Showing papers in "Academic Psychiatry in 2006"

Body image, media, and eating disorders.

Abstract: Eating disorders, including obesity, are a major public health problem today. Throughout history, body image has been determined by various factors, including politics and media. Exposure to mass media (television, movies, magazines, Internet) is correlated with obesity and negative body image which may lead to disordered eating. The authors attempt to explain the historical context of the problem and explore potential avenues for change. The authors review changes in ideal female body type throughout history, comment on current attitudes toward shape and weight in both men and women and outline interventions aimed at increasing healthy habits and fostering self-esteem in youth. Throughout history, the ideal of beauty has been difficult to achieve and has been shaped by social context. Current mass media is ubiquitous and powerful, leading to increased body dissatisfaction among both men and women. Parents need to limit children’s exposure to media, promote healthy eating and moderate physical activity and encourage participation in activities that increase mastery and self-esteem. Funding for high-quality, visible advertising campaigns promoting healthy life styles may increase awareness.

Education about hallucinations using an internet virtual reality system: a qualitative survey.

Abstract: The authors evaluate an Internet virtual reality technology as an education tool about the hallucinations of psychosis. This is a pilot project using Second Life, an Internet-based virtual reality system in which a virtual reality environment was constructed to simulate the auditory and visual hallucinations of two patients with schizophrenia. Eight hundred sixty-three self-referred users took a self-guided tour. Five hundred seventy-nine (69%) of the users who toured the environment completed a survey. Of the survey responders, 440 (76%) thought the environment improved their understanding of auditory hallucinations 69% thought it improved their understanding of visual hallucinations, and 82% said they would recommend the environment to a friend. Computer simulations of the perceptual phenomena of psychiatric illness are feasible with existing personal computer technology. Integration of the evaluation survey into the environment itself was possible. The use of Internet-connected graphics environments holds promise for public education about mental illness.

Comparison of Burnout Among Medical Residents Before and After the Implementation of Work Hours Limits

Abstract: Objective The authors assess whether implementation of work hour limits is associated with a lower prevalence of medical resident burnout.

Medical students' perceptions of psychiatry as a career choice.

Abstract: Objective This study describes medical students’ perceptions of the field of psychiatry and identifies the impact of those perceptions on their career choices in order to explore the questions: Are we as a field doing all that we can to enhance the educational experience of all medical students, regardless of their career preferences? What are the most appropriate ways to encourage interested medical students that would allow for more targeted recruitment efforts toward the most receptive students?

Work-family balance and academic advancement in medical schools

Abstract: Objective This study examines various options that a faculty member might exercise to achieve work-family balance in academic medicine and their consequences for academic advancement.

Assessing the ACGME Competencies in Psychiatry Training programs.

Abstract: In 2000, the Accreditation Council of Graduate Medical Education (ACGME) laid out a definition of competence that included six specific areas of focus: patient care (including clinical reasoning), medical knowledge, practice-based learning and improvement interpersonal and communication skills professionalism, and systems-based practice. The ACGME’s intention was to mandate increasingly reliable and valid assessment measures to be used by all training programs over the next decade, with the goal of providing “more credible, accurate, reliable and useful educational outcome data.” In this article, the authors will review definitions of competency according to the new ACGME standards and examine the assessment tools currently available, including global evaluations, 360-degree evaluations, checklists, standardized examinations and direct observations. The authors will provide an overview of critical considerations in different assessment methods, including timing, psychometric properties, benchmarks, and feedback. Finally, the authors will discuss the relevant literature concerning the strengths and weaknesses of these various assessment tools. Throughout, the authors will comment on the applicability of the literature on assessment to the field of psychiatry and consider directions for competency assessment within and beyond psychiatric training. Following the paper is an annotated bibliography of the literature for those wishing to explore this topic more deeply and a list of web-based resources that may be used by those wishing to access available instruments.

Electronic Medical Records and Their Impact on Resident and Medical Student Education.

Abstract: Objective Electronic medical records (EMRs) are becoming prevalent and integral tools for residents and medical students. EMRs can integrate point-of-service information delivery within the context of patient care. Though it may be an educational tool, little is known about how EMR technology is currently used for medical learners.

Assessment of Clinical Skills Using Simulator Technologies

Abstract: Simulation technologies are used to assess and teach competencies through the provision of reproducible stimuli. They have exceptional utility in assessing responses to clinical stimuli that occur sporadically or infrequently. In this article, the authors describe the utility of emerging simulation technologies, and discuss critical issues in simulator-based skills assessment and appropriate results analysis. Based on literature search and expert consensus, the authors discuss three simulation technologies: standardized patients and the objective structured clinical examination; the integrated high fidelity mannequin; virtual clinical stations and the objective structured virtual examination. The authors explore the current state of these technologies: uses, cost, limitations, and likely future applications. For instance, tele-standardized patients may test learners’ communication/management approach to challenges during tele-consultation, such as a suicidal patient several hundred miles away. Integrated mannequins may test leadership skills during psychiatric emergencies. Case-based interactive virtual clinical assessment tools may test learners’ decision-making skills or self-reflection. However, these exciting tools must be implemented systematically. Specifically, educators must define the competencies of interest precisely. Appropriate data analysis will generate dependable results, ascribing the correct proportion of outcome variability to individual learner behavior. Careful analysis and utilization of results will allow justification of the costs to major stakeholders. Simulation technologies offer exciting possibilities for skills evaluation and clinical practice improvement. When used creatively and appropriately, they form a useful adjunct in the armament of educators addressing the question, “Is this physician competent?”

Mentoring partnerships for minority faculty and graduate students in mental health services research.

Abstract: Objective The authors developed mentorship programs to train minority junior faculty and advanced graduate students in mental health services research.

Choosing a career in psychiatry: influential factors within a medical school program.

Abstract: To examine the influence of initial interest, pre-clerkship experiences, clerkship experiences, and enrichment activities on choosing a career in psychiatry. Residents in psychiatry at the authors’ medical school completed a survey that examined each of these factors in relation to career choice. Thirty participants ranked initial interest as the most influential factor. Thirteen residents with low initial interest ranked clerkship experiences and negative experiences in other specialties as more influential than the 17 residents with high initial interest. Twelve residents who had attended the authors’ medical school rated enrichment activities, particularly psychiatry electives, as more influential than the remaining 18 from other medical schools did. Although limited by small sample size and potential recall biases, this study suggests that positive clerkship experiences and participation in psychiatry electives may be modifiable programmatic factors that could enhance recruitment to psychiatry.

An Evaluation of Depressed Mood in Two Classes of Medical Students.

Abstract: To assess depression rates in contemporary medical students. The Beck Depression Inventory (BDI) was administered anonymously to two medical school classes at matriculation, the end of first year, and the end of second year. Median scores for both classes were low at all points. The proportion of students scoring in the moderate or severely depressed range increased from 5.8% at matriculation to 10.5% by end of Year 2 for the Class of 2004, and from 5.1% to 11.9% over the same time period for the Class of 2005. Overall, 75–83% of students at every administration scored in the lowest BDI score range. The percentage of medical students who experience depressed mood increased over time, but to a lesser degree than in previous studies.

The junior medical student psychiatry clerkship: curriculum, attitudes, and test performance.

Abstract: Objective The third-year clerkship provides fundamental psychiatric training experience for medical students at Ohio State University. The authors aimed to assess students’ attitudes toward this clerkship, as well as its quality and its relationship to standardized measures of performance.

"How am I doing?": many problems but few solutions related to feedback delivery in undergraduate psychiatry education.

Abstract: Giving performance feedback to students in psychiatry requires particular delicacy and skill since a critique of the subjective artistry of the psychiatric interview may be felt more personally than a critique of an objective skill, such as eliciting a reflex or applying a stethoscope to the chest. Thus, one would expect that psychiatrists 1) are adept at giving feedback and 2) have written about the nuances of feedback delivery in psychiatric education. After a curricular needs assessment in our program revealed that feedback delivery was being neglected at all levels of training, a review of the medical education literature was conducted to find explanations for preceptor difficulty with performance feedback delivery in undergraduate psychiatric education. A qualitative content-analysis review of the Pub Med and OVID literature on feedback delivery and medical education was conducted. Several articles were available on feedback delivery in medical education, but only one of the studies was specific to undergraduate psychiatric education. Several articles offered practical tips to address deficiencies in the feedback process, but there was little to no explanation for the reasons behind the deficiencies. Reasons for the challenges faced by medical students and teachers during feedback conversations have not been fully explored in the literature. In contrast to other areas of medicine, little has been written specifically about feedback to students in undergraduate psychiatric education. Although there are many resources to assist medical educators with feedback delivery skills, an understanding as to why physicians and students struggle with feedback conversations is needed. Reasons for the apparent disconnect between what should be happening and what is actually happening during feedback conversations with undergraduate psychiatry students need to be understood. The authors hypothesize causes for the problems with feedback delivery in undergraduate psychiatric education.

E-Learning Systems: Promises and Pitfalls

Abstract: This review examines the use of e-learning systems in psychiatric education. The authors review the Instructional System Design process, focusing on ADDIE (Analysis, Design, Development, Implementation and Evaluation). The authors also report on two representative teaching projects, discussing the planning, work and assessment required. The basic operations of these education software systems are relatively easy to learn. The real work is the project preparation which precedes software use and final implementation. Internet-based learning software is another tool in the educator’s armamentarium. Educators must still utilize sound educational pedagogy to create effective learning instruments.

Training in tobacco treatments in psychiatry: a national survey of psychiatry residency training directors.

Abstract: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. The authors recruited training directors to complete a survey of their program’s curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents’ skills for addressing nicotine dependence in psychiatric patients. Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents’ skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time. The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders.

Virtual Reality, Telemedicine, Web and Data Processing Innovations in Medical and Psychiatric Education and Clinical Care

Abstract: Objective This article highlights technology innovations in psychiatric and medical education, including applications from other fields.

A developmental model for enhancing research training during psychiatry residency.

Abstract: Objective The authors describe a developmental model for enhancing residency research training for careers in academic psychiatry. Over the past 10 years, the University of Pittsburgh Department of Psychiatry has developed a research track (RT) for its residents. While the Department’s plan has been to address the critical need of training physician-scientists in psychiatry, the RT continues to evolve as a structured extension of the University’s residency-training program. Recently, the University’s departmental leadership has taken several steps that address regulatory, institutional, and personal barriers to residency research training put forth by the 2003 Institute of Medicine (IOM) report.

Use of standardized patients during a psychiatry clerkship.

Abstract: Standardized patients are used in teaching medical students and evaluating their clinical skills during the psychiatric clerkship. The purpose of this study was to evaluate whether the addition of a Psychiatry Clinical Standardized Patient Examination (PCX) during the third-year clerkship improved students’ performances on the psychiatry component of the Clinical Competency Examination (CCX) that is used at our institution to prepare fourth-year students for the National Board of Medical Examiners Step 2 Clinical Skills Exam (Step 2 CSA). Scores on the CCX were analyzed by two-by-two tables (yes/no response to each clinical competency item versus took/did not take PCX) using Fisher’s exact test. Of the 469 students who took the CCX between 2002 and 2004, 246 students also took the PCX. Compared to students who did not take the exam students who took the PCX were significantly more likely (p>0.05) to receive positive ratings on the CCX items for professionalism, addressingpatients’ stressors at work and home and inquiring about thoughts of harm to self or others. The implementation of the PCX during the psychiatry clerkship significantly improved student performance on several important components of the CCX, which is used to prepare students for the Step 2 CSA. This suggests that the use of standardized patients during the clerkship may help students improve their interviewing and interpersonal skills.

Students' and residents' perceptions regarding technology in medical training.

Abstract: This pilot study provides firsthand feedback from medical students and residents in training regarding their perceptions of technology in medicine. The authors distributed an e-mail invitation to an anonymous Web-based survey to medical students and residents in two different U.S. training institutions. Respondents unanimously expressed that technology skills were important in medical training and felt it most important to learn about electronic medical records and accessing scientific information on the Internet. At the point of patient care, trainees’ preferred reference sources were the Internet and PDA, in that order. Most clinical trainees felt PDAs were critical in patient care and met their clinical needs, and they were most likely to use them for medication reference. The majority of trainees preferred printed media over digital media for initial learning, but the converse for referencing. Instructor-led small groups were viewed as the best environment in which to receive instruction. Trainees in medical education are technologically savvy and provide invaluable feedback regarding initiation, development and refinement of technological systems in medical training.

Considerations in Change Management Related to Technology.

Abstract: Objective The authors describe the complexity of social processes for implementing technological change. Once a new technology is available, information about its availability and benefits must be made available to the community of users with opportunities to try the innovations and find them worthwhile, despite organizational resistances.

Visualizing the future: technology competency development in clinical medicine, and implications for medical education.

Abstract: In this article, the authors ask three questions First, what will physicians need to know in order to be effective in the future? Second, what role will technology play in achieving that high level of effectiveness? Third, what specific skill sets will physicians need to master in order to become effective? Through three case vignettes describing past, present, and potential future medical practices, the authors identify trends in major medical technological and cultural shifts that will shape medical education and practice From these cases, the authors generate a series of technology-related competencies and skill sets that physicians will need to remain leaders in the delivery of medical care Physicians will choose how they will be end-users of technology, technology developers and/or the interface between users and developers These choices will guide the types of skills each physician will need to acquire Finally, the authors explore the implications of these trends for medical educators including the competencies that will be required of educators as they develop the medical curriculum Examining historical and social trends, including how users adopt current and emerging technologies, allows us to anticipate changes in the practice of medicine By considering market pressures, global trends and emerging technologies, medical educators and practicing physicians may prepare themselves for the changes likely to occur in the medical curriculum and in the marketplace

An Approach to Address Grade Inflation in a Psychiatry Clerkship

Abstract: Objective Universally, clerkship grading is diverse and not standardized. The authors’ faculty was troubled by the inability to provide meaningful evaluations, as more than 60% of students received the highest grade. Although a psychiatry clerkship mandate of a faculty-observed student clinical interview existed for several years, the majority of students reported not completing the interview under direct observation by a faculty member and no meaningful feedback or evaluation for this activity existed. In order to create diversity in grading criteria and to examine clinical skills more thoroughly than previously, written and oral examinations were developed and supervised interviews of patients and written comprehensive psychiatric evaluations were added. A core group of department faculty was instructed in the use of materials and instruments designed to standardize the experiences and the student evaluations.

To Commit or Not to Commit: The Psychiatry Resident as a Variable in Involuntary Commitment Decisions

Abstract: Objective To study whether psychiatry residents’ personalvariables (such as age, gender, level of training, previous experience with patient suicide or lawsuits) and their temperamental predispositions have an impact on their decisions to seek involuntary commitment.

Family Skills for General Psychiatry Residents: Meeting ACGME Core Competency Requirements

Abstract: The authors discuss the knowledge, attitudes, and skills needed for a resident to be competent in supporting and working with families, as mandated by the residency review committee (RRC) core competencies The RRC core competencies, as they relate to patients and their families, are reviewed The Group for Advancement of Psychiatry (GAP) presents an operational version of these core competencies Methods of assessment, challenges in teaching, and ways of overcoming programmatic constraints are outlined Examples of training programs that offer ways of integrating the teaching of family skills into existing programs are described The implications of the current RRC core competency requirements pertaining to families have the potential to change the training environment substantially The GAP Family Committee proposes recommendations to facilitate the training of residents in family skills

Mental health disparities, diversity, and cultural competence in medical student education: how psychiatry can play a role.

Abstract: The authors review recent developments in healthcare policy, including eliminating disparities in mental healthcare, increasing diversity in the healthcare workforce, and cultural competence. Following a discussion of the Liaison Committee on Medical Education (LCME) standards, as they relate to disparity, cultural competence, and diversity, the authors discuss an action plan describing the role of psychiatry in addressing these issues. Key policy documents are reviewed for disparities, cultural competence, and diversity in healthcare and then in mental health specifically. Important developments in healthcare policy regarding these areas have occurred. Psychiatry can play a vital role in addressing disparities, cultural competence, and diversity in medical student education.

The problem of the psychopharmacologist.

Abstract: Objective The psychopharmacologist designation currently pervades and heavily influences the practice, perception, and teaching of clinical psychiatry. The authors hope to make a case and provide the raw material for informed discussion of this role during psychiatric residency training.

A Neural Systems-Based Neurobiology and Neuropsychiatry Course: Integrating Biology, Psychodynamics, and Psychology in the Psychiatric Curriculum

Abstract: Psychotherapy and biological psychiatry remain divided in psychiatry residency curricula. Behavioral neurobiology and neuropsychiatry provide a systems-level framework that allows teachers to integrate biology, psychodynamics, and psychology. The authors detail the underlying assumptions and outline of a neural systems-based neuroscience course they teach at the National Capital Consortium Psychiatry Residency Program. They review course assessment reports and classroom observations. Self-report measures and teacher observations are encouraging. By the end of the course, residents are able to discuss both neurobiological and psychodynamic/psychological concepts of distributed biological neural networks. They verbalize an understanding that psychology is biology, that any distinction is artificial, and that both are valuable. A neuroscience curriculum founded on the underlying principles of behavioral neurobiology and neuropsychiatry is inherently anti-reductionistic and facilitates the acquisition of detailed information as well as critical thinking and cross-disciplinary correlations with psychological theories and psychotherapy.