Showing papers in "Academic Psychiatry in 2012"

Survey of the Prevalence of Burnout, Stress, Depression, and the Use of Supports by Medical Students at One School

Abstract: The authors determined the prevalence of stress, depression, and burnout in medical students and the resources used by students in one school to alleviate psychological distress. A survey was administered to 526 students in the first 3 years of medical school (336 responders; response rate: 70%) at one institution, using a modified Maslach Burnout Inventory Human Services Survey (MBI-HSS), the two-question PRIME-MD depression screening survey, the Perceived Medical School Stress Scale, along with questions on demographics and helpful programs to cope with stress. The percentage of respondents scoring in the High Burnout range was approximately 55% for all three subscales. Depressive symptoms were reported by 60% of respondents. The most helpful coping mechanisms reported were social support from peers and faculty, counseling services, and extracurricular activities. The prevalences of burnout, depression, and stress were higher in this sample of first-through third-year medical students when compared with other medical student groups previously studied. Important limitations of this research included the fact that it was cross-sectional in design and that the PRIME-MD tool is simply a screening tool and does not diagnose major depression. Medical educators, deans, and administrators should appreciate the possibility of higher levels of psychological distress among their own students than those previously reported.

Medical Student Attitudes About Mental Illness: Does Medical-School Education Reduce Stigma?

Abstract: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students’ attitudes toward patients with mental health problems deteriorate as they progress through medical school. Authors examined medical students’ attitudes to mental illness, as compared with attitudes toward other medical illness, and the influence of the number of years spent in medical school, as well as of several key socio-demographic, ethnic, and cultural variables. A group of 760 U.K. medical students completed a nationwide on-line survey examining their attitudes toward patients with five conditions (pneumonia, depression, psychotic symptoms, intravenous drug use, long-standing unexplained abdominal complaints), using the Medical Condition Regard Scale (MCRS). Students were also asked whether they had completed the psychiatry rotation or had personal experience of mental disorders themselves or among their friends or family members. They were also asked about their ethnic group (using U.K. national census categories), religious affiliation, and how important religion was in their lives. Independent-samples t-tests and one-way ANOVA were used to compare differences between groups on the MCRS. Students showed the highest regard for patients with pneumonia and lowest regard for patients with long-standing, unexplained abdominal complaints. Although attitudes toward pneumonia were more positive in fifth-year students than in first-year students, attitudes toward unexplained chronic abdominal pain were worse in fifth-year students than in first-year students. Personal experience of mental health treatment, or that among family and friends, were associated with less stigmatizing attitudes. Men showed more stigmatization than women for nearly all conditions; Chinese and South Asian students showed more stigmatizing attitudes toward delusions and hallucinations than their white British counterparts. Medical students in this survey showed the lowest regard for patients with unexplained abdominal pain, and these attitudes were worse in the most experienced medical students. Students’ gender, culture and direct or indirect experience of mental illness influenced stigmatizing attitudes.

Burnout in premedical undergraduate students.

Abstract: There has been growing recognition that medical students, interns, residents and practicing physicians across many specialties are prone to burnout, with recent studies linking high rates of burnout to adverse mental health issues. Little is known about the trajectory and origins of burnout or whether its roots may be traced to earlier in medical training, specifically, during undergraduate studies. Here, the authors surveyed undergraduates at UC San Diego (UCSD) to assess the relationship of burnout to premedical status while controlling for depression severity. Undergraduate students at UCSD were invited to participate in a web-based survey, consisting of demographic questions; the Maslach Burnout Inventory Student Survey (MBI-SS), which gauged the three dimensions of burnout; and the nine-item Patient Health Questionnaire (PHQ-9), to assess depression severity. A total of 618 premedical students and 1,441 non-premedical students completed the questionnaire. Premedical students had greater depression severity and emotional exhaustion than non-premedical students, but they also exhibited a greater sense of personal efficacy. The burnout differences were persistent even after adjusting for depression. Also, premedical women and Hispanic students had especially high levels of burnout, although differences between groups became nonsignificant after accounting for depression. Despite the limitations of using a burnout questionnaire not specifically normed for undergraduates, the unique ethnic characteristics of the sample, and the uncertain response rate, the findings highlight the importance of recognizing the unique strains and mental health disturbances that may be more common among premedical students than non-premedical students. Results also underscore the close relationship between depression and burnout, and point the way for subsequent longitudinal, multi-institutional studies that could help identify opportunities for prevention and intervention.

Trends in psychotherapy training: a national survey of psychiatry residency training.

Abstract: Objective The authors sought to determine current trends inresidency training of psychiatrists.

Exploring Benefits of Audience-Response Systems on Learning: A Review of the Literature

Abstract: Electronic-response systems (ERS) or audience-response systems (ARS) can be powerful instructional tools. Since the earliest adoption of ARS in the mid-1960s, the technology has changed significantly, especially in recent years, with advances in wireless communications. Over the years, ARS has become more sophisticated, more userfriendly, and cheaper. Typical ARS technology now allows instructors to present questions to the audience, and individual audience members respond with a keypad; responses are then automatically tabulated and displayed in a variety of graphic formats on-screen for feedback to the group. The tool is similar to that of the TV show “Who Wants to Be a Millionaire?” where every member of the audience transmits his or her response, and the distribution of responses is displayed on-screen. According to a recent study, the diffusion of this instructional technology is so widespread now that almost all universities in the United States and over 3,000 schools at the primary and secondary levels are currently using ARS (1). To increase learner-engagement, medical education and health-profession education, in general, including many continuing medical education programs are increasingly turning to ARS as a tool to promote learner participation and create an interactive learning environment (2, 3). ARS claims to promote student participation and engagement through elicitation of content-understanding and creating a safer, anonymous environment for learners to participate freely without fear of embarrassment or being singled out. Also, the public display of the distribution of responses either reaffirms their understanding or can be used to help gauge the learner’s own responses against the group norm. The recent reviews of the literature have reported several benefits of using ARS (4–6). Although these reviews provided a comprehensive list of benefits and potential barriers for successful implementation of the technology in the classrooms, they lacked a theoretical framework to help synthesize the reported outcomes of using ARS. The purpose of this review is to provide a theoretical framework for understanding the context for the intended and unintended consequences of using ARS. Given that only a handful of studies was conducted using a randomized, controlled design with validated measures, this review focused on the themes emerging from the literature, rather than performing a systematic review for comparison of studies or summarize the findings with metaanalysis. The focus of the review is on types of outcomes reported and context for implementation of ARS, rather than a comparison of the magnitude and statistical significance of the findings. This thematic review presents the findings from the literature in the context of existing learning theories and assessment models to help build upon the previous literature reviews. Although use of ARS has grown rapidly over the last decade, reports on efficacy of the technology have mostly focused on perceived benefits to learners, with the exception of a small number of studies on knowledge-retention, which showed inconsistent results (6). Recent studies from both health-profession education and higher-education settings have reported significant improvement in learning and knowledge-retention (7, 8). However, a recent randomized, controlled study in the continuingmedical education (CME) setting failed to show improved knowledge-gain from ARS versus the traditional didactic lecture environment (9). Despite widespread adoption in certain fields (5, 10), there is limited systematic review of the impact of ARS on instruction and learning outcomes. The purpose of this paper is to provide a review of the literature to 1) evaluate the benefits and consequences of using ARS; 2) present existing theories and models that help provide context for the reported outcomes; and 3) offer recommendations for optimal utilization of this technology for instruction and learning.

Professionalism and the internet in psychiatry: What to teach and how to teach it

Abstract: The digital revolution has had a profound impact on medicine and patient care. Patients have a growing expectation that they can find medical information on the web and discuss it with their physician by e-mail (1). Physicians, including psychiatrists, are increasingly using blogs and Twitter to promote their practices (2, 3). The internet itself is used as a vehicle for therapeutic modalities, even psychotherapy (4). Social networking among patients, physicians, and other “friends” are blurring boundaries as never before (5, 6). The potential clinical, legal, ethical, and professionalism issues in using the internet and digital media in psychiatry have been outlined elsewhere, including explicit recommendations for resident education in this area (7). This article focuses on how to teach residents about appropriate use of the internet. The evidence of unprofessional online behavior among physicians and the complexity of the potential issues raised with internet use in psychiatry suggest that psychiatric residents, educators, and administrators need explicit teaching about potential clinical, ethical, and legal pitfalls of internet use. In 2010, the President of the American Association of Directors of Psychiatric Residency Training (AADPRT) established a Taskforce on Professionalism and the Internet, charged with reviewing the literature and creating a curriculum to teach psychiatric trainees about online professionalism. Participants in a Taskforce-run workshop on this subject were asked for examples from their own experience of online professionalism concerns (8), and an outpouring of vignettes ensued. TheTaskforce undertook to create a curriculum based on vignettes designed to promote similar discussion. The principles elicited in these vignettes might be seen as extensions of well-established principles of professionalism (9, 10). Trainees accustomed to continual use of interactive technologies, however, may overlook boundary and other professionalism issues if they are not made explicit in training. The curriculum strives to address principles, rather than specific technologies, since the latter are expected to continue to evolve rapidly. The vignettes in this curriculum (available online at aadprt.org (11)) are designed for either group discussion or individual study; they are accompanied by relevant references and a teacher’s guide. The vignettes are organized around nine issues that may be relevant to various teaching venues: liability, confidentiality, and privacy; psychotherapy and boundaries; safety issues; mandated reporting; libel; conflicts of interest; academic honesty; “netiquette;” and professionalism remediation. We discuss the first eight of these topics, using vignettes from the curriculum for illustration. Where vignettes are based on actual cases, all identifying details are disguised.

A Method for Evaluating Competency in Assessment and Management of Suicide Risk

Abstract: Objective Although health professionals increasingly are expected to be able to assess and manage patients’ risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI—S), and evaluates its use in an objective structured clinical examination (OSCE).

Interactive virtual-patient scenarios: an evolving tool in psychiatric education.

Abstract: Standardized patients (SPs) are routinely used to teach medical students communication and physical diagnosis skills (1–5). Standardization and decreased risk of possible harm being committed by training students (6) are only a few of the advantages provided by SPs. SPs can provide a detailed history, can answer directly to the students, and give feedback for improvement (1, 6, 7). However, SP interactions are limited by the availability of the actors, time constraints, and costs (8). An alternative to SPs is use of computer simulation. Virtual-patient (VP) systems are computer programs that simulate real-life clinical scenarios in which the learner can complete a patient interview and physical exam, while making diagnostic and therapeutic decisions (9). VP systems allow standardized instruction, immediate and objective performance feedback, and unlimited opportunity for repetitive practice (10). VPs and computer simulations are already used in various branches of medicine to teach communication, counseling, crisis management, procedures, leadership, teamwork, and medical decision-making skills (11). Virtual reality is already used as exposure therapy to treat panic disorders, posttraumatic stress disorder, (12) social phobias, and specific phobias (13, 14). In 1966, ELIZA (15) became the first virtual psychiatric tool by engaging the user in a text-based psychotherapy session. It was never used as an actual treatment protocol, but it did set the stage for using computer simulation as a tool in diagnosing and treating mental illnesses (13). However, even with the foundation laid, there are only a few published applications of a psychiatric VP scenario used as a training modality in medical student education (8, 16). We present the preliminary evaluation of a web-based VP scenario that assesses students’ ability to elicit symptoms of major depression. The study was performed using the online application called Virtual People Factory (VPF; http://www. virtualpeoplefactory.com), (17) developed by the University of Florida’s Virtual Experiences Research Group. Currently, many VP systems entail the learners’ going through an evolving scenario where they sequentially answer multiple-choice questions about history, diagnosis, and management of patients. VPF is a web-based, instantmessaging application that elicits a VP’s medical history, based on the questions a user asks, therefore allowing students to make their own assessments of the most appropriate next step in the interview, rather than passively choosing from a list of possible answers. The process of creating a VPF interaction entails the following steps: Initially, an editor creates a script of the medical scenario, including what can be potentially said to the VP (questions/statements) and what the VP will respond back (speeches). Next, the scenario is sent out to users. Users log in to the system, are presented with a brief introduction of the patient similar to the introduction given to students before they enter the room to interview an SP, and then ushered into the chat interface. Once inside the interface, the user can engage the patient in conversation to obtain a full medical history. Every user’s input will yield a speech response. If there is not a speech response affiliated with a question or if the speech response is incorrect for a given question, the event is logged for the editor, to either create a new speech response or connect it correctly with the right question. Numerous user interactions will therefore allow for a robust database of the various questions and speech responses to be built for any medical scenario. Received June 17, 2010; revised November 22, 2010; accepted January 29, 2011. From Georgia Health Sciences University (HS, DL, SDL, AF), University of Florida (BR, BL), and Drexel University College of Medicine (SDL). Send correspondence to Dr. Foster; afoster@ georgiahealth.edu (e-mail). Copyright © 2012 Academic Psychiatry

An Approach to Integrating Interprofessional Education in Collaborative Mental Health Care

Abstract: Objective This article describes an evaluation of a curriculum approach to integrating interprofessional education (IPE) in collaborative mental health practice across the pre- to post-licensure continuum of medical education.

Coping with a patient's suicide: a curriculum for psychiatry residency training programs.

Abstract: Objective The suicide of a patient is often experienced as a traumatic event by the clinician involved. Many articles have identified the need for education to guide clinicians through the aftermath of patient suicide; however, little has been published on development of such a curriculum, particularly for residents. This article describes one residency training program’s development of an organized curriculum on coping with patient suicide and evaluates the impact of a core aspect of the training on clinicians’ knowledge about and confidence with coping with patient suicide.

Cinemeducation in Psychiatry: A Seminar in Undergraduate Medical Education Combining a Movie, Lecture, and Patient Interview.

Abstract: Psychiatric educators are often faced with students’ negative attitudes toward psychiatry. A new type of seminar has been established in order to enable students to gain a deeper understanding of psychiatric illness. A “cinemeducation seminar,” combining a movie, a lecture, and a patient interview, has been established as part of the undergraduate curriculum at Hamburg Medical School, where 1,032 students attended 39 cinemeducation seminars between 2005 and 2008. A student evaluation covering different aspects of education took place after each seminar. The students valued the combination of a movie and a seminar and found the movie and the additional patient interview useful for accessing the subject of Psychiatry and understanding the underlying psychiatric illnesses shown in the movies. From the students’ perspective, this type of seminar seems to be helpful for providing an impression of psychiatric illnesses and enabling students to put themselves in the position of a person suffering from these illnesses. Therefore, we judged the cinemeducation seminar to be an appropriate teaching format in undergraduate medical education.

Survey of Threats and Assaults by Patients on Psychiatry Residents.

Abstract: Objectives The authors sought to determine the prevalence of threats and assaults by patients on psychiatry residents, their consequences, and the perceived adequacy of supports and institutional responses.

Identifying and addressing stresses in international medical graduates.

Abstract: International medical graduates (IMGs), by definition, move from the country in which they received their training to another country in which to train and/or settle down. This process of migration and subsequent adjustment can lead to a number of issues that affect personal functioning and response to the new country. The authors carried out a literature review to ascertain which factors may cause stress and which factors may contribute to successful adjustment by the IMGs. The reasons for migration by IMGs can be political, educational, or economic. Each reason brings with it a series of difficulties, both for the individual and the society to which they move, as well as the society they leave behind. It is inevitable that acculturation and settling down will raise specific issues in the functioning of the IMGs. In this article, the authors highlight some of the factors related to migration by IMGs and make suggestions on how to support them and help reduce their stress.

Recruiting Researchers in Psychiatry: The Influence of Residency vs. Early Motivation

Abstract: The declining numbers of clinician-researchers in psychiatry and other medical specialties has been a subject of growing concern. Residency training has been cited as an important factor in recruiting new researchers, but there are essentially no data to support this assertion. This study aimed to explore which factors have influenced motivation to conduct research among senior psychiatry residents. The authors surveyed senior residents, inquiring about their level of interest in research, demographics, background, research experiences, and factors influencing motivation for research. The authors had confirmed participation from 16 of 33 residency programs with a class size of 10 or more. They received 127 responses, a 67% response rate, from participating programs. Residents with high stated interest in research differed from those with low and moderate interest in their research-intense post-residency plans. They were more likely to have graduate degrees. Those planning research careers had a consistent pattern of interest and involvement in research, starting well before residency. The majority of residents had had research exposure in college, but research involvement of those with very high versus lower interest diverged sharply thereafter. Those with high research interest were overwhelmingly male and tended to have lower debt than those with less interest. The great majority of residents appear to have decided whether or not to pursue a research career by the time they reached residency, and few of those with less than the highest research interest were enrolled in research tracks. Efforts to increase recruitment into research should center on identifying early developmental influences, eliminating barriers specific to women, and ensuring adequate funding to provide secure careers for talented potential researchers.

Addressing Stigma to Strengthen Psychiatric Education

Abstract: Neuropsychiatric disorders are recognized by the World Health Organization as the most important cause of disability, accounting for approximately one-third of years lost due to disability (YLD) among individuals age 15-andover, across gender and income, around the world (1). Unipolar depressive disorders alone are the third-largest contributor to global burden of disease, and the first in middleand high-income countries, ranking above ischemic heart disease, HIV/AIDS, and cerebrovascular disease. In the United States, it is estimated that 25% of adults have a mental illness, and nearly half will develop at least one mental illness during their lifetime (2–4). However, in 2005, of the approximately 11% of the population that met criteria for a high probability of serious mental illness, fewer than one-half (45%) reported receiving any mental health treatment in the previous year (5). The number of American mental health professionals available is already inadequate to provide for this need: there are only 13.7 psychiatrists per 100,000 population (6)—whereas the burden of psychiatric disease is projected to continue to grow (1). In the context of these findings, it is incumbent upon the medical field to effectively prepare its next generation to address psychiatric disorders. This effort to prepare the future physician workforce includes training specialists to treat mental illness, as well as educating providers in other medical specialties to be versed in general psychiatric issues, since most physicians, regardless of discipline, will treat many patients with coexisting mental illness. The field of psychiatric education is inexorably influenced, however, by the shadow of societal stigma inwhich it stands. Many studies have documented the negative stereotypes and prejudicial beliefs that the general public holds toward individuals with mental illness, toward psychiatry and psychiatric treatments, and toward psychiatrists and other mental health professionals (7, 8). Although holding a neurobiological conception of psychiatric disorders has been correlated with an increased likelihood of support for psychiatric treatment, it has not been consistently shown to decrease stigma or community rejection (9). Indeed, stigma surrounding psychiatry spills over into the medical school, as well. Medical students have been found to share many of the negative stereotypes about mentally ill people that are present in the general population (10). Psychiatry as a discipline, as compared with other specialties, tends to be viewed very negatively by entering medical students, in a manner suggesting that, to many, the field is not considered part of mainstream medical practice (11). Harsh attributions toward trainees in or approaching psychiatry have been observed both in the United States and internationally. Clerkship students note that psychiatry has low prestige among the general public and also does not have high status within medicine (12–15). These clerks describe hearing disparaging comments made about psychiatry by physicians in other fields, including residents and faculty with whom they work (16). A significant number report that family and friends discourage them from considering psychiatry as a career and that students who express interest in psychiatry risk being viewed as “odd, peculiar, or neurotic.” In some countries, psychiatric trainees are also seen as weak academically, with a large number of medicalstudent respondents indicating that “many people who could not obtain a residency position in other specialties eventually enter psychiatry” (12–15). Perhaps most tragic is the observation that medical students and residents in Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA. Send correspondence to Belinda ShenYu Bandstra, M.D., M.A., Dept. of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA; e-mail: bandstra@stanford.edu Copyright © 2012 Academic Psychiatry

Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes Toward Homeless Persons

Abstract: Objective The purpose of the study was to explore changes in medical students ’ attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the “hidden curriculum” in medical education, in which values are communicated from teacher to student outside of the formal instruction.

The student-run clinic: a new opportunity for psychiatric education.

Abstract: Objective Student-run clinics are increasingly common in medical schools across the United States and may provide new opportunities for psychiatric education. This study investigates the educational impact of a novel behavioral health program focused on depressive disorders at a student-run clinic.

Reducing Medical Students’ Stigmatization of People With Chronic Mental Illness: A Field Intervention at the “Living Museum” State Hospital Art Studio

Abstract: The authors designed an intervention to reduce beginning medical students’ stigmatization of people with chronic mental illness (CMI). Pre-clinical medical students visited a state psychiatric facility’s “Living Museum,” a combination patient art studio/display space, as the intervention. During the visit, students interacted with artist-guides who showed their work and discussed their experiences creating art. Students completed a self-assessment survey developed to measure attitudes and feelings toward people with CMI after half of the class visited the Living Museum, constituting a Visit/No-Visit cross-sectional comparison. Students who visited the Living Museum (N=64), as compared with those who did not visit (N=110), endorsed more positive attitudes toward people with CMI. Among the students who visited, however, those who reported having spoken individually with a patient-artist (N=44), paradoxically, indicated less-positive feelings toward people with CMI. An intervention in which pre-clinical medical students visited patient-artist guides in an art-studio setting generally improved students’ attitudes toward people with CMI. Thus, nontraditional psychiatric settings offer a valuable adjunct to more traditional clinical settings to reduce stigma when introducing medical students to the field of psychiatry.

Preparing International Medical Graduates for Psychiatry Residency: A Multi-Site Needs Assessment

Abstract: Objective Despite the growing number of international medical graduates (IMGs) training in medicine in Canada and the United States, IMG-specific challenges early in psychiatry residency have not been fully explored. Therefore, the authors conducted a needs-assessment survey to determine the needs of IMGs transitioning into psychiatry residency.

Patient suicides in psychiatric residencies and post-vention responses: a national survey of psychiatry chief residents and program directors.

Abstract: Objectives This report focuses on post-vention measures taken by U.S. psychiatry residencies when a resident-in-training experiences a patient suicide.

Improving Student Comfort with Death and Dying Discussions through Facilitated Family Encounters.

Abstract: Objective The purpose of this study was to explore the educational potential for a collaboration between palliative medicine and psychiatry designed to improve first-year medical students’ knowledge and comfort with end-of-life issues through a facilitated small-group discussion with family members of recently-deceased loved ones.

The State of Medical Student Wellness: A Call for Culture Change

Abstract: In recent years, multiple studies exploring medical student mental health highlight the increased frequency and severity of emotional problems during physicians’ formative years. Although these studies demonstrate a clear burden on medical students, we have not achieved a broader understanding of malleable factors in student wellness, and, thus, effective interventions to promote wellness are lagging behind. The development of evidence-based preventive and clinical programs in academic centers requires an appropriate focus on overall medical student wellness, encompassing academic and institutional elements. Successful models of student wellness programs exist (1); however, best-practices in this area have not yet been developed. A systematic review of studies among U.S. and Canadian medical students showed a higher prevalence of anxiety and depression among these students than in their age-matched peers (2). Even more worrisome, 11% of students in a longitudinal cohort from seven medical schools admitted to having had suicidal thoughts in the previous year (3). Over time, medical student health centers have seen an increased utilization of services (4, 5). It is unclear whether this is due to a higher prevalence and/or severity of mental disorders, increased identification of disorders, improved availability of services, reduced stigma, or a combination of these factors. This commentary will review factors that may contribute to student distress and discuss suggestions for effective interventions to address these. Our purpose is to provoke thought and debate about student wellness and to inspire action through the development of evidence-based interventions to improve wellness at medical schools across the country. Contributing Factors and Strategies for Culture Change Factors contributing to students’ mental health difficulties during medical school may be individual (intrapersonal and interpersonal) and/or environmental (institutional; see Table 1). These may include preexisting or de novo medical and/or mental illness; academic difficulties; emotional intelligence (EI) deficits (being unaware of one’s own or others’ emotions and having limited ability to effectively communicate and work with others); intolerable stress due to high workload, with high performance expectations and exposure to human suffering; confronting the hierarchical culture of medicine, including intergenerational clashes; neglect of social support networks, leading to isolation; and interpersonal stressors (e.g., a family member’s illness, divorce, separation, long-distance relationships, and financial pressures) (6, 7). The following sections outline factors contributing to student distress, paired with potential strategies for addressing them. In some cases, solutions have been described in the literature. Additional suggestions are presented, based on our institutions’ experiences.

Virtual patients as novel teaching tools in psychiatry.

Abstract: Effective interviewing skills are an essential core competency of psychiatric training, especially when eliciting sensitive clinical information from child and adolescent psychiatric patients. Since it is not always possible to interview patients with the full range of psychiatric disorders during training, simulations such as “standardized patients” (SPs), that is, actors hired to portray patients, are nearly universal in current medical education (1, 2), and have been used to evaluate trainees’ skills with objective structured clinical examinations (OSCE) (3). Use of computer-generated “virtual human patients” (VPs) is increasingly appealing as technology produces VPs that are consistent and realistic (4–7). A recent randomized trial found that both VPs and SPs produced equivalent improvements in diagnostic ability among nurses, physicians, psychologists, and public health workers (8), and the versatility of VPs makes them well suited to teach clinical reasoning skills (9). VPs can be programmed to reflect a wide variety of clinical symptoms and behaviors useful in teaching trainees critical thinking and diagnostic acuity (9). VPs can also be utilized to evaluate psychiatric residents’ and medical students’ clinicalmanagement strategies. Both SPs and VPs offer a supervised practice for trainees before they encounter a challenging, live patient (e.g., patients with trauma exposure, sexual assault/rape, physical attacks, and physical/sexual abuse); however, VPs, unlike SPs, are not limited by potential financial constraints to train actors (2). At present, there is little published data to guide the design and integration of VPs into psychiatric education; thus, research is needed (9). The potential benefits of VPs in medical education are the unlimited realistic simulations of patients of all ages and diverse ethnic and cultural characteristics to students, in a safe and reproducible manner (10). The objective of this pilot studywas to investigate the feasibility of interviewing a virtual adolescent patient (VP) with posttraumatic stress disorder (PTSD) and to increase trainees’ and educators’ awareness of this technology (5–7).

Shorter Psychiatry Clerkship Length Is Associated With Lower NBME Psychiatry Shelf Exam Performance

Abstract: Objective The goal of this study was to evaluate a recent medical school curriculum change at our institution 3 years ago; specifically: shortening the Psychiatry core clerkship from 4 to 3 weeks and adding an optional 6-week core/elective combination rotation in lieu of the 3-week core. The authors aimed to determine whether clerkship length was associated with lower scores on the NBME Psychiatry shelf exam (PSE), a requirement of all third-year medical students at our institution.

Helping International Medical Graduates Engage in Effective Feedback

Abstract: Objective Timely, specific, behaviorally-based feedback is a cornerstone of medical education. The authors review basic tenets of effective feedback delivery in the context of potential challenges faced by (non-United States) international medical graduates (IMGs).

Sexting: the impact of a cultural phenomenon on psychiatric practice.

Abstract: Sexting is a cultural phenomenon that has garnered significant public attention within the last few years. The topic has received media attention from a variety of sources—talk shows, evening news segments, and even situation comedies (sitcoms) (1–4). The Macmillan Dictionary (5) defines sexting as the practice of sending sexual images or messages to a person’s cell phone. A more narrow definition is provided by the Pew Research Foundation in their report on teen sexting. They define sexting as “the creating, sharing, and forwarding of sexually suggestive, nude or nearly-nude images by minor teens” (6). Sexting is a relatively recent phenomenon that has only come to public awareness within the past few years, but which has triggered concern among parents, educators, and law enforcement officials. One major factor in the recent development of the phenomenon is the dramatic increase in cell phone use and ownership by teenagers over the past few years. According to the Pew Internet 2004 survey (7) of 1,102 teens age 12–17, 18% of 12-year-olds and 64% of 18-year-olds owned cell phones. By 2009, these numbers had risen to 58% of 12-year-olds and 83% of 17-year-olds owning cell phones. Among teens, age is the most important variable in cell phone ownership, and older teens are much more likely to own phones than younger teens. The largest increase occurs at age 14, the point when most teens enter high school. In their January 2010 report on teen consumption of media, the Kaiser Family foundation (8) reported that the 8to 18-year-olds surveyed spent an average of 7 hours and 38 minutes daily using media. The subjects used their cell phones for a variety of media purposes, not just for chatting with or texting peers. On a typical day, 8to 18-year-olds reported spending an average of 49 minutes listening to music, playing games, or watching TV on their cell phones. Also, on a typical day, 46% of 8to 18-yearolds reported sending text messages on a cell phone, and it is estimated that those who text send an average of 118 messages a day. On average, 7th-to-12th graders reported spending about 11⁄2 hours per day engaged in sending and receiving texts. Thus, we see that over the past few years, there has been an explosion in the ownership and use of cell phones by children and teens, and, that, in a given day, teens are using their phones for a variety of purposes, not the least of which is to text peers. Adolescence marks a key period of development in the human life-cycle. Erikson (9) characterized this life-stage as the time of “identity formation”—a stage when children make the transition from childhood to adulthood and learn to establish their sense of values, self, and relationship to the outside world. This period is marked by an increased interest in the individual’s own emerging sexuality and an increased importance of peer relationships. Also, adolescence is a time of impulsivity, grandiosity, and risk-taking. These developmental norms, coupled with the ubiquity of technology, provide a potentially dangerous combination. Teenagers’ tendency toward exhibitionism and narcissism, their desire for intimacy in relationships, their desire and preoccupation with sexual exploration, and the hope of creating their identities as individuals who are attractive and desired may make them more vulnerable to the allure of sexting. Thus, a setting is created in adolescence in which sexting is more likely to occur. In response to the phenomenon, the American Academy of Pediatrics (10) issued a parent bulletin in August 2009, titled “Help Kids With Cell Phones Get the Message: ‘Say No to Sexting.’” The bulletin educates parents on the phenomenon and advises them to have discussions with their children about the legal, social, and emotional risks involved with sexting. Received October 12, 2010; revised February 5, 2011; accepted February 9, 2011. From the Dept. of Psychiatry, Mass. General Hospital, Boston, MA. Correspondence: JSADHU@PARTNERS.ORG. Copyright © 2012 Academic Psychiatry

The Role of International Medical Graduate Psychiatrists in the United States Healthcare System

Abstract: International medical graduates (IMGs) make up a substantial proportion of the United States physician workforce, including psychiatrists in practice. The purpose of this study was to describe, based on current data, the characteristics and qualities of IMG psychiatrists who provide patient care in the US. Physician data from the Educational Commission for Foreign Medical Graduates, American Medical Association, and American Board of Medical Specialties were combined. Descriptive statistics provided an overview of the characteristics and qualities of IMG psychiatrists. The authors contrasted demographic and practice profiles of IMG and U.S. medical graduate (USMG) psychiatrists. International medical graduates make up almost one-third of the practicing psychiatrist workforce. Nearly one-quarter of these individuals attended medical school in India. Compared with USMG psychiatrists, IMG psychiatrists were more likely to be employed in a hospital and less likely to be Board-certified by the American Board of Psychiatry and Neurology. International medical graduate psychiatrists play an important role in the U.S. healthcare system. Given their numbers and their propensity to practice in settings and areas where USMGs do not, efforts to monitor their practice patterns and qualities, both cross-sectionally and longitudinally, are warranted.