Showing papers in "Academic Psychiatry in 2016"

Reformulating Suicide Risk Formulation: From Prediction to Prevention

Abstract: Psychiatrists-in-training typically learn that assessments of suicide risk should culminate in a probability judgment expressed as “low,” “moderate,” or “high.” This way of formulating risk has predominated in psychiatric education and practice, despite little evidence for its validity, reliability, or utility. We present a model for teaching and communicating suicide risk assessments without categorical predictions. Instead, we propose risk formulations which synthesize data into four distinct judgments to directly inform intervention plans: (1) risk status (the patient’s risk relative to a specified subpopulation), (2) risk state (the patient’s risk compared to baseline or other specified time points), (3) available resources from which the patient can draw in crisis, and (4) foreseeable changes that may exacerbate risk. An example case illustrates the conceptual shift from a predictive to a preventive formulation, and we outline steps taken to implement the model in an academic psychiatry setting. Our goal is to inform educational leaders, as well as individual educators, who can together cast a prevention-oriented vision in their academic programs.

Experiences of Psychological Distress and Sources of Stress and Support During Medical Training: a Survey of Medical Students

Abstract: Objective The authors examine the prevalence of psychological distress, the stressors experienced, and the supports used by medical students and residents during their medical training at a Canadian university.

A Pathway to Freedom: An Evaluation of Screening Tools for the Identification of Trafficking Victims

Abstract: Objectives Because training residents and faculty to identify human trafficking victims is a major public health priority, the authors review existing assessment tools. Methods PubMed and Google were searched using combinations of search terms including human, trafficking, sex, labor, screening, identification, and tool. Results Nine screening tools that met the inclusion criteria were found. They varied greatly in length, format, target demographic, supporting resources, and other parameters. Only two tools were designed specifically for healthcare providers. Only one tool was formally assessed to be valid and reliable in a pilot project in trafficking victim service organizations, although it has not been validated in the healthcare setting. Conclusions This toolbox should facilitate the education of resident physicians and faculty in screening for trafficking victims, assist educators in assessing screening skills, and promote future research on the identification of trafficking victims.

Medical Student Stress, Burnout and Depression in Trinidad and Tobago.

Abstract: Health-care workers in developed nations are well known to experience high levels of burnout and psychiatric morbidity, but little information is available from the Caribbean and other less well-developed regions. This study sought to explore the prevalence of stress, burnout, and depressive symptoms and associated risk factors among medical students in Trinidad and Tobago, the southernmost Caribbean island. A cross-sectional survey design was used to sample students. Data was collected utilizing standardized questionnaires that assess stress, burnout, and depressive symptoms. Demographic data and information pertaining to potential risk factors was also gathered. Overall, 450 questionnaires were distributed and analysis was performed upon 381 completed surveys (response rate 85 %). Students demonstrated high levels of stress and a significant prevalence of burnout (52 %) and depressive symptoms (40 %). Final year students demonstrated higher levels of burnout and depressive symptoms. Students who (i) felt they lacked emotional support, (ii) had little opportunity for relaxation and exercise, and (iii) did not feel they had control of their daily schedule all demonstrated higher levels of burnout and depressive symptoms. However, students who practiced from a faith base and considered their religion important demonstrated lower levels of both. Medical students in Trinidad and Tobago are experiencing high levels of stress with a large proportion suffering from burnout and depressive symptoms. These data suggest that immediate interventions are necessary to help students cope with the challenges faced during medical school. Additionally, more research is needed to explore the potential causal links between burnout and depression during medical school and the effectiveness of tailored interventions especially within the context of developing nations.

The Impact of Medical School on Student Mental Health.

Abstract: The pace of medical school is extremely rigorous. Students commonly report high stress due to feelings of lack of control, problems without solutions, and exposure to death and dying for the first time. Medical student’s tendency to be a perfectionist and their struggle to re-identify as patients only add to this stress. Stress has negative physiological and psychological effects on individuals which could result in poor mental health, substance use, and the need to develop healthy coping strategies. Poor mental health can also lead to other negative outcomes including medical school dropout [1] and suicidal ideation and burnout [2]. Previous studies show that students begin medical school with similar rates of depression as their non-medical peers [3, 4]. However, various studies suggest that the mental health of students worsens throughout medical school [3, 5]. Other studies have reflected on factors which impact student success, such as the use of alcohol and illicit substances [6]. A study fromWebb et al. revealed that university students experiment with illicit drugs and that medical students do not differ markedly from other student groups despite their knowledge of the potential hazards of illicit drugs [7]. Additionally, the culture of medicine has created expectations of physicians to always put patients first and ignore their own needs. As a result, it may be difficult for physicians to accept help. The impact of depression and anxiety, as well as marijuana and cocaine use, needs to be understood so students, who experience difficulty, seek help. Additionally, this could assist in the integration of preventive health programs to help medical students remain mentally healthy and prevent the long-term consequences of mental illness and substance use. The purpose of this study is to understand the current rates of depression, anxiety, use of marijuana and cocaine, and help-seeking behavior in medical students.

The Medical Education of Generation Y.

Abstract: Medical schools face challenges preparing students to meet evolving health-care needs in society. However, little has changed in the way that education is delivered to aspiring health professionals [1]. The in-class lectures continuing in the majority of classrooms across the country do not acknowledge the unique proclivities of the current crop of medical students. An explanation of this observation is gleaned by understanding the fundamental attributes of the current generation of medical trainees. Educational research in schools outside of medicine demonstrates that students with different learner characteristics will value instructional measures in relation to the way they suit their own habits, ideas, and preferences of learning well [2]. To be effective, teaching styles have to take into account learning styles [3]. Therefore, instructional measures should address learner beliefs to improve the quality of student learning [2]. Our paper responds to the need to examine the impact of social and motivational variables in learning. Specially, we sought to understand the implications of generational differences in medical education, and how medical education can consciously evolve to accommodate the learning styles of current trainees.

Correlates of Depression and Burnout Among Residents in a Lebanese Academic Medical Center: a Cross-Sectional Study

Abstract: This study aims to assess the prevalence of depressive symptoms, severity of burnout, and suicidal ideation among residents in a range of specialties and to identify factors that are associated with these symptoms. A cross-sectional study was carried out at the American University of Beirut Medical Center between August and October 2013. In total, 118 out of 311 eligible residents responded. The survey included general sociodemographic questions and standardized validated tools to measure depressive symptomatology (PHQ-9), burnout (burnout measure), anxiety (GAD-7), alcohol use (AUDIT), and drug abuse (DAST-10). Overall, 22 % of the residents qualified for major depressive symptomatology. Stressful personal life events and burnout were significantly associated with depression. Drug abuse, but neither alcohol abuse nor anxiety, was associated with depression. Twenty-seven percent of the residents met criteria for burnout. Additionally, 13 % of residents had suicidal ideation, which was significantly associated with the severity of depression and not using mental health services. These findings increase awareness regarding the vulnerability of residents internationally. Addressing the mental health of residents is a pressing issue, and training programs need to actively address the psychological well-being of residents.

The Time is Now: Improving Substance Abuse Training in Medical Schools

Abstract: This commentary highlights the growing demand for substance abuse prevention and treatment, summarizes the literature regarding the current insufficiencies in substance abuse training in medical schools, and suggests strategies to address this gap in physician education. The authors describe how the combination of mandated coverage for substance abuse services and expanding treatment needs means that more physicians, regardless of their patient populations, will be faced with addressing the problem of substance use. The authors review the literature on substance abuse training in medical schools, which indicates insufficient exposure to this topic. The authors describe how current substance abuse training at medical schools is focused on transmitting scientific knowledge with relatively little education or training in attitudes and skills central to effective prevention and treatment. Given the gap between clinical need and physician education, the authors suggest several strategies for medical schools to increase training in substance abuse knowledge, attitudes, and skills, which will enhance the practice of evidence-based care. The authors posit that medical curricular reform, combined with initiatives to change clinical culture around substance abuse, will translate into improved rates of screening, shorter overall length of treatment, effective referrals for continued treatment, and increased access to care for individuals who use substances and so reduce the morbidity and mortality associated with substance use.

Physician Wellbeing: A Critical Deficiency in Resilience Education and Training.

Abstract: As physicians, we hold a unique place in society. We are entrusted with the responsibility of healing people and advancing the health of populations. This role is an honor and a privilege, and yet it is one that comes with the cost of jeopardizing our wellbeing. Physicians may be considered an “at risk” population, with higher rates of depression, anxiety, suicide, divorce, stress, and emotional exhaustion than other segments of the overall population. The role played by physicians requires many sacrifices—long hours, isolation from friends and family, psychological stress and responsibility in caring for very sick patients, tolerance of uncertainty, sleep deprivation, and huge economic burdens following many years of costly education, among others. Threats to the wellbeing of physicians begin early in training. The stresses of medical school, residency, and postgraduate work all involve managing tremendous pressures to acquire information, garner skills, develop and integrate a professional identity with the early-career physician’s sense of self, and balance work and life. Roughly half of medical students experience burnout over the first 4 years of medical training. Burnout is defined as emotional exhaustion, depersonalization (i.e., treating patients as objects), and feelings of worthlessness. Burnout results in poor self-care and patient care, diminished empathy, medical error, and poor physical health [2]. Among medical students, more than 20 % will suffer from depression within the first 2 years and up to 9 % will have suicidal ideation before graduation [3]. The number of those who are depressed may increase during the first year of residency [4]. Among practicing physicians, the suicide rate is approximately double the rate in the general population [5]. In the USA, approximately one physician dies by suicide every day—thus each year we lose to suicide about the number of graduates from two medical schools. Many factors contribute to the distress experienced by physicians. Shortages of health care professionals, demanding caseloads, verbal abuse and other belittling or bullying behaviors, tremendous debt following lengthy medical education, increased regulatory pressures, decreased insurance reimbursements for services, and staying current with overwhelming amounts of new knowledge are but a few examples. These challenges are compounded by our profession’s hidden curriculum—the reluctance to admit weakness, expose our shame of suffering from the stigma of a psychiatric disorder, or even discuss the pressures we share. It turns out that we are all deeply imperfect and that we will need to overcome much on our paths as physicians. With greater recognition of the risks associated with becoming and being a physician has also come greater understanding that our profession has, to a great extent, failed to * Eugene V. Beresin eberesin@partners.org

Psychiatrists' and Psychiatry Residents' Attitudes Toward Transgender People.

Abstract: Gender minority groups, such as transgender individuals, frequently encounter stigma, discrimination, and negative mental health outcomes, which can result in contact with mental health professionals. Recent studies suggest that negative attitudes toward transgender individuals are prevalent and measurable within the general population. The Genderism and Transphobia scale (GTS) measures anti-transgender feelings, thoughts, and behaviors. The purpose of this study was to use the GTS to conduct an investigation of psychiatrists’ attitudes toward transgender individuals. A cross-sectional survey of n = 142 faculty members and residents from the Department of Psychiatry at the University of Manitoba was conducted. Respondents completed an online survey consisting of demographic questions and the GTS. Responses were analyzed descriptively and compared to previously published data on the GTS. There was a trend for psychiatrists and psychiatry residents within this sample to endorse less negative attitudes toward transgender people compared to other published data using a sample of undergraduate students. Descriptive analyses suggest that psychiatrists’ and psychiatry residents’ GTS scores may be related to gender identity, political ideology, religiosity, and levels of both professional and personal contact. These data evoke optimism regarding psychiatrists’ and psychiatry residents’ attitudes toward transgender individuals. Additional larger-scale studies comparing this medical specialty group with other specialty groups will further elucidate factors that modify physician attitudes toward this patient population. These findings may contribute to the development of educational strategies to ensure that the transgender population receives medical treatment without stigma or attitudinal compromise.

Special-"T" Training: Extended Follow-up Results from a Residency-Wide Professionalism Workshop on Transgender Health.

Abstract: Objective Transgender people face unique challenges when accessing health care, including stigma and discrimination. Most residency programs devote little time to this marginalized population.

What is taught on firearm safety in undergraduate, graduate, and continuing medical education? A review of educational programs

Abstract: OBJECTIVE: Because there have been no published formal reviews on teaching of firearm safety, we set out to systematically locate and review the literature on curricula that educated physicians and other health care providers, residents across specialties, and medical students on how to counsel on firearm safety. METHODS: We searched for all papers with outcomes that described firearm safety training programs for healthcare providers and trainees. Studies were identified through PubMed, Scopus, Google Scholar, PsychInfo, EMBASE, and MedEdPortal databases and electronically searched using combinations of words from general topic areas of firearms, learners, and education. RESULTS: We found four programs that met inclusion criteria. These targeted a narrow range of learners including medical students, pediatric residents, practicing pediatricians, and nurse practitioners. Teaching methods included lectures, case-based learning, group discussions, and audiotape training. There were two randomized controlled trials, one cohort design, and one posttest design. One of the randomized controlled trials was an office-based high quality multisite national study, although the focus of teaching was not on firearm safety alone. All studies used different outcomes, and only one study validated the outcome measures. There were no studies targeting psychiatrists or psychiatry residents. CONCLUSION: These results underscore a priority for developing firearm safety education programs in undergraduate, graduate, and continuing medical education settings. Language: en

Thorny Laurels: the Impostor Phenomenon in Academic Psychiatry

Abstract: Originally described by Drs. Pauline Rose Clance and Suzanne Imes in 1978 [1], the impostor phenomenon is slowly gaining recognition in academic medicine, although it has been better studied in other fields, such as psychology and business. The impostor phenomenon is a psychological construct (not a clinical syndrome, per se) which may be encountered in high achievers who believe that others overestimate their skills and abilities. Individuals with this phenomenon have a persistent tendency to attribute their successes to external factors (such as luck) or to disproportionate effort and believe that they will soon be “found out” to be less competent than they appear [1]. Up to 70 % of successful people in the USA may have impostor feelings, according to Dr. Clance’s landmark work, The Impostor Phenomenon ([2], p. 97). This construct was initially thought to bemore prevalent in women, although recent studies have shown less marked gender differences [1, 2]. On one hand, the impostor phenomenon may have a positive impact on one’s productivity, by driving superior achievements; on the other hand, it can be associated with a series of counterproductive behaviors, ranging from maintaining a low profile to self-sabotage and acting out. Psychiatrists are often at the forefront of educational reform in academic health centers and, in this role, may be in a position to effect institutional culture changes. As will be discussed below, the impostor phenomenon may have deleterious effects on faculty, staff, and trainees’ mental health. Academic leaders who develop wellness or academic support programs may want to become familiar with this phenomenon and its potential negative consequences, so they can readily identify and address these. A PubMed search with the search terms impostor phenomenon and impostor syndrome revealed scarce findings. Additional articles were retrieved from Dr. Clance’s website (http://www.paulineroseclance.com/) as well as manual search of references listed in review articles. Few studies have explored the impostor phenomenon among health care professionals or trainees, and none to date has focused on academic physicians [3–5]. The Clance Impostor Phenomenon Scale (CIPS) is a validated instrument for assessing impostor phenomenon characteristics, which consists of 20 questions rated on a Likert-type scale from 1 to 5 where 1=not at all true and 5=very true [2]. Scores higher than 62 are considered relevant [1], and this cutoff was used in all three studies discussed below [3–5]. Henning and colleagues [3] administered the CIPS to 477 medical, nursing, dental, and pharmacy students. Approximately a third (27. 5 %) of the participants reported high psychiatric distress levels as assessed through the Brief Symptom Inventory, which strongly correlated with CIPS scores [3]. This study also found that high CIPS scores were associated with perfectionism, and significantly more women than men scored above the cutoff [3]. In a survey of 185 family medicine residents [4], 41 % of women and 24 % of men had high CIPS scores, which correlated with anxiety and depressive symptoms. Additionally, in a study of 48 internal medicine residents fromCanada [5], CIPS scores negatively correlated with theMaslach Burnout Inventory personal accomplishment subscale (low scores on this subscale indicate high burnout levels). Female residents had significantly higher CIPS scores than their male colleagues, consistent with previous studies in the health care professions. This is the only study published to date that specifically examined impostor phenomenon * Andreea L. Seritan alseritan@ucdavis.edu

Exploring the Impact of a Culturally Tailored Short Film in Modifying Dementia Stigma Among Chinese Americans: A Pilot Study.

Abstract: Chinese Americans, one of the fastest growing ethnic groups among the US elderly population, perceive high levels of dementia stigma. The authors examined the extent of the stigma and explored the impact of media through a culturally tailored short film to modify dementia stigma. Chinese American participants were asked to answer a dementia questionnaire. A short film was then used to address the impact of media on dementia stigma. Among 90 randomly selected participants, 89 % (n = 80) found the short film to be a useful way to modify their misconceptions about dementia. In the comparison between the group who felt less influenced by the short film and the group who recognized the short film to be extremely helpful, the latter group had a higher baseline of stigma toward dementia, as well as a shorter duration of residence in the USA. Chinese Americans still perceive severe dementia stigma. Nevertheless, a culturally tailored short film demonstrated promising impact in modifying stigma toward dementia.

How do clinicians prefer cultural competence training? Findings from the DSM-5 cultural formulation interview field trial

Abstract: This study’s objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians’ first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. Most frequently, clinicians named case-based behavioral simulations as “most helpful” and video as “least helpful” training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician’s age was associated with a preference for behavioral simulations: OR = 1.05 (95 % CI: 1.01–1.10; p = 0.025). Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.

From Surviving to Advising: A Novel Course Pairing Mental Health and Addictions Service Users as Advisors to Senior Psychiatry Residents

Abstract: The authors describe a novel course that pairs service users as advisors to senior psychiatry residents with the goals of improving the residents’ understanding of recovery, reducing negative stereotypes about people in recovery, and empowering the service users who participated. Service users who had experience working as peer support workers and/or system advocates were selected for a broad and deep understanding of recovery and an ability to engage learners in constructive dialogue. They met monthly with resident advisees over a period of 6 months. They were supported with monthly group supervision meetings and were paid an honorarium. Quantitative evaluations and qualitative feedback from the first two cohorts of the course, comprising 34 pairs, are reported here. The first cohort of residents responded with a wide range of global ratings and reactions. In response to their suggestions, changes were made to the structure of the course to create opportunities for small group learning and reflective writing and to protect time for residents to participate. The second cohort of residents and both cohorts of service users gave acceptably high global ratings. Residents in the second cohort described gaining a number of benefits from the course, including an enhanced understanding of the lived experience of recovery and a greater sense of shared humanity with service users. Advisors described an appreciation for being part of something that has the potential for changing the practice of psychiatry and enhancing the lives of their peers. Positioning service users as advisors to psychiatry residents holds promise as a powerful way of reducing distance between future psychiatrists and service users and facilitating system reform toward person-centered recovery-oriented care.

The Suicide Prevention, Depression Awareness, and Clinical Engagement Program for Faculty and Residents at the University of California, Davis Health System

Abstract: The objective of the study is to present results of a depression and suicide screening and treatment referral program for physicians at an academic medical center. An anonymous web-based screening questionnaire was sent to all physicians at a large academic center. Responses were classified as indicating either high, moderate, or low risk for depression and suicide. Physicians at high and moderate risk were contacted by a counselor through a messaging system. The counselor’s message contained information on risk level and an invitation to meet in person. High-risk respondents who did not reply to the message or declined to meet received mental health resources. Respondents who met with the counselor were offered individualized treatment referrals and to participate in a 1-year follow-up of self-reports every 3 months. The questionnaire was sent to approximately 1800 residents, fellows, and faculty from February 2013 through March 2019. A total of 639 questionnaires were received, 100 were excluded for various reasons, and 539 were used to conduct analyses (14.4% response rate). The majority of respondents were classified at moderate (333 [62%]) or high (193 [36%]) risk for depression or suicide. Eighty-three respondents were referred for mental health care, and 14 provided data for the follow-up study. Results of screening physicians for depression and suicide at one academic medical center highlight the challenges of engaging most of them in this activity and the satisfaction of the minority who successfully engaged in a treatment referral program.

Factors Modifying Burnout in Osteopathic Medical Students.

Abstract: The purposes of the current study are to examine factors modifying burnout and identify which of these factors place osteopathic medical students at risk for developing burnout. The current study used a cross-sectional study design and an anonymous, web-based survey to assess burnout and depression in osteopathic medical students. The survey included Maslach Burnout Inventory, the Patient Health Questionnaire, the Stressors and their impact scale, students’ sleeping and studying habits, and students’ extracurricular involvement. In total, 1294 osteopathic medical students completed the survey. Burnout was present in 516 (39.9 %) osteopathic medical students, and 1006 (77.0 %) met criteria for depression. Females were 1.5 times more likely to be burned out in comparison to males. For the burnout subscales, males had lower emotional exhaustion, slightly higher depersonalization, and lower personal accomplishment. Lesbian/gay/bisexual/asexual students were 2.62 times more likely to be burned out compared with heterosexual students. Depression and academic, personal, and family stressors were all strongly linked to overall burnout. Finally, for modifiable factors, average hours of sleep, average hours spent studying, and club involvement appeared to be linked to burnout. The current study suggested that a variety of factors, including non-modifiable, situational, and modifiable, impact burnout in osteopathic medical students. Future research is necessary since burnout in physicians affects the quality of care provided to patients.

The Mental Health Education Gap among Primary Care Providers in Rural Nepal.

Abstract: In low- and middle-income countries, the majority of individuals with mental illness go untreated largely because of a severe shortage of mental health professionals. Global initiatives to close the mental health treatment gap focus on primary care providers delivering this care. For this to be effective, primary care providers require the skills to assess, diagnose, and treat patients with mental illness. To assess primary care providers’ training and experience in caring for mental health patients, the authors conducted five focus groups at three isolated district hospitals in rural Nepal where there was no access to mental health professionals. Primary care providers reported limited training, lack of knowledge and skills, and discomfort in delivering mental health care. To address the mental health education gap, primary care providers in Nepal, and perhaps other low- and middle-income countries, require more training during both undergraduate and graduate medical education.

Effects of Brief Psychoeducational Program on Stigma in Malaysian Pre-clinical Medical Students: A Randomized Controlled Trial

Abstract: If presented with serious mental illness (SMI), individuals’ low help-seeking behaviors and poor adherence to treatment are associated with negative stereotypes and attitudes of healthcare providers. In this study, we examined the effects of a brief psychoeducational program on reducing stigma in pre-clinical medical students. One hundred and two pre-clinical medical students (20–23 years old) were randomly assigned to face-to-face contact + educational lecture (n = 51) condition or video-based contact + educational lecture (n = 51) condition. Measures of pre-clinical medical students’ mental illness-related stigma using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) were administered at pre-, post-treatment, and 1-month follow-up. A 2 (condition: face-to-face contact + educational lecture, video-based contact + educational lecture) by 3 (time: pre-treatment, post-treatment, and 1-month follow-up) mixed model MANOVA was conducted on the Attitudes, Disclosure and Help-Seeking, and Social Distance OMS-HC subscales. Participants’ scores on all subscales changed significantly across time, regardless of conditions. To determine how participants’ scores changed significantly over time on each subscale, Bonferroni follow-up comparisons were performed to access pairwise differences for the main effect of time. Specifically, pairwise comparisons produced a significant reduction in Social Distance subscale between pre-treatment and post-treatment and between pre-treatment and 1-month follow-up, and a significant increase between post-treatment and 1-month follow-up, regardless of conditions. With respect to the Attitudes and Disclosure and Help-Seeking subscales, pairwise comparisons produced a significant reduction in scores between pre-treatment and post-treatment and a significant increase between post-treatment and 1-month follow-up. Our findings provide additional evidence that educational lecture on mental illness, coupled with either face-to-face contact or video-based contact, is predictive of positive outcomes in anti-stigma programs targeting future healthcare providers.

Social Media: Portrait of an Emerging Tool in Medical Education

Abstract: The authors compare the prevalence of challenges and opportunities in commentaries and descriptive accounts versus evaluative studies of social media use in medical education. A previously published report of social media use in medical education provided an in-depth discussion of 14 evaluative studies, a small subset of the total number of 99 articles on this topic. This study used the full set of articles identified by that review, including the 58 commentaries and 27 descriptive accounts which had not been previously reported, to provide a glimpse into how emerging tools in medical education are initially perceived. Each commentary, descriptive account, and evaluative study was identified and compared on various characteristics, including discussion themes regarding the challenges and opportunities of social media use in medical education. Themes related to the challenges of social media use in medical education were more prevalent in commentaries and descriptive accounts than in evaluative studies. The potential of social media to affect medical professionalism adversely was the most commonly discussed challenge in the commentaries (53 %) and descriptive accounts (63 %) in comparison to technical issues related to implementation in the evaluative studies (50 %). Results suggest that the early body of literature on social media use in medical education—like that of previous innovative education tools—comprises primarily commentaries and descriptive accounts that focus more on the challenges of social media than on potential opportunities. These results place social media tools in historical context and lay the groundwork for expanding on this novel approach to medical education.

Racial and Ethnic Diversity in the US Psychiatric Workforce: A Perspective and Recommendations.

Abstract: Diversity refers to myriad personal characteristics—e.g., race, ethnicity, culture, nationality, religion, language, sexual orientation, gender identity, age, experiences, political party affiliation, and physical abilities, among others. Although a diverse psychiatric workforce would ideally embrace many of these elements, our focus here is on race and ethnicity, since these are two well-studied elements of diversity for physicians. Race and ethnicity are often confused and incorrectly used interchangeably. In general, race is understood to refer to the group a person belongs to based on physical features such as skin color, which reflect ancestry as identified by self or others (e.g., Black, Asian, Hispanic). In contrast, ethnicity refers to the social group a person belongs to, identifies with, or is identified with by others because of shared characteristics such as geographical origins, ancestry, and/or cultural traditions (e.g., Cuban, Pakistani, Taiwanese) [1]. While the US is already home to tremendous racial and ethnic diversity, projections suggest that our nation is on track to become even more diversified [2]. By 2040, non-Hispanic whites will be the minority race in this country, and by 2060, about one in five Americans is projected to be foreign-born [3]. The US healthcare systemwill be challenged to cultivate a more diverse physician workforce to address these changing demographics [4]. This need is even greater in psychiatry, where culture disproportionately impacts key aspects of care including symptom expression and attribution, care-seeking behaviors, stigma, and access to mental health services [5]. We contend that it is necessary for the US mental health care system to increase the training and retention of racial/ ethnic minorities within psychiatry in light of evidence that patients often prefer and report greater satisfaction with racially matched providers, particularly in the field of mental health. Beyond these benefits for direct patient care, increased workplace diversity has been shown to exert positive effects on group performance and innovation, suggesting benefits for provider organizations as well—e.g., through influence at team meetings or other activities [6]. It is implausible to expect that all mental health catchment areas throughout this country will have access to psychiatrists who perfectly reflect all elements of racial and ethnic diversity within the communities they serve, not to mention myriad other characteristics that contribute to personal identity such as gender and sexual orientation. For this reason, in addition to improving the recruitment and retention of minorities into the mental health care workforce, we also believe it is necessary to promote an attitude of cultural respect and humility among all mental health clinicians to prepare them for the challenges of caring for diverse patient populations. We advocate for cultural humility rather than cultural competence because the latter implies a finite outcome with tangible skills, which does not account for the rapidly changing demographics in the US that requires ongoing learning with accumulated skills never reaching a finite end. In this article, we outline demographic trends in the US and their likely impact on healthcare disparities. We then discuss (via clinical vignettes) limitations in the concept of “cultural competence” and argue for the increasingly relevant idea of “cultural respect.” Finally, we provide suggestions on how different stakeholders can contribute to training a more diverse psychiatric workforce while also promoting an attitude of cultural respect among practitioners. * Hermioni N. Lokko hlokko@partners.org

Managing Stigma Effectively: What Social Psychology and Social Neuroscience Can Teach Us.

Abstract: Psychiatric education is confronted with three barriers to managing stigma associated with mental health treatment. First, there are limited evidence-based practices for stigma reduction, and interventions to deal with stigma against mental health care providers are especially lacking. Second, there is a scarcity of training models for mental health professionals on how to reduce stigma in clinical services. Third, there is a lack of conceptual models for neuroscience approaches to stigma reduction, which are a requirement for high-tier competency in the ACGME Milestones for Psychiatry. The George Washington University (GWU) psychiatry residency program has developed an eight-week course on managing stigma that is based on social psychology and social neuroscience research. The course draws upon social neuroscience research demonstrating that stigma is a normal function of normal brains resulting from evolutionary processes in human group behavior. Based on these processes, stigma can be categorized according to different threats that include peril stigma, disruption stigma, empathy fatigue, moral stigma, and courtesy stigma. Grounded in social neuroscience mechanisms, residents are taught to develop interventions to manage stigma. Case examples illustrate application to common clinical challenges: (1) helping patients anticipate and manage stigma encountered in the family, community, or workplace; (2) ameliorating internalized stigma among patients; (3) conducting effective treatment from a stigmatized position due to prejudice from medical colleagues or patients' family members; and (4) facilitating patient treatment plans when stigma precludes engagement with mental health professionals. This curriculum addresses the need for educating trainees to manage stigma in clinical settings. Future studies are needed to evaluate changes in clinical practices and patient outcomes as a result of social neuroscience-based training on managing stigma.

Medical Students’ Stress, Psychological Morbidity, and Coping Strategies: a Cross-Sectional Study from Pakistan

Abstract: The authors studied the prevalence of psychological morbidity, sources and severity of stresses, as well as coping strategies in Pakistani medical students. Medical students in Lahore, Pakistan, completed a cross-sectional, self-administered questionnaire in 2013 on the sources and severity of various stressors. The General Health Questionnaire-12 (GHQ-12) and Brief COPE assessed the psychological morbidity and coping strategies. Out of 1500 students, 527 responded to the survey. The prevalence of psychological morbidity was 23.3 %; 52.3 % respondents showed evidence of distress. By logistic regression analysis, GHQ-12 caseness was associated with being male and occurrence of health-related stressors. The most common stressors were related to academic concerns. Coping strategies showed variation by GHQ-caseness. The significant psychological morbidity and distress warrants establishing support systems to support students and bringing about evidence-based changes to teaching and evaluation systems. Adequate counseling facilities should be made available and students encouraged to seek help.

Obsessive-Compulsive Symptoms in Medical Students: Prevalence, Severity, and Correlates

Abstract: The study aims were to estimate the prevalence and correlates of symptoms suggestive of obsessive-compulsive disorder (OCD) among medical students and investigate the severity and correlates of specific obsessive-compulsive symptom (OCS) dimensions in this population. A cross-sectional study with 471 Brazilian medical students, who were assessed using the Obsessive-Compulsive Inventory-Revised (OCI-R). The main outcomes were “probable OCD” (OCI-R score >27) and overall/dimensional OCI-R scores. Sociodemographic data, depressive symptoms, and several aspects of academic life were also investigated. Bivariate analyses were followed by regression models. Eighteen (3.8 %) participants presented probable OCD, which was associated with depression. The mean OCI-R score was 8.9, and greater overall severity was independently associated with being a freshman, difficulty in adaptation, and depressive symptoms. Higher scores in the “checking” and “washing” dimensions were associated with being a freshman, in the “neutralization” and “ordering” dimensions with adaptation difficulties, and in the “hoarding” dimension with adaptation difficulties and depressive symptoms. The “obsession” dimension was associated with being a freshman, difficulty making friends, depressive symptoms, and psychological/psychiatric treatment. Probable OCD is more frequent in medical students than in the general population and is associated with depressive symptoms. Efforts are required to identify OCS in this population, particularly among first-year students and to provide treatment, when necessary. Institutional programs that properly receive freshmen, enhancing their integration with other colleagues and their adaptation to the city, may decrease the level of stress and, consequently, OCS severity.

Pilot Evaluation of a Communication Skills Training Program for Psychiatry Residents Using Standardized Patient Assessment.

Abstract: Mental health clinicians can experience difficulties communicating diagnostic information to patients and their families/carers, especially about distressing psychiatric disorders such as schizophrenia. There is evidence for the effectiveness of communication skills training (CST) for improving diagnostic discussions, particularly in specialties such as oncology, but only limited evidence exists about CST for psychiatry. This study evaluated a CST program specifically developed for psychiatry residents called ComPsych that focuses on conveying diagnostic and prognostic information about schizophrenia. The ComPsych program consists of an introductory lecture, module booklets for trainees, and exemplary skills videos, followed by small group role-plays with simulated patients (SPs) led by a trained facilitator. A standardized patient assessment (SPA) was digitally recorded pre- and post-training with a SP using a standardized scenario in a time-limited (15 min) period. Recorded SPAs were independently rated using a validated coding system (ComSkil) to identify frequency of skills used in five skills categories (agenda setting, checking, questioning, information organization, and empathic communication). Thirty trainees (15 males and 15 females; median age = 32) undertaking their vocational specialty training in psychiatry participated in ComPsych training and pre- and post-ComPsych SPAs. Skills increased post-training for agenda setting (d = −0.82), while questioning skills (d = 0.56) decreased. There were no significant differences in any other skills grouping, although checking, information organization, and empathic communication skills tended to increase post-training. A dose effect was observed for agenda setting, with trainees who attended more CST sessions outperforming those attending fewer. Findings support the generalization and translation of ComPsych CST to psychiatry.

Improved Attitudes to Psychiatry: A Global Mental Health Peer-to-Peer E-Learning Partnership.

Abstract: Health links aim to strengthen healthcare systems in low and middle-income countries through mutual exchange of skills, knowledge, and experience. However, student participation remains limited despite growing educational emphasis upon global health. Medical students continue to report negative attitudes to psychiatry in high-income countries, and in Somaliland, the lack of public sector psychiatrists limits medical students’ awareness of mental healthcare. The authors describe the design, implementation, and mixed-methods analysis of a peer-to-peer psychiatry e-learning partnership between UK and Somaliland students arising from a global mental health link between the two countries. Medical students at King’s College London and Hargeisa and Amoud universities, Somaliland, were grouped into 24 pairs. Participants aimed to complete ten fortnightly meetings to discuss psychiatry topics via the website MedicineAfrica. Students completed initial and final evaluations including Attitudes toward Psychiatry (ATP-30) questions, a stigma questionnaire, and brief evaluations after each meeting. Quantitative findings demonstrated that enjoyment, interest, and academic helpfulness were rated highly by students in Somaliland and moderately by students in the UK. Somaliland students’ attitudes to psychiatry were significantly more positive post-participation, whereas UK students’ attitudes remained stable. Qualitative findings identified more gains in factual knowledge for Somaliland students, whereas UK students reported more cross-cultural learning. Reasons for non-completion and student-suggested improvements emphasized the need to ensure commitment to the program by participants. This partnership encouraged students to consider global mental health outside the standard medical education environment, through an e-learning format solely utilizing existing resources. This new approach demonstrates potential benefits to students in contrasting locations of brief, focused online peer-to-peer education partnerships, expanding the scope of health links to the medical professionals of the future.

Training in Buprenorphine and Office-Based Opioid Treatment: A Survey of Psychiatry Residency Training Programs.

Abstract: Psychiatrists are well suited to provide office-based opioid treatment (OBOT), but the extent to which psychiatry residents are exposed to buprenorphine training and OBOT during residency remains unknown. Psychiatry residency programs in the USA were recruited to complete a survey. Forty-one programs were included in the analysis for a response rate of 23.7 %. In total, 75.6 % of the programs currently offered buprenorphine waiver training and 78.1 % provided opportunities to treat opioid dependence with buprenorphine under supervision. Programs generally not only reported favorable beliefs about OBOT and buprenorphine waiver training but also reported numerous barriers. The majority of psychiatry residency training programs responding to this survey offer buprenorphine waiver training and opportunities to treat opioid-dependent patients, but numerous barriers continue to be cited. More research is needed to understand the role residency training plays in impacting future practice of psychiatrists.

Career Development Institute with Enhanced Mentoring: A Revisit

Abstract: The need for innovative methods to promote training, advancement, and retention of clinical and translational investigators in order to build a pipeline of trainees to focus on mental health-relevant research careers is pressing. The specific aim of the Career Development Institute for Psychiatry is to provide the necessary skill set and support to a nationally selected broad-based group of young psychiatrists and PhD researchers to launch and maintain successful research careers in academic psychiatry. The program targets such career skills as writing, negotiating, time management, juggling multiple demanding responsibilities, networking, project management, responsible conduct of research, and career goal setting. The current program builds on the previous program by adding a longitudinal, long-distance, virtual mentoring, and training program, seen as integral components to sustaining these career skills. Career development activities occur in four phases over a 24-month period for each annual class of up to 18 participants: online baseline career and skills self-assessment and goal setting, preparations for 4-day in-person workshop, long-distance structured mentoring and online continued learning, peer-mentoring activities, and post-program career progress and process evaluation. Program instructors and mentors consist of faculty from the University of Pittsburgh and Stanford University as well as successful past program graduates from other universities as peer mentors. A comprehensive website facilitates long-distance activities to occur online. Continued training occurs via webinars every other month by experts discussing topics selected for the needs of each particular class. Personally assigned mentors meet individually bimonthly with participants via a secure web-based “mentor center” that allows mentor dyads to collaborate, share, review, and discuss career goals and research activities. Preliminary results after the first 24 months are favorable. Almost uniformly, participants felt the program was very helpful. They had regular contact with their long-distance mentor at least every 2 months over the 2-year period. At the end of the 2-year period, the majority of participants had full-time faculty appointments with K-award support and very few were doing primarily clinical work. The longitudinal program of education, training, mentoring, peer support, and communications for individuals making the transition to academic research should increase the number of scientists committed to research careers in mental health.

A Call to Restructure Psychiatry General and Subspecialty Training.

Abstract: Dire shortages of psychiatrists with special expertise in geriatrics, substance abuse, forensics, and psychosomatics create barriers to care for populations with complex mental disorders and pose a significant public health concern. To address these disparities in access to care, we propose streamlining graduate medical education to increase efficiency and enhance cost-effectiveness while simultaneously increasing the number of psychiatric subspecialists in these key areas. We propose that trainees interested in subspecialties complete their general training in 3 years, while meeting ACGME required milestones, and then utilize their 4th year to complete subspecialty fellowship training. Eligible trainees would then qualify for psychiatry subspecialty certification and general psychiatry ABPN certification at the end of 4 years.