Showing papers in "Academic Psychiatry in 2021"

Reimagining Merit and Representation: Promoting Equity and Reducing Bias in GME Through Holistic Review.

Abstract: This study aims to evaluate the capacity of a holistic review process in comparison with non-holistic approaches to facilitate mission-driven recruitment in residency interview screening and selection, with particular attention to the promotion of race equity for applicants underrepresented in medicine (URM). Five hundred forty-seven applicants to a psychiatry residency program from US allopathic medical schools were evaluated for interview selection via three distinct screening rubrics—one holistic approach (Holistic Review; HR) and two non-holistic processes: Traditional (TR) and Traditional Modified (TM). Each applicant was assigned a composite score corresponding to each rubric, and the top 100 applicants in each rubric were identified as selected for interview. Odds ratios (OR) of selection for interview according to URM status and secondary outcomes, including clinical performance and lived experience, were measured by analysis of group composition via univariate logistic regression. Relative to Traditional, Holistic Review significantly increased the odds of URM applicant selection for interview (TR-OR: 0.35 vs HR-OR: 0.84, p < 0.01). Assigning value to lived experience and de-emphasizing USMLE STEP1 scores contributed to the significant changes in odds ratio of interview selection for URM applicants. Traditional interview selection methods systematically exclude URM applicants from consideration without due attention to applicant strengths or potential contribution to clinical care. Conversely, holistic screening represents a structural intervention capable of critically examining measures of merit, reducing bias, and increasing URM representation in residency recruitment, screening, and selection.

Depression, Suicidal Thoughts, and Burnout Among Physicians During the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study.

Abstract: Frontline workers have been a bulwark in the fight against COVID-19, while being subject to major unexpected stressors. These include conflicting news, evolving guidelines, perceived inadequate personal protective equipment, overflow of patients with rising death counts, absence of disaster training, and limitations in the implementation of social distancing. This study investigates the incidence and associated factors of depression, suicidal thoughts, and burnout among physicians during the COVID-19 pandemic. In a cross-sectional survey-based study of resident, fellow, and attending physicians from a tertiary university hospital during the height of the COVID-19 pandemic in New York from April 24 to May 15, 2020, demographics and practice specialty, attending vs. resident/fellow status, call frequency, emotional exhaustion, depersonalization, and depression severity were examined. Two hundred twenty-five subjects completed the survey (response rate of 16.3%), with rates of 6.2% depression, 6.6% suicidal ideation, and 19.6% burnout. Depression, suicidal ideation, and burnout were all associated with history of prior depression/anxiety and frequency of on call. Suicidal ideation and burnout were also associated with younger age. There was no difference in rates of depression, suicidal ideation, or burnout between attending and resident physicians. Female physicians reported less work-life balance and more burnout. These findings highlight the importance of considering physician mental health during times of peak stress, such as natural or man-made disasters. The prominence of premorbid depression/anxiety as a relevant factor underscores the need to further understand physician mental health and provide early screening and treatment.

Prevalence of Depression and Anxiety Among Medical Students and House Staff During the COVID-19 Health-Care Crisis.

Abstract: The objective of the study was to evaluate the prevalence of anxiety and depression among medical trainees during the initial wave of the COVID-19 pandemic. This was a cross-sectional study of the prevalence of depression and anxiety among medical students, residents, and fellows at a medical university hospital in New York using self-reported PHQ-9 and GAD-7 screening tools administered via an anonymized survey. The study was conducted in April 2020. The authors received 438 responses (33.4% response rate). Nearly half (44.5%) were medical students and female (56.6%). The prevalence of positive screen for depression (45.3%) and anxiety (48.1%) was high. Many reported moderate to severe depression (17.2%) and anxiety (20.3%). Over half (57.3%) experienced significant mood changes and inability to concentrate, and 14.6% had reconsidered their choice of profession since the start of the pandemic. Those who had reconsidered their profession had higher PHQ-9 [8.1 (6.4) vs 4.4 (4.3), p < 0.0001] and GAD-7 scores [8.3 (6.1) vs 4.7 (4.6), p < 0.0001], indicating adverse mental health partly contributed to their reconsideration of choice of profession. Women were more likely to screen positive for anxiety (OR: 1.68) and medical students more likely to screen positive for anxiety (OR: 2.55) and depression (OR: 2.74). The COVID-19 pandemic has placed great strain on health-care resources, including the mental health of medical trainees.

Conceptual Competence in Psychiatry: Recommendations for Education and Training.

Abstract: It has been recognized since the early days of modern psychiatry that conceptual and philosophical questions are intimately tied to more practical and clinical issues such as classification, diagnosis, and treatment. For instance, in the early twentieth century, philosopher and psychiatrist Karl Jaspers argued in his magnum opus, General Psychopathology, for the importance of phenomenological thinking and methodological pluralism [1]. The evolution of the interdisciplinary field of philosophy of psychiatry in the last few decades, with its analytic outlook and renewed focus on examination of fundamental concepts in psychiatry (sometimes dubbed the “new philosophy of psychiatry” [2], is in many ways a philosophical response to the criticisms of the antipsychiatry movement. The highly controversial and heavily contested claims of Thomas Szasz that mental illness as a category does not exist and is a “myth” relied on philosophical arguments regarding the nature of mental disorders [3]. The outright rejection of psychiatry as a medical enterprise by Szasz and others such as R.D. Laing and Michel Foucault was itself rejected by most psychiatrists, thoughmany also recognized that academic engagement with the philosophical questions raised by such criticism was warranted [2]. The resulting body of academic work has addressed important topics such as the role of values in psychiatric diagnosis and treatment, the nature of causation and explanation in psychiatry, and the scientific status of psychiatric classification. Importantly, contemporary philosophy of psychiatry does not have an adversarial relationship with the profession. It recognizes the tremendous suffering of the mentally ill and its focus is on providing clinical psychiatry the philosophical foundations required to address that suffering. Parallel to the advent of this new philosophy of psychiatry has been the rise of the “critical psychiatry”movement [4]. Its proponents often begin with conceptual concerns but focus more on their practical implications such as the medicalization of human distress, the impact of diagnosis on the lived experiences of those so labeled, the influence of the pharmaceutical industry on psychiatric practice, institutional corruption, and coercion in psychiatry [4]. Unfortunately, despite the flourishing of the sister movements of contemporary philosophy of psychiatry and critical psychiatry, mainstream psychiatry has remained largely insulated from philosophical discourse. As a result, the conceptual malaise surrounding the nature of mental disorder that philosophy of psychiatry is meant to address is increasingly evident in the discourse within and about psychiatry. As recently as October 2019, commentators in The New England Journal ofMedicine have called for “a fundamental rethinking of psychiatric knowledge creation and training” in the context of what they call psychiatry’s identity crisis [5]. We believe one of the reasons the profession finds itself in its current predicament is that the conceptual and philosophical underpinnings of psychiatric theory and practice have not been accorded the prominence they deserve and require and, in fact, have been excluded from medical student and residency training in most programs. The considerable challenges facing our discipline will not be met without rethinking our approach to educating and training the next generation of psychiatrists, specifically attending to the implicit—and thus rarely confronted, examined, and questioned—conceptual foundations of the field. To remedy this state of affairs, we introduce in this article the notion of “conceptual competence” and argue for the necessity of its achievement by psychiatry trainees. We present what we consider to be the essential elements of conceptual competence and offer suggestions of resources for educators seeking to redress this deficiency. Moreover, our proposal comes in the context of increasing calls to modernize psychiatric training [6], to include philosophy of psychiatry in * Awais Aftab awaisaftab@gmail.com

Racial Implicit Associations in Psychiatric Diagnosis, Treatment, and Compliance Expectations

Abstract: Racial and ethnic disparities are well documented in psychiatry, yet suboptimal understanding of underlying mechanisms of these disparities undermines diversity, inclusion, and education efforts. Prior research suggests that implicit associations can affect human behavior, which may ultimately influence healthcare disparities. This study investigated whether racial implicit associations exist among medical students and psychiatric physicians and whether race/ethnicity, training level, age, and gender predicted racial implicit associations. Participants completed online demographic questions and 3 race Implicit Association Tests (IATs) related to psychiatric diagnosis (psychosis vs. mood disorders), patient compliance (compliance vs. non-compliance), and psychiatric medications (antipsychotics vs. antidepressants). Linear and logistic regression models were used to identify demographic predictors of racial implicit associations. The authors analyzed data from 294 medical students and psychiatric physicians. Participants were more likely to pair faces of Black individuals with words related to psychotic disorders (as opposed to mood disorders), non-compliance (as opposed to compliance), and antipsychotic medications (as opposed to antidepressant medications). Among participants, self-reported White race and higher level of training were the strongest predictors of associating faces of Black individuals with psychotic disorders, even after adjusting for participant’s age. Racial implicit associations were measurable among medical students and psychiatric physicians. Future research should examine (1) the relationship between implicit associations and clinician behavior and (2) the ability of interventions to reduce racial implicit associations in mental healthcare.

We're Not Sure We Like It but We Still Want More: Trainee and Faculty Perceptions of Remote Learning During the COVID-19 Pandemic.

Abstract: In this study, the authors aim to compare perceptions of remote learning versus in-person learning among faculty and trainees at a single institution during the COVID-19 pandemic and to evaluate the impact that a brief faculty training on best practices in online teaching would have on faculty attitudes towards remote learning. The authors conducted an attitude survey on remote learning among trainees and faculty members approximately 3 months after the transition from in-person to remote learning. The authors then conducted a faculty training on best practices in online teaching followed by an evaluation survey. Study findings were examined descriptively and by Fisher’s exact testing. The response rates for the attitudes survey were 68% among trainees and 61% among faculty. Trainees and faculty perceived in-person learning more favorably than remote learning across a variety of domains, including overall enjoyment, interpersonal connection, ability to communicate, and concentration. Despite these trends, only 10% of trainees and 14% of faculty felt that all lectures would be most effectively delivered in-person when this becomes possible again. The response rate for the faculty training evaluation survey was 16%. Compared to non-attendees, faculty attendees reported more confidence in their ability to teach remotely (89% vs 56%, p=0.02) but not increased optimism (89% vs 63%, p=0.06). The study findings suggest that both trainees and faculty perceive remote learning negatively compared to in-person learning but still feel that some lectures should be delivered remotely even after a return to in-person learning is possible.

Post-graduate Medical Training in Intellectual and Developmental Disabilities: a Systematic Review.

Abstract: Despite the increasing number of people with autism-spectrum disorder (ASD), intellectual disabilities (ID), and developmental disabilities (DDs), individuals with these conditions continue to have high levels of unmet physical and mental health needs. Robust training of health professionals can help bridge this gap. A systematic review was conducted to describe the features and educational outcomes of existing postgraduate medical education curricula to inform the development of future training to address the growing unmet care needs of people with intellectual and developmental disabilities (IDD) such as ASD and ID. Four major databases were searched for peer-reviewed, English-language research focusing on post-graduate training in IDD education. Educational curricula and outcomes were summarized including Best Evidence in Medical Education (BEME) Quality of Evidence and Kirkpatrick training evaluation model. Sixteen studies were identified with a majority published after 2000 (69%). Pediatric departments were involved in 69%, Psychiatry 19%, Medicine-Pediatrics 19%, and Family Medicine 6.3%. Analysis of Kirkpatrick outcomes showed 31% were level 1 (satisfaction or comfort); 38% level 2 (change in objective knowledge or skills); 13% level 3 (change in behavior); and none at level 4. BEME analysis showed 19% of studies were grade 1 (no clear conclusions), 31% grade 2 (ambiguous results), and half (50%) grade 3 (conclusions can probably be based on findings), with none scoring four or higher. There is a paucity of objectively evaluated research in the area. Studies reviewed show clear promise for specialized, interdisciplinary, competency-based education which may be foundational for future curriculum development.

Maladaptive Perfectionism, Impostor Phenomenon, and Suicidal Ideation Among Medical Students.

Abstract: Suicide is a leading cause of death for young adults, and medical students experience elevated rates of suicide and suicidal ideation. The present study uses mediation analysis to explore relationships between suicidal ideation and two dysfunctional mindsets common among medical students: maladaptive perfectionism, high standards accompanied by excessive self-criticism, and impostor phenomenon, pervasive feelings of inadequacy despite evidence of competence and success. Two hundred and twenty-six medical students at a single institution completed an online survey which assessed maladaptive perfectionism, impostor phenomenon, and suicidal ideation. After calculating measures of association between all study variables, linear regression was conducted to establish the relationship between maladaptive perfectionism and suicidal ideation. To evaluate whether impostor phenomenon mediated the relationship between maladaptive perfectionism and suicidal ideation as hypothesized, a series of regression models were constructed and the regression coefficients were examined. The statistical significance of the indirect effect, representing the mediated relationship, was tested using bootstrapping. Significant positive associations between maladaptive perfectionism, impostor phenomenon, and suicidal ideation were observed. Impostor phenomenon score was found to mediate the relationship between maladaptive perfectionism and suicidal ideation. Medical students who exhibit maladaptive perfectionism are at increased risk for feelings of impostor phenomenon, which translates into increased risk for suicide. These results suggest that an intervention targeted at reducing feelings of impostor phenomenon among maladaptive perfectionists may be effective in reducing their higher risk for suicide. However, interventions promoting individual resilience are not sufficient; systemic change is needed to address medicine’s “culture of perfection.”

Women in Academic Psychiatry: Inequities, Barriers, and Promising Solutions.

Abstract: For the first time in US history, first-year female medical school matriculants (50.7%) outnumbered men (49.3%) in 2017 [1]. Moreover, in 2019, women accounted for 50.5% of all medical students for the first time [1]. Yet, female faculty continue to be underrepresented at the highest rankings in academic medicine as a whole and in psychiatry [2, 3]. Women represent only 26% and 32% of full professors among all medical faculty and psychiatry faculty, respectively, with a majority identified as White [3]. Structural racism, gender bias, and discrimination, along with the lack of systematic strategies that aim to achieve gender and racial equity, result in persistent achievement and promotion disparities among students, residents, and faculty, especially among those who are underrepresented in medicine [4, 5]. We will review the barriers women face advancing their careers in academic medicine in general, and academic psychiatry in particular, with specific attention paid to inequities for Black, Indigenous, and People of Color (BIPOC) women and especially underrepresented in medicine (URM) women compared to White women based on race/ethnicity. We will also consider the intersecting impact of sexual orientation and gender identities on women. Although there is a substantial body of research on academic medical career progression for women and URM, research identifying strategies and challenges for URM women is limited. Challenges noted include institutional barriers related to mentoring, time management, influence of bias, exclusion from formal and informal networks, and involvement in committees and non-promotion activities. Notably, the literature often considers women homogenously and does not account for nuanced differences between groups. Still, we propose solutions to narrow persistent gender and racial/ethnic disparity gaps for womenidentifying faculty. The Association of American Medical Colleges defines underrepresented in medicine (URM) as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population” [6].We use the term “URMwomen” to describe these women, who include all who do not identify as exclusively White or Asian [6]. We use the term “Black, Indigenous, and People of Color (BIPOC) women” to describe women whose racial/ ethnic identities are non-White to recognize the significant past and present history of violence, structural racism, and injustice toward Black and Indigenous people in the USA. We use the term “LGBTQIA+ women” to refer to lesbian, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minoritized women in recognition of the discrimination and oppression they experience.

Race, Metaphor, and Myth in Academic Medicine.

Abstract: We are currently living in an unprecedented historical time duringwhich efforts to unmask injustice and demand systemic change are far-reaching and unbridled. Corporations and service institutions alike are struggling to conjure up slogans and marketing strategies to align with the righteous demands of protestors and citizens, often times skipping the critical steps of institutional reflection and fundamental paradigm shifting. As advocates dedicated to promoting racial justice in our residency program and medical center, we have witnessed parallel processes in academic medicine—an expressed wish to market diversity without the institutional accountability requisite to promote justice and radical transformation. Throughout our experience as practitioners of equity initiatives in academic medicine, we have encountered many widely utilized metaphors in the Diversity and Inclusion frameworks provided to us—variably by our own institutions, professional organizations, published in our most prominent journals, and by academic medicine’s flagship, the Association of American Medical Colleges (AAMC). While these tools are intended to advance principles of unity and equity, we have been unsettled by the subtle but nevertheless powerful racial mythology they often advance. Many of these frameworks which remain in common use carry an undercurrent which perpetuates racial hierarchies, cultural determinism, and white hegemony. It is our experience that as they are currently defined, generally understood, and commonly practiced, many “diversity” frameworks used throughout academic medicine and in the clinical learning environment fail to adequately illuminate mechanisms of injustice. Through use of imagery and rhetorical devices that contain racialized myths, these frameworks often propagate the same unjust paradigms they are intended to address. These metaphors are ubiquitous throughout medical education, and their eradication is a matter of joint accountability among all physicians. As psychiatrists, however, we call on our field to catalyze this work, for we believe that our training offers a unique preparedness to consider how cognitive devices perpetuate oppression. Critical race theory (CRT) asserts that racism is ubiquitous, operating through unspoken assumptions, beliefs, and systems. CRT therefore challenges the organizing principles behind these ideas and racialized power relations not only to understand inequity but to eliminate it [2, 3]. In this commentary, we strive to advance the quality of the light by which we scrutinize our collective work by applying a CRT framework in drawing attention to the harmful racialized mythology latent in three well-circulated diversity concepts. These myths pertain to the etiology of racial oppression, the scarcity of marginalized applicants in medicine, and the effectiveness of a diversity operating system. We offer counter-narratives and alternative imagery in order to challenge the ongoing rote adoption of harmful frameworks in our field. While some of the images we discuss have been previously critiqued, they are nevertheless continually relied upon in the dominant discourse, thereby demanding cont inued at tent ion. Additionally, we offer new perspectives in critique of previously unchallenged norms embedded within Diversity and Inclusion frameworks. These contributions reflect our understanding that tools for deconstructing racism are necessarily dynamic and ever-improving. We hope to contribute to a collective CRT-inspired praxis of increasing our powers of perception and critical reflection within the medical community, so as to improve the nuance, honesty, and power of the just systems we are able to create. * Nicolás E. Barceló nbarcelo@mednet.ucla.edu

Burnout, Work Satisfaction, and Well-being Among Non-consultant Psychiatrists in Ireland

Abstract: The aim of this study was to explore the areas of psychological well-being, satisfaction at work, and burnout among non-consultant psychiatrists in Ireland, and to assess for potential contributory factors. The College of Psychiatrists of Ireland distributed the survey online to 100 non-consultant psychiatry doctors working in Ireland. The survey contained questions relating to demographic and work-related variables, the Abbreviated-Maslach Burnout Inventory (a-MBI), Basic Needs Satisfaction at Work (BNSW) scale, and WHO-5 Well-being Index. Descriptive statistics were used by the authors to summarize the data and univariate associations were explored between baseline data and subscales. Sixty-nine percent of our sample completed the survey. Thirty-six percent of the sample met the criteria for burnout, with lack of supervision the only variable significantly associated with this. Lack of regular supervision was associated with lower scores across all work satisfaction domains of the BNSW scale. The WHO-5 Well-being Index identified that 30% of respondents scored low in personal well-being, indicating that this proportion screened positive for depression, based on international diagnostic criteria. Lack of regular supervision was found to be significantly associated with low psychological well-being. This study indicates that lack of supervision is significantly associated with burnout, lower satisfaction at work, and poorer psychological well-being. Close evaluation of these areas is important to identify vulnerable individuals and areas of training which can be improved upon, which may lead to relevant measures being implemented for the benefit of psychiatrists, patients, and the wider society.

Competence vs. Identity, Trainees vs. Physicians: How COVID-19 Has Highlighted Role Confusion in Residency Training.

Abstract: The idea for this paper occurred much prior to the COVID-19 pandemic. It was supposed to be a more light-hearted and cheekier take on how residents are the “teenagers” of medical education: almost grown-up, but not quite. The initial intent was to highlight how sometimes residents are viewed as having all the responsibility of being full-grown “adult” doctors, while at other times needing to be protected and/or controlled, enjoying very few privileges of autonomous physicians. The COVID-19 pandemic and response have obviously required swift changes to medical education, but have only further highlighted the mixed messaging and treatment that U.S. residents face during training. Prior to COVID-19, almost the entirety of this paper was going to be an examination of Erik Erickson’s Psychosocial Stages of Development [1], how they relate to educational level, and whether a competency-based evaluation system is sufficient for individuals who are also starting professional identity formation. I will try to do this briefly, then move on to how the current COVID-19 crisis has served to amplify these points for psychiatry residents.

From Screening to Interventions: Teaching Clinical Suicide Prevention Skills to Medical Students

Abstract: Suicide is a public health problem. Approximately 38% of individuals make a health care visit within 1 week prior to a suicide attempt, with the majority of these visits occurring in the primary care setting [1]. While it is not known to what degree these contacts can prevent suicide, the pattern is consistent with the seeking of health services. Thus, these visits represent a potential window of opportunity to detect and treat individuals at risk for suicide by addressing risk factors, identifying warning signs, and providing interventions just as one would recommend lifestyle changes and medical interventions for those at risk of stroke or myocardial infarction [2]. Despite these facts, many primary care providers report limited confidence in managing patients at risk for suicide [3]. A 2007 survey of residency program directors from primary care specialties highlighted insufficient training in suicide prevention and the need for a standardized curriculum [4]. This gap is compounded by underdeveloped educational guidelines for teaching medical students suicide prevention skills outside of psychiatry clerkships. The Association of Directors of Medical Student Education in Psychiatry [5] states that by the completion of medical school, students will be able to “identify risk factors for suicide” and “apply knowledge of the risk factors for suicide when making treatment plans.” The authors recognized this gap as a novel opportunity for academic psychiatrists to teach critical suicide prevention skills to pre-clerkship medical students, many of whom will become primary care providers. This article describes the implementation and impact of an educational module designed to introduce clinical suicide prevention skills earlier in medical education and provide a foundation for learning suicide-safer care throughout training. The module was developed at the authors’ institution, a large, public medical school where, in 2019, 44% of graduating medical students matched into a primary care specialty. Formal pre-clerkship clinical suicide prevention education was not previously included in the School of Medicine curriculum.

The Association Between Adverse Childhood Experiences and Burnout in a Regional Sample of Physicians

Abstract: Little research has occurred in physicians on the prevalence of adverse childhood experiences (ACEs) and their potential correlation with burnout. The authors hypothesized that there would be a relationship between burnout levels and ACE scores, with physicians reporting more burnout being likely to have higher ACE scores. Three hundred physicians completed the ten-question ACE scale and two burnout scales, the Mini-Z, and two items from the Maslach Burnout Inventory. One hundred and thirty eight (46%) of the physicians were positive on one or the other of the two burnout measures, and 49% of the respondents were positive for at least one ACE, while 9% were positive for four or more ACEs. The most common ACEs reported by the group were having a family member being depressed, being mentally ill, or attempting suicide (22%). The burnout measures correlated strongly with each other (r = 0.68, p < .001), and separate logistic regression models revealed that the physicians with an ACE score of 4 or more had more than two and half times the risk of burnout on either burnout scale measured. In this group of physicians, almost half reported experiencing ACEs, and half reported symptoms of burnout. The research hypothesis, which physicians reporting more burnout would be more likely to have higher ACE scores, was supported. It is possible that ACEs are a vulnerability factor in physicians for the development of burnout. This possibility and potential protective factors should be further studied.

Not Just Surviving, But Thriving: Overcoming Barriers to Career Advancement for Women Junior Faculty Clinician-Researchers.

Abstract: Although women attend medical school and residency at similar rates to men, they experience lower levels of academic career advancement than men. To inform national gender equity efforts, the authors conducted a qualitative study to explore potential gender differences in the career experiences of junior research faculty at a premier research institution. Focus group discussions were conducted among women and men junior research faculty at the School of Medicine at an urban public research university. Participants were early mentored career development award recipients (K-awardees). Two same-gender focus groups of nine women and six men were conducted. Discussions focused on two domains: barriers to maintaining a research career and facilitators for research career development. Data were analyzed using ATLAS.ti and content analysis methods. Both women and men identified a challenging funding environment, difficulty bridging the salary gap, and lack of institutional support as barriers to maintaining their research careers. Women perceived two primary barriers to their career advancement that were different from their male counterparts: They were more likely to feel undervalued at the institution and to experience significant strains related to both childbearing and childcare. Women also reported receiving inadequate mentorship, having poor negotiation skills, and experiencing a lack of negotiation opportunities. Academic research institutions should consider interventions that provide financial, emotional, and practical support to women research faculty, particularly during their childbearing and childrearing years.

Recruiting Underrepresented Minority Students into Psychiatry Residency: a Virtual Diversity Initiative.

Abstract: The COVID-19 pandemic has significantly hindered medical student career planning and clinical rotations. Recruitment and networking may be more influential in match outcomes than previous cycles. Medical residency training programs have significant challenges in recruiting diverse applicants. The American Psychiatric Association’s Black Caucus developed a virtual recruitment event for residency programs with robust diversity initiatives and underrepresented medical students. This article evaluates our methods, short-term results, and influence on participating medical students. The authors sent web-based invitations to all programs subscribed to the American Association of Directors of Psychiatric Residency Training listserv. Programs that demonstrated intention and commitment to diversity, equity, and inclusion were selected. The authors used various social media platforms and the Black Caucus listserv to advertise to medical students. Student participants received an online feedback survey consisting of multiple-choice and open-ended questions. Thirty-six programs and one hundred seven medical students participated in the 2-day diversity fair. Seventy-six students completed the following survey, which is a response rate of 71%. A majority of students reported that this event strongly influenced their interest in a program (71.05) and are actively considering a residency program they had not previously considered (69.74). A majority of medical students (89.47) strongly agreed that program representatives treated them with professionalism and respect. This event improved communication between highly valued underrepresented minority students applicants and residency programs. A notable majority of participants found the program overwhelmingly beneficial.

Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students

Abstract: Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were “extremely” or “very” concerned about family members getting infected (n = 71, 76% School of Medicine (SOM); n = 31, 76% School of Nursing (SON); n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM; n = 28, 68% SON; n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.

Depression, Stress, and Perceived Medical Errors in Singapore Psychiatry Residents.

Abstract: Doctors in training, especially psychiatrists, are at high risk of depression and burnout, which have been linked to increased medical errors. This study looks at prevalence and risk factors of depression and perceived stress among psychiatry residents in Singapore. An anonymous online questionnaire was completed by 65.3% (47/72) of residents, which included the Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale (PSS), and 2 burnout screening questions. They were asked if they were concerned about making a medical error. Majority of residents (70.2%) slept 6–8 h/night, while 55.3% worked < 60 h/week. Based on PHQ-9 score ≥ 10, 38.3% had depression. Depression was associated with sleeping < 6 h/night (OR 13.62, 2.96–62.6; p = 0.0008) and working ≥ 60 h/week (OR 3.8, 1.096–13.18; p = 0.035). Six residents (12.8%) endorsed suicidal ideation. The mean score on the PSS scale was 23.89 ± 1.95. Higher PSS scores were associated with sleeping < 6 h/night (OR 4.92, 1.51–8.33; p = 0.007). One third of residents (34%) reported feeling burnt out fairly or very often. Residents who slept < 6 h/night were more likely to report feeling burnt out (OR 6.69, 1.69–26.45; p = 0.0068). PHQ scores correlated highly with PSS scores and burnout measures. Self-perceived medical errors were associated with depressive symptoms, suicidal thoughts, and < 6 h/night of sleep. Less sleep and longer working hours were associated with higher risk of depression, suicidality, stress, and perceived medical errors in Singapore psychiatry residents. It is important to address depression and stress as it can affect physician well-being and patient care.

Resident Mental Health Care: a Timely and Necessary Resource.

Abstract: Residency training is associated with stress and burnout that can contribute to poor mental health, yet many residents do not get the help needed. While some healthcare institutions provide mental health services specifically for residents, literature has documented few examples. The objective of this study was to investigate the utilization and patient characteristics of a resident mental health program. The authors conducted a retrospective records analysis of residents who utilized outpatient mental health services through the Thomas Jefferson University Hospital Emotional Health and Wellness Program for House Staff from 2010 to 2018. A total of 158 resident patient charts were reviewed. Utilization was highest for females, first years, and general internal medicine residents. Initial help-seeking was most common for summer, winter, and intern year. The most frequent diagnoses were adjustment, depressive, and anxiety disorders. Of residents who completed screening tools, 43% screened positive for moderate to severe depression, 11% screened positive for hazardous alcohol consumption, and 15% endorsed thoughts of death or suicide. Resident physicians manifest psychiatric symptoms, mental disorders, and suicidal ideation that require treatment and intervention. Yet, a minority of residents make use of services. This data emphasizes the need to promote help-seeking behaviors among residents and ensure timely access to comprehensive mental health services.

“You Really Never Forget It!” Psychiatry Trainee Supervision Needs and Supervisor Experiences Following the Suicide of a Patient

Abstract: Suicide is the second leading cause of death in children, adolescents, and young adults ages 10–34 and the rates continue to rise in the USA. An estimated 30–60% of Psychiatry Residents experience patient suicide during their training. This study aimed to understand trainee and supervisor experiences after the suicide of a patient in order to better inform the supervision and response to such an event. Twenty-seven participants were identified by criterion sampling and recruited from General Psychiatry residency, Consultation Liaison fellowship, and Child and Adolescent Psychiatry fellowship training programs in the New England region of the USA. Semi-structured interviews of trainees and supervisors were conducted and analyzed using inductive thematic analysis. The death of a patient by suicide was described as a notable event with a significant impact on the professional lives of the participants. The event was typically characterized as having an immediate emotional impact, led to changes in self-efficacy, and a sense of responsibility for the patient’s death. Responses to suicide were influenced by modifiable factors such as (1) unpreparedness of individuals, program, and institution and (2) mediating/complicating factors, including the credibility of the supervisor, societal expectations, and specific patient characteristics. The death of a patient is a personal and emotional experience for the psychiatrist, for which they do not consistently feel well prepared. The institutional response may be misaligned, more analytical in character and prioritize assessment of risk. There is significant room to improve supervision and preparedness for the death of a patient by suicide.

Increasing Resident Support Following Patient Suicide: Assessing Resident Perceptions of a Longitudinal, Multimodal Patient Suicide Curriculum.

Abstract: Patient suicide is a common experience in psychiatry residency, and its effects on trainees can be profound. There are currently no ACGME Common Program Requirements for education about patient suicide, and a need exists for evidence-based curricula to prepare residents for this difficult outcome. A comprehensive patient suicide curriculum was developed utilizing multiple modes of delivering content, including a training designed to foster built-in support among peers in the healthcare workplace. The content was delivered at intervals over the course of the 2019–2020 academic year for 43 psychiatry residents at The Ohio State University Wexner Medical Center. Pre- and post-curriculum surveys were obtained to assess the resident experience of the new curriculum. Twenty-seven residents completed the pre-curriculum survey and 25 completed the post-curriculum survey. Results demonstrated statistically significant improvements in ratings of preparedness to deal with the loss of a patient by suicide, preparedness to support a co-resident who has experienced the death of a patient by suicide, program-level support for residents, understanding systems-level and quality processes, and knowledge of what steps to take if finding out a patient has completed suicide. A multimodal approach incorporating understanding emotional reactions, provision of support, delineation of procedural issues, and education regarding quality and risk management considerations was effective at improving resident preparedness to cope following a patient suicide.

Impact of Reflection on Empathy and Emotional Intelligence in Third-Year Medical Students.

Abstract: This study analyzed the impact that structured Reflection Rounds had on self-reported empathy and emotional intelligence scores for third-year medical students. Third-year students at the Renaissance School of Medicine at Stony Brook University (RSOM) were required to participate in Reflection Rounds during their core clinical clerkships. Over the study period, 285 students participated. Reflection Rounds are facilitated, small-group meetings, where students reflect upon their thoughts, feelings, and emotions about clinical experiences and receive feedback from peers and a trained facilitator. Empathy and emotional intelligence (EI) scores were measured pre- and post-intervention utilizing the Jefferson scale of empathy (JSE) student version and Wong law emotional intelligence scale (WLEIS) (Hojat 2016; Wong and Law Leadersh Q. 13:243–74, 2004). Participation in the study was voluntary. Pre-intervention surveys were collected from 185 students for the JSE and 173 students for the WLEIS. Post survey responses were collected from 120 students for both scales. Empathy scores increased from 80.4 to 82.6 (p = 0.02) post-intervention. No significant difference in EI scores was demonstrated post-intervention, 5.4 to 5.5 (p = 0.55) Students who participated in Reflection Rounds did not demonstrate the erosion of empathy that has been previously documented following the completion of the clerkship year. Improvements in empathy scores were demonstrated. No change in EI was observed post-intervention. It is possible that an intervention such as Reflection Rounds may represent a way of preventing the empathy decline that can be seen in medical students as they progress through their training.