and manage patients with psychiatric emergencies. Methods: The American Association for Emergency Psychiatry (AAEP) Education Committee developed these guidelines using a consensus-building process. Conclusion: These guidelines address all aspects of training including objectives, recommended training sites, rotation length, clinical supervision, curriculum content and evaluation. The objectives emphasize acute assessment and intervention skills. The AAEP Education Committee hopes that by implementing these guidelines, training programs will enable residents to become competent and comfortable working in a psychiatric emergency service.
TL;DR: An overview of forensic psychiatry topics likely to be of benefit to general psychiatry residents is provided to be a springboard for future development of forensic curricula suitable for residents rather than a blueprint for an educational program.
Abstract: Objective: The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been published on the topic. Methods: The objective of this article is to provide an overview of forensic psychiatry topics likely to be of benefit to general psychiatry residents. Results: The article is intended to be a springboard for future development of forensic curricula suitable for residents rather than a blueprint for an educational program. Conclusion: Although most general psychiatry residents will not specialize in forensic psychiatry, a working knowledge of basic concepts in forensic psychiatry should be considered an important component of general psychiatry education.
TL;DR: Residents exhibited qualities of adult learners for whom personal interests were more important than training requirements with regard to seeking training in new modes of treatment, suggesting that postgraduate medicine might be uniquely suited to the study of adult learning theory.
Abstract: Objective: This study surveyed residents’ experiences learning an emerging area of demand in psychiatry at a time when there is a lag in training resources. Unexpectedly, the data generated useful evidence in support of adult learning theory. The result is a post hoc examination of learner attitudes and activities during the spread of a new medical content domain. Implications of the results for adult learning theory are considered. Methods: A survey evaluating interest, motivation, perceptions, and barriers toward learning cognitive-behavioral therapy (CBT) was given to 85 psychiatry residents at a single institution, with a 95% return rate and even distribution across years of training. Results: The vast majority of residents were highly interested and motivated to learn CBT. One hundred percent considered CBT clinically useful, and 99% anticipated using it in future practice. Consistent with the model of adult learning theory, reasons for seeking CBT training tended to focus on personal interest (86%), motivation (81%), and opinion of its clinical usefulness (68%). Only a minority considered training requirements a motivation for seeking training (44%). The most commonly reported difficulty in gaining exposure to CBT was supervisor availability (65%). Conclusions: Residents exhibited qualities of adult learners for whom personal interests were more important than training requirements with regard to seeking training in new modes of treatment. In the wake of recent theoretical scrutiny of adult learning and its applicability to undergraduate medicine, these results suggest that postgraduate medicine might be uniquely suited to the study of adult learning theory.
TL;DR: A curriculum for international medical graduate (IMG) psychiatry residents that addresses their culture-based deviations from normative boundary-keeping practices common to U.S. based psychotherapy practices is developed.
Abstract: Objective: The author sought to develop a curriculum for international medical graduate (IMG) psychiatry residents that addresses their culture-based deviations from normative boundary-keeping practices common to U.S.-based psychotherapy practices. Methods: A group consisting of 12 IMG psychiatry residents and one United States graduate (USG) participated in a curriculum consisting of eight monthly, 1-hour seminars. An eight-item, Likert-type 7-point scale, post-then-pre questionnaire assessed the instructional impact of the curriculum. Results: Responses indicated that participation in the curriculum significantly increased the IMG residents’ levels of confidence with respect to boundary theory and practice. Conclusion: International medical graduates confidence levels regarding psychotherapeutic boundaries can be significantly increased through participation in a curriculum that addresses cultural differences.
TL;DR: Men and women practicing psychiatry in Canada show similar differences to that reported in the U.S., although women report more satisfaction with their careers than men in Canada, a finding not reported inTheU.S.
Abstract: Objective: The authors explored practice characteristics, activities, and career satisfaction of male and female psychiatrists. Method: A questionnaire was mailed to all practicing psychiatrists in Ontario, Canada, to which 52% responded. Results: More women specialized in child, women’s mental health and geriatrics than did men, while men specialized more in forensics and psychosomatics. Women saw fewer patients for pharmacotherapy than did men. Women spent more time in session with their patients than did the men. Women were less involved in research, less likely to hold pharmaceutical funding, and less likely to have published within the last 5 years than men. Women described their careers as less successful than men but felt less regret in choosing psychiatry as a career. Conclusions: Men and women practicing psychiatry in Canada show similar differences to that reported in the U.S., although women report more satisfaction with their careers than men in Canada, a finding not reported in the U.S.
TL;DR: Trainees with access to high-speed realtime connections rated their experience more highly compared with those who used slower web streaming technology, particularly with regard to the sound quality.
Abstract: Objective: The advent of videoconferencing technology has created opportunities to pool educational resources across different training programs. Methods: The authors surveyed participants and presenters in a seminar series utilizing interactive video-conferencing and a web-based course management system. Results: Trainees with access to high-speed realtime connections rated their experience more highly compared with those who used slower web streaming technology, particularly with regard to the sound quality. Conclusions: Specific recommendations on optimizing the use of video-conferencing and web-based course management tools in the training of residents are offered.
TL;DR: That there were few residents in clinical rotations suggests a need to explore causes, including funding problems, and whether there is sufficient academic community psychiatry faculty to enable clinical competency in this public health problem.
Abstract: Objectives: This study aims to document how psychiatric residencies address homelessness and mental illness, to discover training barriers, and to identify educational recommendations. Methods: The authors mailed a survey to 178 American psychiatric residency programs, requesting information about didactic and clinical offerings in homelessness. Programs without offerings were asked to provide reasons why. Results: Of 106 responses, 60% had educational offerings. Concerning clinical experiences, most had fewer than 20% of residents rotating, and only 11% had mandatory rotations. Programs without offerings usually noted that training in this area was a low priority, and this was most frequently linked with perceived low community homelessness prevalence. Conclusion: Psychiatric residency programs have addressed education in mental illness and homelessness in various ways. That there were few residents in clinical rotations suggests a need to explore causes, including funding problems, and whether there is sufficient academic community psychiatry faculty. The findings also evoke the need for a model curriculum that enables clinical competency in this public health problem.
TL;DR: An interviewing course for psychiatry clerks that combines practice, observation, and feedback in a small group setting is described that improves students’ self-perceived skill in interviewing and differential diagnosis.
Abstract: Objective: Taking a psychiatric history is a key educational objective in the psychiatry clerkship. Medical students arrive on psychiatry clerkships unprepared for the unique challenges of psychiatric interviewing. This paper describes an interviewing course for psychiatry clerks that combines practice, observation, and feedback in a small group setting. Methods: A quasi -experimental cohort design with medical student self-ratings as the dependent variable. Results: Students’ self-perceived skill in interviewing and differential diagnosis improved more than students who did not have the interviewing course. Students’ self-perceived skills also correlated significantly with the number of times they observed interviews. Conclusion: Clerkship directors in psychiatry should provide students with opportunities to practice interviewing skills, observe interviews, and receive feedback.
TL;DR: Web-based lectures appear to be a feasible and satisfactory way to ensure didactic comparability across clinical sites and to assess student satisfaction with such lectures.
Abstract: Objective: In recent years, the trend in medical education has been to utilize clerkship settings outside the medical school. Subsequently, students rotate at distant sites from the main campus and have lectures of varying quantity and quality. The objective of the present study was to standardize the core didactic experience for students in the Psychiatry clerkship by using web-based lectures and to assess student satisfaction with such lectures. Methods: Students completed a brief satisfaction questionnaire after viewing both web-based and live lectures. Results: Students rated both web-based and live lectures positively, although overall satisfaction ratings were higher for live lectures. Shelf-exam scores improved for the current year, suggesting that learning was not negatively affected by the use of web-based lectures. Conclusions: Web-based lectures appear to be a feasible and satisfactory way to ensure didactic comparability across clinical sites.
TL;DR: A systematic progression toward cultural competence with populations of African descent begins with increasing the residents’ awareness of their own cultural identity and the concept of achieving cultural competence as a continuum is utilized.
Abstract: Training psychiatric residents to address cross-cultural issues in their practice of psychiatry is a necessary objective of contemporary psychiatric education. Cultural issues play a critical role in the formation and expression of a patient’s personality. In addition, they are a major determinant of the context in which mental illness develops. This proposed curriculum outlines a systematic progression toward cultural competence with populations of African descent. It begins with increasing the residents’ awareness of their own cultural identity. The concept of achieving cultural competence as a continuum is utilized. Trainees should be prepared for any unfavorable reactions to this novel material. The curriculum must include accurate historic information about black culture, and general topics of diagnosis and treatment of African Americans must be covered. This should occur in congruence with trainees’ development from students to residents to psychiatrists, as they move from inpatient to outpatient, hospital to community, close supervision to autonomous functioning, gaining both skill and confidence.
TL;DR: The approval processes for subspecialties and the mechanisms for certification and recertification are described and the status of training programs and numbers of diplomates with subspecialty certification are reviewed.
Abstract: Objective: The authors describe the approval processes for subspecialties and the mechanisms for certification and recertification and review the status of training programs and numbers of diplomates with subspecialty certification. Methods: Published information and relevant data bases were reviewed. To date, 5,327 child and adolescent psychiatry, 2,595 geriatric psychiatry, 1,854 addiction psychiatry, and 1,384 forensic psychiatry certificates have been awarded. In clinical neurophysiology and pain medicine, specialties that are primarily for neurologists and child neurologists, 21 and 28 psychiatrists, respectively, have been certified. There are 113 residency programs in child and adolescent psychiatry, 62 in geriatric psychiatry, 43 in addiction psychiatry, and 40 in forensic psychiatry. There are no psychiatry-based training programs in clinical neurophysiology and pain medicine. While this may not be of concern for clinical neurophysiology, it may lessen psychiatry’s contribution to pain medicine. Results: The ABPN took a conservative approach to establishing subspecialty certification in psychiatry. Conclusion: It is expected that subspecialists will enhance patient care through their clinical activities as well as through teaching and research.