Showing papers in "Academic Psychiatry in 2008"

A conceptual model of medical student well-being: promoting resilience and preventing burnout.

Abstract: This article proposes and illustrates a conceptual model of medical student well-being. The authors reviewed the literature on medical student stress, coping, and well-beingand developed a model of medical student coping termed the “coping reservoir.” The reservoir can be replenished or drained by various aspects of medical students’ experiences. The reservoir itself has an internal structure, conceptualized as consisting of the individual’s personal traits temperament and coping style. The coping reservoir metaphor is used to highlight the dynamic nature of students’ experiences, with potential outcomes including enhanced resilience and mental health versus distress and burnout. Medical student well-being is affected by multiple stressors as well as positive aspects of medical training. Attention to individual students’ coping reservoirs can help promote well-being and minimize burnout; formal and informal offerings within medical schools can help fill the reservoir. Helping students cultivate the skills to sustain their well-being throughout their careers has important payoffs for the overall medical education enterprise, for promotion of physician resilience and personal fulfillment, and for enhancement of professionalism and patient care. This and other models of coping should be empirically validated.

The stigma of families with mental illness.

Abstract: This article describes family stigma, which is defined as the prejudice and discrimination experienced by individuals through associations with their relatives. The authors describe family stigma and present current research related to mental illness stigma experienced by family members. Research indicates this type of stigma negatively impacts family members and relatives with mental illness. The authors also present strategies to eliminate stigma and discuss implications for the training goals of psychiatrists throughout the text. The authors end this article with recommendations for psychiatry training goals.

Suicide and Stigma: A Review of the Literature and Personal Reflections

Abstract: Objective The authors aim to educate mental health practitioners and trainees regarding the issues of stigma and suicide and how stigma impacts this diverse population of suicide at tempters, completers, their families, friends, therapists, and others both personally and therapeutically.

Observations on burnout in family medicine and psychiatry residents.

Abstract: Objective To investigate the relationship between burnout, work environment, and a variety of personalvariables, including age, gender, marital, parental and acculturation status within a population of family medicine and psychiatry resident physicians.

Prevalence of health-related behaviors among physicians and medical trainees.

Abstract: The authors studied the prevalence of health-promoting and health-risking behaviors among physicians and physicians-in-training Given the significant potential for negative outcomes to physicians’ own health as well as the health and safety of their patients, examination of the natural history of this acculturation process about physician self-care and wellness is critical to the improvement of the western health care delivery system 963 matriculating medical students, residents, or attending physicians completed the Empathy, Spirituality, and Wellness in Medicine (ESWIM) survey between the years 2000 and 2004 Items specific to physician wellness were analyzed These included healthy behaviors as well as risk behaviors Both medical students and attending physicians scored higher in overall wellness than did residents Residents were the lowest scoring group for getting enough sleep, using seatbelts, and exercising Medical students were more likely to smoke tobacco and drink alcohol Medical students reported less depression and anxiety and more social contacts Medical school training may prevent students from maintaining healthy behaviors, so that by the time they are residents they exercise less sleep less and spend less time in organizational activities outside of medical school If physicians do not engage in these healthy behaviors, they are less likely to encourage such behaviors in their patients and patients are less likely to listen to them even if they do talk about it

Peer Group Mentoring of Junior Faculty.

Abstract: The purpose of this article is to document and evaluate the initiation of a mentoring model for junior faculty utilizing a peer group approach rather than the traditional dyadic model. Junior faculty members in an academic department of psychiatry at Sunnybrook Hospital, University of Toronto, were invited to take part in a peer mentoring program involving evening meetings every 2 months over a 1-year period from 2004–2005. Of the 12 invitees, 10 agreed to participate in the program. The group participants developed the program agenda collectively. Learning objectives as well as a list of topics of interest were established at the inaugural meeting. A focus group was held at the end of 12 months to provide a descriptive, qualitative evaluation. The focus group leader prepared a report based on observations and notes taken during the focus group. The report prepared by the focus group leader identified six main themes that included: program development, knowledge gains, interpersonal gains, psychological/emotional gains, process of the program and future directions. The overall response was clearly favorable with a unanimous decision to maintain the group and continue meeting into the next year. A peer group mentoring format for junior faculty in an academic department of psychiatry can be an effective model of mentoring.

Attitudes toward Psychiatry: A Survey of Medical Students at the University of Nairobi, Kenya.

Abstract: The authors aim to determine the attitudes of University of Nairobi, Kenya, medical students toward psychiatry. The study design was cross-sectional. Self-administered sociodemographic and the Attitudes Toward Psychiatry-30 items (ATP-30) questionnaires were distributed sequentially to every third medical student in his or her lecture theater before or immediately after the lectures. Analysis was done using SPSS version 11.5 and the results are presented in tables. Nearly 75% of the students had overall favorable attitudes toward psychiatry but only 14.3% considered psychiatry as a potential career choice. Sixty-six percent reported that they would not choose psychiatry as a career while the remaining 19.7% were not decided. There is dissonance between positive attitudes toward psychiatry and the choice of psychiatry as a potential career. Therefore, there is a need to bridge the gap by addressing the various factors that potentially account for this dissonance.

Does a Clerkship in Psychiatry Contribute to Changing Medical Students’ Attitudes Towards Psychiatry?

Abstract: Objective The psychiatric clerkship is perceived as an intervention point in medical students’ attitude toward psychiatry and career choice after graduation. The authors aim to assess the impact of the psychiatric clerkship in students from Israeli and U.S. origin on their attitude toward psychiatry.

"Attitude is a little thing that makes a big difference": reflection techniques for addiction psychiatry training

Abstract: The authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with substance use and other addictive disorders. Reflection discussion times, reflection journaling, and mandatory end-of-rotation reflection papers were embedded into a core addiction psychiatry postgraduate training block. Qualitative analysis of 28 reflection papers was performed to determine key factors and constructs that impacted on the development of attitudes and professionalism. A number of constructs emerged that demonstrated the attitudes, beliefs, stereotypes, and stigmas students have regarding addictive disorders. Some constructs also highlighted that students felt much more comfortable dealing with addictive disorders after the training and would treat individuals with these conditions in a more effective manner. Reflection techniques were endorsed as extremely valuable by students, especially in the development of professional attitudes that will help clinicians effectively engage and provide appropriate care for individuals suffering from addictive disorders. The authors suggest that reflective practices be used more extensively in psychiatric training in order to build and establish reflexive self-awareness as a core professional competence essential to work effectively in clinical practice, especially in the most demanding contexts.

Training clinicians in cultural psychiatry: a Canadian perspective.

Abstract: The authors summarize the pedagogical approaches and curriculum used in the training of clinicians in cultural psychiatry at the Division of Social and Transcultural Psychiatry, McGill University. We reviewed available published and unpublished reports on the history and development of training in cultural psychiatry at McGill to identify the main orientations, teaching methods, curriculum, and course content. Student evaluations of teaching were reviewed. The training strategies and curriculum are related to the larger social context of Canadian society including the history of migration, current demography, and policies of multiculturalism. The McGill program includes core teaching, clinical rotations, an intensive summer program, and annual Advanced Study Institutes. The interdisciplinary training setting emphasizes general knowledge rather than specific ethnocultural groups, including: understanding the cultural assumptions implicit in psychiatric theory and practice; exploring the clinician’s personal and professional identity and social position; evidence-based conceptual frameworks for understanding the interaction of culture and psychopathology; learning to use an expanded version of the cultural formulation in DSM-IV for diagnostic assessment and treatment planning; and developing skills for working with interpreters and culture-brokers, who mediate and interpret the cultural meaning and assumptions of patient and clinician. An approach to cultural psychiatry grounded in basic social science perspectives and in trainees’ appreciation of their own background can prepare clinicians to respond effectively to the changing configurations of culture, ethnicity, and identity in contemporary health care settings.

Evaluation of an Evidence-Based Tobacco Treatment Curriculum for Psychiatry Residency Training Programs

Abstract: Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness. The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005–2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California. The curriculum was associated with improvements in psychiatry residents’ knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients with initial changes from pre- to posttraining sustained at 3-months’ follow-up. Residents’ self-reported changes in treating patients’ tobacco use were substantiated through systematic chart review. The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers.

Stigma in mental health care.

Abstract: Received November 28, 2007; accepted December 12, 2007. Drs. Tsao, Tummala, and Roberts are affiliated with the Departments of Psychiatry and Behavioral Health at the Medical College of Wisconsin in Milwaukee, Wis. Address correspondence to Carol I. Ping Tsao, M.D., Psychiatry and Behavioral Health, Medical College of Wisconsin, 5000 W. National Ave, Milwaukee, WI 53295; ctsao@mcw.edu (e-mail). Copyright 2008 Academic Psychiatry Stigma marks someone as different from others, leading to devaluation of that person. A social construction, stigma occurs within relationships. In his classic 1963 description, Goffman (1) defines stigma as “an attribute that is deeply discrediting,” where a person is diminished “from a whole and usual person to a tainted, discounted one.” Shifting from a focus on individual traits, subsequent formulations have identified certain psychosocial processes that lead to stigmatization. These include labeling, stereotyping, separating, status loss, and discrimination in a context of power imbalance (2). Stigma affects people adversely. Academic achievement is lower for members of stigmatized groups as compared with nonstigmatized groups, and members of stigmatized groups are at greater risk for both mental and physical diseases (3). Patients with mental illnesses are stigmatized and suffer adverse consequences such as increased social isolation, limited life chances, and decreased access to treatment (4– 6). In addition to poorer social functioning as assessed by housing and employment status (7), those with the stigma of mental illness also encounter a significant barrier to obtaining general medical care (8) and to recovery from mental illness (9). As stated by Chin and Balon (10), “The added burden that stigma imposes on the struggle to recovery can alter behavior, generate anxiety, and ultimately cause isolation from the mainstream culture.” In this issue, several manuscripts make a case for increasing familial involvement in the care of patients with mental illnesses with the aims of improving social and health outcomes for patients and providing support to family members. Suggestions range from managing confidentiality while increasing family engagement in the treatment of distressed adolescents (11) to optimizing the benefits of family money management (12) to inclusion of family across the spectrum of psychiatric clinical care (13) to more formalized reintegration of family therapy training in psychiatry residency programs (14) to making afterdeath calls to family members (15). Stigma also affects family members of persons with mental illness. Referred to as “courtesy” (1) or “associative” (16) stigma, its psychological impact can be quite deleterious. In a Swedish study, 18% of relatives of patients with severe mental illness reported that the patient would be better off dead (17). This figure increased to 40% in relatives who felt that the patient’s mental illness caused mental health problems in themselves (17). In this issue, two articles report literature reviews on stigma of families with mental illness (18) and stigma associated with suicide (19). In the first article (18), parental stigmatization of children with mental illnesses and the stigmatization of children with parents who have mental illnesses are explored. Parents are often blamed for causing mental illness in their children through poor parenting. Children are often perceived as being somehow tainted by their parents’ mental illness. In the second article (19), three survivors of suicide report their experiences and make suggestions to further diminish stigma associated with suicide. Survivors of suicide, as compared with other bereaved persons, experience more guilt and less social support. Candid disclosure about the decedent’s struggle with mental illness and suicide being the cause of death, having someone to talk with openly about the loss, and/or participation in a suicide support group can provide significant comfort to familial survivors of suicide and may go some distance in decreasing stigma. As a group, mental health professionals are no less susceptible to stigmatizing beliefs than the general population (20–22). And medical education has only a very limited benefit with regard to reducing stigmatizing beliefs (23). In a study of resident physicians from an array of medical

Television Media as a Potential Negative Factor in the Racial Identity Development of African American Youth

Abstract: Received and accepted February 8, 2008. Dr. Martin is a Child and Adolescent Psychiatrist at West Central Mental Health Center in Canon City, Colo. Address correspondence to Ardis C.Martin,M.D., Child and Adolescent Psychiatrist, Private Practice, 3765 Cherry Plum Dr., Colorado Springs, CO 80920; acmartin99@netzero.net (e-mail). Copyright 2008 Academic Psychiatry Racism and discrimination continue to be a pervasive problem within our society. The images seen in media, in general, and on TV, in particular, perpetuate these negative stereotypes about African Americans and impact majority society’s views of Blacks. These images also may influence minority cultures’ view of themselves and have the potential to affect the developing minds of African Americans. Negative stereotypes may be highly detrimental to African American children and adolescents as they attempt to traverse their way through the normal course of identity development. The process of adolescent identity exploration is fraught with elements of distress and continuous discovery. Adolescents have the task of trying on new roles, coming to terms with their sexuality, separation and individuation from their family, establishment of autonomy, and understanding their place in society and the world. African American youth are met with the additional challenge of discovering what it means to be black. They must also discover their racial identity. This endeavor can prove to be difficult because they find that the world around them has already defined them by the color of their skin. They are bombarded with negative images of the self—reinforced by the media, either overtly or subtly, which may ultimately have an impact on their development and their overall sense of who they are or who they can become. African American youth struggle to define what it means to be black in spite of the stereotypes which are seen around them. In this article, I explore how stereotypical images seen on TV and the promotion of racial discrimination may impact racial identity development and two theories of racial identity development and their stages. I also explore how positive images and social supports can counteract these stereotypical images and aid in a more fluid transition through the development process of racial identity to create a sense of resiliency as a protective device against the negative environment that African Americans will continue to face. Finally, I look at the importance of this knowledge within the child psychiatric community in promoting therapeutic support for AfricanAmerican patients.

An Integrative Approach to Cultural Competence in the Psychiatric Curriculum.

Abstract: Objective As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country.

Peer-Mentored Research Development Meeting: A Model for Successful Peer Mentoring Among Junior Level Researchers

Abstract: This report describes a model for the development, process, and tracking methods of a Peer-mentored Research Development Meeting (PRDM), an interdisciplinary peer mentoring program The program was initiated in 2004 by a group of post-doctoral scholars and junior faculty from the Schools of the Health Sciences at the University of Pittsburgh From February 2004 through February 2006, PRDM’s first five members tracked and documented their research activity (eg, manuscripts, grants) every 4 months The defining features of PRDM are adherence to a structured frequency and format for meetings, systematic tracking and evaluation of research development activities, and maintenance of ongoing relationships with senior mentors During the 24-month data collection period, members were involved in 91 research development projects including grant applications, journal article manuscripts, book chapters, and conference abstracts Members’ productivity increased during the 24-month period, as did the efficiency and focus of the completed projects Members increased the efficiency and focus of their research development activities during the study period Structured peer-mentoring groups have the potential to enhance research productivity among junior investigators in research intensive environments

Our Fallen Peers: A Mandate for Change

Abstract: Objective The author identifies and seeks to remove barriers contributing to physician/medical students’ decisions NOT to seek mental health care.

Pilot study and evaluation of postgraduate course on "the interface between spirituality, religion and psychiatry".

Abstract: Understanding the role of religion and spirituality is significant for psychiatric practice. Implementation of formal education and training on religious and spiritual issues, however, is lacking. Few psychiatric residencies offer mandatory courses or evaluation of course utility. The authors present findings from a pilot study of a course on the interface between spirituality, religion, and psychiatry. Course objectives were to increase both residents’ understanding of clinically relevant spiritual/religious issues and their comfort in addressing these issues in their clinical work. A 6-hour mandatory course was implemented for third- and fourth-year psychiatry residents at the University of British Columbia. Teaching sessions consisted of didactic and case-based modules delivered by multidisciplinary faculty. The Course Impact Questionnaire, a 20-item Likert scale, was used to assess six areas: personal spiritual attitudes, professional practice attitudes, transpersonal psychiatry, competency, attitude change toward religion and spirituality, and change in practice patterns. A pre/post study design was used with the questionnaire being administered at week 0, week 6, and 6 months follow-up to two groups of residents (N=30). Qualitative feedback was elicited through written comments. The results from this pilot study showed that there was increased knowledge and skill base for residents who participated in the sessions. Paired t test analysis indicated a statistically significant difference between the pre- and postsession scale for competency. No other statistically significant differences were found for the other components. The findings suggest improvement in the competency scores for residents and overall usefulness of this course; however, limited conclusions can be made due to a small sample size and lack of adequate comparison groups. Establishing educational significance will require gathering larger usable control data as well as validation of the Course Impact Questionnaire tool to distinguish between different skill levels.

How are the experiences and needs of families of individuals with mental illness reflected in medical education guidelines

Abstract: This descriptive study explored the extent that medical education curriculum guidelines contained content about the experiences and needs of family members of people with serious mental illness. Key family-focused-literature themes about the experiences and needs of families of individuals with mental illness were drawn from a review of over 6,000 sources in the mental health practice literature that were identified within a systematic search and thematic development process. The study identified the extent and nature of family-focused key literature themes as reflected in medical education curriculum guidelines for psychiatry and primary care practice specialties of family practice, internal medicine and pediatrics. An iterative process was used to retrieve and analyze text data drawn from the curriculum guidelines of national accrediting organizations for undergraduate, graduate, and continuing medical education. The key family-focused themes, as drawn from the mental health practice research literature, were: mental illness stigma; family caregiver burden; information exchange and referral; family stress, coping, and adaptation; family support; crisis response; and family psychoeducation. Two of these seven themes appeared in medical education curriculum guidelines: information exchange and caregiver burden. The most frequently appearing family-focused key literature theme was information exchange. Psychiatry and undergraduate medical education reflected the most family content. It appears that medical education curriculum guidelines have insufficient content about families of people with mental illness. The educational experiences of psychiatrists and primary care physicians may not adequately prepare them for working with family members of their patients. It is recommended that medical education curriculum guidelines incorporate information about family stigma; family/caregiver burden; information exchange; family stress, coping, and adaptation; family support; crisis response; and multiple family group psychoeducation.

Attitudes of pakistani medical students towards psychiatry as a prospective career: a survey.

Abstract: Pakistan is facing a shortage of psychiatrists; there are about 350 psychiatrists in a country of 150 million. Medical specialty choice surveys of medical students have approached this issue from various angles. The authors’ objective is to explore the attitudes of Pakistani medical students toward psychiatry as their future career. Third-year medical students from four medical colleges in different regions of Pakistan participated. A questionnaire was hand distributed and collected in each medical college by a contact person who was not affiliated with the department of psychiatry in any of the medical colleges included in the survey. The response rate was 60% out of a sample of 381 students. The mean age was 21 years, and 57% were female. The majority (98.4%) were Muslims. Respondents were similar in all demographic characteristics except household income. Only 7.6% reported psychiatry to be either their chosen career or a highly likely choice. A Friedman test found a significant difference in mean scores of ratings of the attractiveness of various career aspects of different specialties. Relatively small numbers of students identified psychiatry as their specialty of choice. This trend is similar to many other studies. Given the small number of practicing psychiatrists in Pakistan, this finding is not very encouraging.

Diversity initiatives in academic psychiatry: applying cultural competence.

Abstract: This article describes the process of change in an academic department of psychiatry that has led to the development of a diversity initiative in teaching, research, recruitment, and services. The authors performed a literature review of diversity initiatives using PubMed. The authors then wrote a case study of the development of a diversity initiative at UC Davis. Some articles on diversity initiatives were found, but none that detailed the administrative process, funding, or sustainability of such initiatives. In 1999, the UC Davis Department of Psychiatry and Behavioral Sciences recognized the importance of issues of diversity and established the Diversity Advisory Committee, a group of department faculty and residents that explores and addresses the diversity needs of the department. In our observations, there are at least three requirements for a successful diversity initiative: a diverse patient population, a “critical mass” of interested faculty, and support of the administration. With these three factors in place, the Diversity Advisory Committee produced four Continuing Medical Education symposia focused on diversity topics, developed a 4-year cultural psychiatry curriculum and a 4-year religion and spirituality curriculum within the residency, and supported nine residents who received awards from the APA’ s Minority Fellowships in 8 years. Future plans include department-wide and medical school faculty-wide diversity training, educational research, and a postgraduate fellowship in cultural psychiatry. This article shows that a diversity initiative can be undertaken with interested minority and nonminority faculty, administrative support, and a diverse patient population. The authors hope this article will provide assistance to other academic departments in developing diversity initiatives.

Poor intentions or poor attention: misrepresentation by applicants to psychiatry residency.

Abstract: This study examines the veracity of self-reported data by applicants to psychiatry residency. The authors reviewed the reported publications of all applicants to a psychiatry residency training program over a 2-year span. Nine percent of applicants reporting publications were found to have misrepresented them. International medical graduates were found to be more likely to have misrepresented their publications than U.S. medical graduates. A small but significant number of applicants to psychiatry residency training misrepresent their publications. Identification of misrepresentation may provide valuable information about the applicant and their future performance in training and practice.

Cross-cultural psychiatric residency training: the Oregon experience.

Abstract: The purpose of this article is to describe the goals and structure of cross-cultural psychiatric training at Oregon Health and Science University (OHSU). This training in core knowledge, skills, and attitudes of cultural psychiatry over the past three decades has included medical students, residents, and fellows, along with allied mental health personnel. The curriculum includes both didactic sessions devoted to core topics in the field and varied clinical experiences in community settings and the Intercultural Psychiatric Program under the supervision of experienced academic faculty. The authors review the central elements of the training experiences and include a detailed description of the core clinical settings and experiences. At the conclusion of their clinical experiences, trainees have specialized cross-cultural psychiatric knowledge and skills, including treatment of refugees and immigrants, sociocultural variables that influence the assessment and treatment of a wide range of psychiatric conditions, and comfort with cultural dynamics that influence both the doctor/patient relationship and collaboration with a wide range of mental health professionals. Because of rapid demographic changes in the U.S. population, providing cross-cultural training for students, residents, and fellows is an essential foundation for the education of the next generation of clinicians and health care leaders. OHSU has provided a long-term model for this training in a busy clinical and academic setting that places an emphasis on multi-disciplinary and multicultural collaboration.

Can admissions interviews predict performance in residency

Abstract: The authors aim to determine whether admission interviews predict performance in residency. The authors determined whether interview and other admission data were correlated with performance during postgraduate years 2–4 and with remaining in the residency in 544 residents enrolled in a single psychiatry residency program between 1963 and 2004. Considered together, admissions data predicted 13% of the variance in performance ratings in postgraduate year 2 (PGY-2) and 5% in PGY-4. Interview scores were moderately correlated with performance ratings in PGY-2, modestly correlated with performance in PGY-3, and not correlated with performance ratings in PGY-4. Letters of reference were moderately correlated with performance ratings in PGY-2 and modestly correlated with performance in PGY-3 and PGY-4. In PGY-2, interview scores differentiated between the top quartile of performance and the other three quartiles, while letters of reference differentiated performance in the top and bottom quartiles from the middle quartiles. Numerical differences among groups were not great enough to be practically useful, and no variables predicted which residents would leave the program before completing it. As they are currently conducted, application interviews do not have sufficient power to predict performance during residency. Letters of reference may be useful to the extent that they reflect personal experience with the applicant, but differences in ratings of these letters are not great enough to base admission decisions on them. As it is currently performed, the interview process may be more useful as a means of interesting applicants in the program than of evaluating their potential for success in the residency.

Personal health care of residents: preferences for care outside of the training institution.

Abstract: The personal health care issues of residents are important but have received minimal study. Available evidence suggests that residents experience difficulties obtaining care, partly related to both the demands of medical training and concerns about confidentiality and privacy. A self-report survey was distributed in 2000–2001 to advanced residents at the University of New Mexico Health Sciences Center. Questions related to personal health and health care attitudes, behaviors, preferences, and experiences, and vignettes related to personal illness and treatment. Here the authors report findings regarding preferences for obtaining health care “at” versus “outside” of one’s training institution. Data from 141 residents are presented. A substantial minority of residents had obtained care outside of their institution in the preceding year. Residents expressed concerns about their medical privacy and confidentiality related to obtaining care within their own institution, including concerns about being seen by other residents or by past or future attendings. Women expressed more concern than did men on numerous issues, as did residents in primary care versus specialty training. Residents expressed a preference for care outside the training institution when taking into account confidentiality and prevention of embarrassment; care at their own institution was preferred when considering expense and scheduling. Outside care was more strongly preferred for more stigmatizing illnesses (e.g., mental health-related). Most residents felt poorly informed regarding their personal health care confidentiality rights and did not know whether their institution had confidentiality policies regarding residents who develop physical or mental health problems. Residents worry about confidentiality and privacy when deciding where to obtain personal medical care. Trainees’ concerns are relevant to crafting policies on resident health care. Programs should strive to inform residents thoroughly about policies and rights pertaining to personal health care.

Training Psychiatric Residents and Fellows in a Telepsychiatry Clinic: A Supervision Model

Abstract: The authors assess the effectiveness of a specialized telepsychiatry training and supervision training model. Fifteen residents and eight child fellows rotated through Cedars Sinai Medical Center Telepsychiatry Developmental Disability Clinic and completed questionnaires of knowledge and self-assessed skills at commencement and completion of the rotation. The supervision was on site, side-by-side, and directive. Both the residents and the fellows demonstrated improvement. Increase in knowledge was equal in the study cohorts, while residents’ self-assessed skills were significantly greater than the fellows’. A telepsychiatry clinic appears to be an appropriate setting in which to provide direct supervision. Exposure to such opportunities early in training may yield a greater impact.

Multicultural psychiatric education: using the DSM-IV-TR Outline for Cultural Formulation to improve resident cultural competence.

Abstract: The authors present a 9-week multicultural competence course organized around the DSM-IV-TR Outline for Cultural Formulation. The course alternated large group lectures with experiential small group discussions to acquire knowledge, develop skills, and explore attitudes. The authors evaluated the effectiveness of the course on residents’ training and application of multicultural knowledge, skills, and attitudes. Second-, third- and fourth-year residents completed anonymous self-report questionnaires immediately before and after the course and 9 months following the course. Residents’ pre- and postcourse scores indicated statistically significant increases in multicultural knowledge, attitudes, and clinical application. Residents did not report additional gains in multicultural knowledge, skills, and attitudes at the 9-month follow-up. This multicultural training course resulted in modest gains in resident training in multicultural knowledge, skills, and attitudes. Further study is needed to determine ways to sustain immediate multicultural knowledge and ways to support long-term application of multicultural education.

Overcoming stigma: involving families in medical student and psychiatric residency education.

Abstract: Objective The primary purpose of this article is to present a possible mechanism for increasing communication about psychiatric matters such as diagnoses, treatment, and stigma between the physicians, including psychiatrists, and the families of persons with mental illness through a NAMI presentation.

Training Researchers in Cultural Psychiatry: The McGill-CIHR Strategic Training Program

Abstract: Objectives The authors aim to summarize the pedagogical approaches and curriculum used in the training of researchers in cultural psychiatry at the Division of Social and Transcultural Psychiatry at McGill University.

Positive attitude change toward psychiatry in pharmacy students following an active learning psychopharmacology course.

Abstract: Objective Psychiatric care in many rural communities has been demonstrated to be less adequate compared with urban environments partially because of attitudes and stigmatization issues. Educated pharmacists with professional attitudes can have a major impact in helping mental health patients receive more accurate diagnostic assessments and safe and effective treatment. This report demonstrates the effects of a specialized elective course in psychopharmacology on doctor of pharmacy students’ attitudes toward psychiatric disorders and their treatment.

Using non-feature films to teach diversity, cultural competence, and the DSM-IV-TR outline for cultural formulation

Abstract: Objective Feature films have been used for teaching in psychiatry for many years to demonstrate diagnoses, but the use of documentary and instructional films in resident and staff cultural competence training have not been extensively written about in the medical and psychological literature. This article will describe the films that have been used by the authors and suggest methods for their use in cultural competence and diversity training.