Showing papers in "Academic Psychiatry in 2010"

Prevalence of ADHD diagnosis and nonmedical prescription stimulant use in medical students.

Abstract: Objective The authors aimed to determine the prevalence of ADHD diagnosis and the prevalence of nonmedical prescription stimulant use among a sample of medical students.

Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia : the Toronto Addis Ababa Psychiatry Project (TAAPP)

Abstract: An important issue that underscores such a partnership is the risk of simply exporting Western, America-centric psychiatric training versus creating culturally appropriate models of education.

Clinician-educator tracks for residents: three pilot programs.

Abstract: Over the past 30 years, clinician-educators have become a prominent component of medical school faculties, yet few of these individuals received formal training for this role and their professional development lags behind other faculty. This article reviews three residency tracks designed to build skills in teaching, curriculum development and assessment, education research, and career development to meet this need. The residency clinician educator tracks at University of Michigan, Baylor College of Medicine, and University of California Davis are described in detail, with particular attention to their common elements, unique features, resource needs, and graduate outcomes. Common elements in the tracks are faculty mentorship, formal didactics, teaching opportunities, and an expectation of scholarly productivity. Essential resources include motivated faculty, departmental support, and a modest budget. Favorable outcomes include a high percentage of graduates in clinical faculty positions, teaching programs created by the residents, positive effects on recruitment, and enhancement of faculty identity as clinician educators. Clinician-educator tracks in residency present a viable means to address the training needs of clinical track faculty. The programs described in this article provide a model to assist other departments in developing similar programs.

Psychotherapy Training for Residents: Reconciling Requirements With Evidence-Based, Competency-Focused Practice

Abstract: Objective The Accreditation Council for Graduate Medical Education (ACGME) and the Royal College of Physicians and Surgeons of Canada (RCPSC) changed the training requirements in psychotherapy, moving toward evidence-based therapies and emphasizing competence and proficiency as outcomes of training. This article examines whether the therapies selected for training are evidence based and the authors review research concerning methods for training and assessment that effectively lead to competence in these psychotherapies.

Writing Multiple-Choice Questions

Abstract: Academic psychiatrists are often asked to write multiple-choice questions. Some will serve on questionwriting teams for standardized examinations, while others may be required to submit questions for course examinations or continuing medical education activities. Multiplechoice tests are popular because of their practicality in testing a wide body of knowledge and the ease of scoring responses, but criticisms are many. For example, they encourage guessing, require only recognition rather than recall of details, and evaluate only a fragmentary memorization of information rather than a deep understanding of applied knowledge. However, the well-written multiple choice question differentiates those who know the material from those who do not, and may emphasize analysis of information rather than direct recall. Psychiatrists writing for high-stakes examinations (e.g., the United States Medical Licensing Examinations or the American Board of Psychiatry and Neurology written examinations) undergo training in question construction. Many others have little training beyond their own experience in taking such examinations. Even experienced question writers may be unfamiliar with the literature in this area, because the bulk is found in nonmedical journals. As a result, questions written for medical education and evaluation are frequently flawed (1, 2). This article will summarize the literature on multiplechoice questions, recommend how to write proper questions, and examine the literature that informs these recommendations.

Points of Contact: Using First-Person Narratives to Help Foster Empathy in Psychiatric Residents

Abstract: Objectives The authors aimed to determine if writing narratives in psychiatric training can foster empathy for severely and persistently mentally ill patients.

The joker: a dark night for depictions of mental illness.

Abstract: The heart of the cultural system is what I call the great storytelling process. From childhood onward, stories make the invisible forces of life visible by creating images of people representing ideas and social types, assigning some fate to each. Fictional and dramatic stories show how things work; news and documentary stories provide selected glimpses of how things are supposed to be. (1, pp 19, 20)

Addressing patient sexual orientation in the undergraduate medical education curriculum.

Abstract: This study aims to estimate the number of hours dedicated to lesbian, gay, bisexual, and transgender content in one medical school’s undergraduate curriculum, compare it to the national average, and identify barriers to addressing this content. Course and clerkship directors were asked to estimate how many hours they spent on lesbian, gay, bisexual, and transgender content, how many hours would be ideal, and what barriers they perceived to teaching this content. Faculty members identified lack of instructional time, lack of relevance to their course content, and lack of professional development on this topic as major barriers. There was a significant negative correlation (rs=−0.47, p=0.047) between “number of hours dedicated” and “perceived barriers to teaching this content.” Course and clerkship directors who perceive more barriers to teaching lesbian, gay, bisexual, and transgender content report dedicating less time to its instruction, but the barriers they perceive can largely be mitigated through faculty development.

Sexual Health Curricula in U.S. Medical Schools: Current Educational Objectives

Abstract: The authors identify the explicit and implicit objectives that shape decisions about what medical schools teach regarding human sexuality. The authors reviewed relevant articles in journals, physician licensing examinations, and publications by professional organizations to identify learning objectives for human sexuality in undergraduate medical curricula. There is consensus about many of the attitudinal objectives and some of the skills medical students should acquire in sexual health. There is less consensus on the sexuality-related information student physicians need to master. The few common informational objectives focus narrowly on diagnosing sexual dysfunction and disease. The model sexual health curricula, licensing exams, and guidelines from professional organizations mainly focus on the pathological aspects of sexuality. Student physicians should master fundamental information on healthy sexual function and become familiar with the roles of practitioners in various therapeutic disciplines in addressing sexual concerns and enhancing patients’ sexual functioning and well-being. Instruction should also address ways to incorporate this important topic in time-limited interactions with patients.

Psychiatric Residents' Views of Quality of Psychotherapy Training and Psychotherapy Competencies: A Multisite Survey.

Abstract: Objective Few studies of residents’ attitudes toward psychotherapy training exist. The authors examined residents’ perceptions of the quality of their training, support for training, their own competence levels, and associations between self-perceived competence and perceptions of the training environment.

Selection factors among international medical graduates and psychiatric residency performance.

Abstract: The authors examine the association between the selection factors used in a psychiatric residency program and subsequent clinical and academic performance among international medical graduate (IMG) candidates. The authors completed a retrospective review of application files and residency evaluations of 50 IMG residents who completed the 4- year psychiatry training in a university- affiliated program from July 1994 through June 2004. United States Medical Licensing Examination (USMLE) Step 1 and personal interview appear associated with residents’ performance determined by the program director’s ranking. Standardized examinations before (USMLE Step 1 and 2) and during the residency (PRITE) were significantly correlated (USMLE 1, r = 0.37; USMLE 2, r=0.40, p<0.003). Personal interview scores and psychotherapy treatment session evaluations were also significantly associated (r=0.38, p<0.003). Further research is necessary to determine predictive factors related to psychiatric residents’ performance, especially among IMGs. Adjusting current selection criteria may result in better outcomes for training programs and future psychiatrists.

Don't leave teaching to chance: learning objectives for psychodynamic psychotherapy supervision.

Abstract: Objective The way in which the competencies for psychodynamic psychotherapy specified by the Psychiatry Residency Review Committee of the Accreditation Council for Graduate Medical Education translate into the day-to-day work of individual supervision remains unstudied and unspecified. The authors hypothesized that despite the existence of competencies in psychodynamic psychotherapy, residents did not know what they should be learning in psychodynamic psychotherapy supervision.

Survey of sexual education among residents from different specialties

Abstract: Objective This study aims to determine how residents are being educated regarding sexual health, and it assesses attitudes toward sexual education and barriers to evaluating patients’ sexuality.

Training in psychiatric genomics during residency: a new challenge.

Abstract: Objective The authors ascertained the amount of training in psychiatric genomics that is provided in North American psychiatric residency programs.

Trainees as teachers in team-based learning.

Abstract: Team-based learning is an active learning modality that is gaining popularity in medical education. The authors studied the effect of using trainees as facilitators of team-based learning sessions. Team-based learning modules were developed and implemented by faculty members and trainees for the third-year medical student clerkship in psychiatry in the 2007–2008 academic year. Evaluation forms were used to elicit student opinions about the team-based learning sessions. Scores for trainee and faculty facilitators were compared using Student’s t tests. Overall scores were positive, reflecting acceptability of this form of instruction. Eight of nine comparisons showed no difference in students’ ratings of faculty versus trainee facilitators. The other comparison showed a modest preference for faculty facilitators. Team-based learning modules can be led as effectively by trainees as by faculty members to teach medical students in the classroom setting.

Star Wars in Psychotherapy: Video Games in the Office

Abstract: Video games are used in medical practice during psycho-education in chronic disease management, physical therapy, rehabilitation following traumatic brain injury, and as an adjunct in pain management during medical procedures or cancer chemotherapy. In psychiatric practice, video games aid in social skills training of children with developmental delays and in cognitive behavioral therapy (CBT). This most popular children’s toy may prove a useful tool in dynamic psychotherapy of youth. The author provides a framework for using video games in psychotherapy by considering the characteristics of video games and describes the ways their use has facilitated various stages of therapeutic process. Just as other play techniques build a relationship and encourage sharing of emotional themes, sitting together in front of a console and screen facilitates a relationship and allows a safe path for the patient’s conflict to emerge. During video game play, the therapist may observe thought processes, impulsivity, temperament, decision-making, and sharing, among other aspects of a child’s clinical presentation. Several features inherent to video games require a thoughtful approach as resistance and transference in therapy may be elaborated differently in comparison to more traditional toys. Familiarity with the video game content and its dynamics benefits child mental health clinicians in their efforts to help children and their families.

Firearm Anticipatory Guidance Training in Psychiatric Residency Programs

Abstract: Objective Most suicides (60%) are committed with firearms, and most (80%) of individuals attempting suicide meet diagnostic criteria for mental illness. This study assessed the prevalence of firearm injury prevention training in psychiatric residency programs. Methods: A three-wave mail survey was sent to the directors of 179 psychiatric residency programs. Outcome measures were the portion of programs offering training in anticipatory guidance for firearms safety, the content of training if offered, and the perceived benefits and barriers to providing such training.

Using Media to Teach How Not to Do Psychotherapy

Abstract: Objective This article describes how using media depictions of psychotherapy may help in teaching psychiatric residents.

A multidisciplinary approach to sexual dysfunction in medical education.

Abstract: Objective Addressing sexual health concerns in medical practice has been an emerging concept for the past two decades. However, there have been very few educational opportunities in medical training that would prepare future physicians for such a responsibility. Since assessing and treating sexual problems requires knowledge that encompasses many disciplines and requires skills typically not within the purview of medical training, the authors propose a multidisciplinary model that includes collaboration with sex therapists.

The current state of genetics training in psychiatric residency: views of 235 U.S. educators and trainees.

Abstract: Objective As researchers make progress in understanding genetic aspects of mental illness and its treatment, psychiatrists will increasingly need to understand and interpret genetic information specific to psychiatric disorders. Little is known about the extent to which residency programs are preparing psychiatrists for this new role. This study was designed to explore the current state of genetics education in psychiatric residency.

Toolbox for Evaluating Residents as Teachers.

Abstract: The authors review existing assessment tools related to evaluating residents’ teaching skills and teaching effectiveness. PubMed and PsycInfo databases were searched using combinations of keywords including “residents,” “residents as teachers,” “teaching skills,” and “assessments” or “rating scales.” Eleven evaluation tools that utilized self-reports, learner evaluations, or observed structured teaching evaluations were found. These varied in length from one to 58 items, most of which were both valid and reliable. Additional evaluation tools were found that utilized direct audio- or videotaped recordings of teaching. This toolbox should facilitate program directors and others in assessing residents’ teaching skills and should promote rigorously conducted research on residents as teachers.

Sexual Education for Psychiatric Residents

Abstract: Objective The authors seek to promote sexuality curriculum development in departments of psychiatry.

Psychiatric residents' self-assessment of teaching knowledge and skills following a brief "psychiatric residents-as-teachers" course: a pilot study.

Abstract: Objectives Resident physicians have an important role in medical student teaching. There has been limited curriculum development in this area for general psychiatric residents. A 4-hour workshop for PGY-2 psychiatric residents was designed and implemented to improve residents’ self-assessment of their knowledge of the medical student curriculum and core teaching skills.

The role of personal therapy in psychiatric residency training: a survey of psychiatry training directors.

Abstract: Objective The authors examine the current place of personal therapy for residents in U.S. training programs.

Psychiatric residents as teachers: development and evaluation of a teaching manual.

Abstract: Objective Psychiatric residents spend much time as teachers and mentors to medical students. Recently, the Canadian Medical Education Directions for Specialists (CanMEDS) roles identified the importance of this role as a scholar. Residents are now expected to develop skills to fulfill this role, one of which involves the ability to teach. However, lack of tools to facilitate the development of resident teaching skills poses a significant problem.

The Psychiatry Institute for Medical Students: A Decade of Success

Abstract: Recruiting medical students into psychiatric residency programs has received much attention In the 1980s and 1990s, North American psychiatric residency programs experienced numerous barriers to recruiting highquality medical students (1–5) This remains a problem around the world The literature suggests that experiences during medical school, personalities of applicants, and beliefs about the practice of psychiatry are all strongly associated with the decision to enter a psychiatric residency Recruitment strategies have been widely recommended to bolster positive psychiatry-related experiences and to alter negative perceptions (6–9) In the mid-1990s, only about 4% of US and 6% of Canadian medical school graduates chose psychiatry (10, 11) More recent studies focused on perceptions and attitudes of medical students about psychiatry careers (12– 17) While initial interest is still the most influential factor, positive experiences during psychiatry clerkships and electives have been described as “modifiable programmatic factors that could enhance recruitment to psychiatry” (17) The Psychiatry Institute for Medical Students at the University of Toronto in Ontario was initiated in 1994 as a novel recruitment strategy (18) To our knowledge, similar programs have not been reported As an indication of how much the recruitment situation has changed in Toronto, the 2008 Canadian Resident Matching Service match was successful in filling all 28 postgraduate year 1 (PGY-1) psychiatric residency positions at the University of Toronto as well as two international medical graduate positions—a total of 30 spots, up from 24 spots 2 years ago (19) As of July 2007, the University of Toronto has 138 psychiatric residents from PGY-1 to PGY-5

Attitudes towards psychiatry: a survey of Romanian medical residents.

Abstract: Attitudes toward psychiatry affect personnel working in the field and treatment of mentally ill patients (1). Attitudes toward psychiatry as a vocation might primarily affect recruitment, whereas attitudes toward psychiatry patients may affect clinical practice; these issues have not been investigated (2). Doctors’ attitudes likely mirror those of the general population, although, unlike the general population, physicians come into contact with psychiatrists and psychiatry patients during their formal training or practice. Thus, a physician may develop a more objective perception of psychiatry than society as a whole. Physicians’ opinions are composed of several elements: impressions of psychiatrists themselves, psychiatry patients, and psychiatry as a discipline. Each of these is independent to a degree; one can have a low perception of psychiatry patients but high regard for psychiatrists (2). There is little research on residents’ or specialists’ perceptions of psychiatry (2–7). Within the medical community, there is controversy over the role and status of psychiatry, not only among other specialists, but among psychiatrists too (7). A number of published studies tried to assess medical students’ perceptions of psychiatry, aiming to counteract the decline of recruitment into psychiatry, although students’ preferences were found to be poor predictors of career choice (8). On one hand, some authors state that general opinions of psychiatry are considerably improving, together with its social image (9–13). On the other hand, according to some U.S., U.K., and Australian studies, the number of students choosing psychiatry as their future specialty has decreased considerably in the last four decades (3, 8, 9, 14–20). Among the possible explanations are psychiatry’s low status, low treatment efficacy, lack of scientific support, and frequent criticism by other physicians (9, 18, 21). While medical students’ attitudes toward psychiatry may influence recruitment, attitudes in trainees and physicians may also influence the ability of doctors to identify, treat, and refer patients with mental disorders. The aim of this study was to evaluate the attitudes of medical residents toward psychiatry and to compare the opinions of residents in psychiatry with those of residents in other specialties. We hypothesized that psychiatric residents would have more favorable attitudes toward their specialty than would residents in other specialties.

Teaching to Teach in Toronto

Abstract: Objective The training objectives for postgraduate education in the United States and Canada both state that teaching skills should be formally developed during training. This article reviews the development of the Teaching-to-Teach program at the University of Toronto Department of Psychiatry, the current curriculum, evaluation, and future directions of the program. The authors highlight some of the challenges encountered and discuss ideas for implementation of similar programs in diverse training settings.