Clinical Training In Psychiatry Research Articles

Embracing different languages and local differences: Co-constructive patient simulation strengthens host countries' clinical training in psychiatry.

Global education in psychiatry is heavily influenced by knowledge from Western, high-income countries, which obscures local voices and expertise. To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures. We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries, speaking their native languages, and following an adaptation of the co-constructive patient simulation (CCPS) model. As local faculty became increasingly familiar with the CCPS approach, they took on the role of facilitators-in their country's native language. Fifty-three learners participated: 19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye (as a group that met online during 3 consecutive months); and 24 trainees and 7 faculty in Israel (divided into 3 groups, in parallel in-person sessions during a single training day). Each of the six cases reflected local realities and clinical challenges, and was associated with specific learning goals identified by each case-writing trainee. Human simulation has not been fully incorporated into psychiatric education: The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development. Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice. Finally, the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.

Effectiveness of Entrustable Professional Activity-Based Clinical Psychiatry Training for Indian Medical Interns: A Preliminary Study

Objective Entrustable Professional Activities (EPA) are discretely measurable specific professional tasks that integrate multiple competencies to define and provide varying levels of faculty support per trainee needs. Methods: We developed an EPA-based psychiatry curriculum for medical interns. Fifty-four interns completed the OSCE stations, Multiple Choice Questions, and Attitude questionnaires to assess EPAs, knowledge and attitudes towards the relevance and utility of clinical psychiatry in general practice. Results: Two weeks of EPA-based psychiatry training resulted in improvement in median scores on attitude questions (p < 0.05), clinical skills measured using EPA levels. Conclusions: EPA-based curriculum can improve clinical skills, knowledge, and attitudes towards clinical psychiatry in interns.

Nursing and medical students’ experiences of interprofessional education during clinical training in psychiatry

ABSTRACT The aim of the study was to describe nursing and medical students’ experiences of participation in an interprofessional education (IPE) activity, “round school,” during their clinical rotations in psychiatric care. Data were collected in six focus groups with 32 students from nursing and medical programs, focusing on their experiences of the IPE activity and their reflections on interprofessional collaboration. The students considered the round school to be meaningful and true-to-life. Important conditions for learning were well-informed staff, sufficient time for preparation and feedback, clear routines, instructions, and an open climate. Non-explicit instructions and limited preunderstanding of psychiatric care left the students feeling uncertain. Students’ reflections regarding interprofessional competences encompassed both similarities and differences in roles, responsibilities, and collaboration. Evidence of hierarchical and stereotypical images of the nurse-physician relationship was identified. Round school is an example of how IPE can be integrated into the units’ regular ward rounds. However, if the clinical everyday work is not based on collaboration between different professions, it can be arduous to implement IPE. Well-planned preparations are necessary, both in the clinic and at the faculty.

Recipes for Adult Learning: Innovations in teaching neuroimaging to geriatric trainees

This session will introduce a mosaic of teaching strategies that utilize adult learning principles and allow for collaborativelearning in neuroimaging foundations and applications, disciplines often undertaught in clinical psychiatry training. To open, there will be a brief session introducing the concept of adult learning, the course, and syllabus (10 mins). We will present data collected from our current cohort of trainees and lessons learned along the way (20 mins). The audience will then break into small working groups and will use the tools introduced in the session to prepare a class about neuroimaging (30 mins). There will be a 30 minute-long large group discussion about the projects created. Learners will leave with ideas on how to approach constructing a neuroimaging curriculum.

A nationwide survey of attitudes towards psychiatry among final-year medical students in Sri Lanka.

Stigma towards psychiatry, a debilitating phenomenon worldwide, is likely to have engendered the longstanding lack of recruitment into psychiatry in Sri Lanka (SL). However, as recent expansion of the undergraduate training in psychiatry in SL may have instigated favorable changes in students' attitudes, we assessed the attitudes of students regarding psychiatry by administering Attitude towards psychiatry-30 (ATP-30) scale to final-year medical students in nine medical schools in SL. This 30-item questionnaire covers eight domains of psychiatry and is rated on a Likert scale, producing a total score out of 150. A multiple linear regression was performed to investigate associated factors. A total of 743 fin. l-year students participated. Of them, 54 % were male. The mean attitude score was 107.7 (SD = 12.3) and 92.2 % showed an overall "positive" attitude. 22.2 % of students considered psychiatry as a potential future career. Students with more than one month of clinical exposure to psychiatry showed a better attitude compared to those with shorter exposure. Female gender and the presence of a close person with mental illness were also associated with better attitudes and career interest. The generally positive attitude towards psychiatry among medical students may be explained, at least partly, by recent advances in undergraduate psychiatry education in SL. Longer clinical exposure to psychiatry being associated with better attitudes indicates the need to ensure adequate duration of clinical training in psychiatry in the undergraduate curriculum.

The effects of education in psychiatry on attitudes towards antidepressants in nursing students: A cross-sectional study

BackgroundStigma associated with depression and antidepressants is strong among the general population but also among patients and health professionals. ObjectivesThis cross-sectional study is aimed at: 1) evaluating the knowledge and attitude towards antidepressant by nursing student; 2) exploring the association between instruction in psychiatry and representation of depression and antidepressants. Participants2037 undergraduate students from 10 French nursing schools were invited to participate in 2017, 1475 (73%) completed the questionnaire. MethodsThe self-report questionnaire included the Drug Attitude Inventory (DAI) and questions about representation on depression and antidepressant. Four groups of students were built: 1) pre-teaching group (PT) as a reference group, 2) clinical training in psychiatry (CT), 3) receiving mental health theoretical education (TE), 4) receiving both (CT + TE). ResultsThe mean (standard deviation) DAI score was negative: -1.9 (±4.4) with only 40% of the nursing students conveying a positive attitude towards antidepressant. A combination of CT and TE was associated with a more positive attitude towards antidepressant in comparison with the PT condition. The CT + TE group was more prone to view antidepressants as effective and safe. ConclusionThere is strong stigma against depression/antidepressants among nursing student. Education combined with clinical experiences in psychiatry improved these representations.

RECIPES FOR ADULT LEARNING: INNOVATIONS IN TEACHING NEUROIMAGING TO GERIATRIC TRAINEES

This session will introduce a mosaic of teaching strategies that utilize adult learning principles and allow for collaborativelearning in neuroimaging foundations and applications, disciplines often undertaught in clinical psychiatry training. To open, there will be a brief session introducing the concept of adult learning, the course, and syllabus (10 mins). We will present data collected from our current cohort of trainees and lessons learned along the way (20 mins). The audience will then break into small working groups and will use the tools introduced in the session to prepare a class about neuroimaging (30 mins). There will be a 30 minute-long large group discussion about the projects created. Learners will leave with ideas on how to approach constructing a neuroimaging curriculum.

Report from an Effort to Optimize Feedback in Undergraduate Psychiatry Training.

Few studies report about the feedback students receive in undergraduate psychiatry training. The aim of this study was to evaluate an effort to optimize feedback to medical students during rotations in psychiatry. A structured feedback tool was constructed and introduced during psychiatric rotations. At the end of each week during 3weeks of clinical psychiatry training, 86 medical students anonymously reported whether they had received any feedback, if the new feedback tool had been used and if the received feedback felt valuable. At the end of rotations, students were also asked to leave text comments about their experience of the feedback tool. Course evaluations concerning perceived feedback, before and after introducing a feedback tool, were compared. The 86 students reported about feedback at three occasions, leaving a total of 212 reports (82% response rate). In all reports, the students affirmed having received some feedback, either with or without the feedback tool. In the 123 (58%) reports where feedback was received with the feedback tool, 110 (89%) answered that the feedback was experienced as valuable. Among those 89 (42%) reports where feedback had been delivered without the feedback tool, 41 (46%) described the feedback as valuable. Course evaluation of perceived feedback improved. Feedback to medical students during psychiatry rotations seems to be optimized by using a structured feedback tool.

Do medical students feel career ready after their psychiatry clinical rotation?

BackgroundIn the South African healthcare system, mentally ill patients first come into contact with primary care physicians who then refer these patients for specialised care if needed. Medical students therefore need to acquire the knowledge, skills and confidence to treat mentally ill patients.AimTo evaluate the perceptions of medical students regarding their career readiness as doctors after their clinical rotation in psychiatry.SettingThe University of Pretoria, South Africa.MethodsData were collected retrospectively from questionnaires completed by final year medical students from 2011 to 2015. These data were analysed overall and by year using Chi-square tests and regression analyses (N = 770).ResultsOverall, 93.10% of medical students felt adequately prepared for their role as medical practitioners after their clinical rotation in psychiatry. The proportion of medical students exposed to post-traumatic stress disorder (p = 0.012), obsessive-compulsive disorder (p = 0.006) and alcohol-use disorder (p = 0.046) was found to vary significantly by year. Exposure to any one psychiatric condition did not influence perceptions of career preparedness. Students perceived themselves to be career ready if they had sufficient exposure to mentally ill patients, knowledge about prescribing appropriate psychiatric medication and especially psychiatric interviewing skills.ConclusionStudents who completed practical and clinical training in psychiatry perceived themselves to be career ready.

The impact of using standardized patients in psychiatric cases on the levels of motivation and perceived learning of the nursing students

BackgroundThe use of standardized patients is not very common in psychiatric nursing education and there has been no study conducted in Turkey. AimThis study evaluated the impact of using standardized patients in psychiatric cases on the levels of motivation and perceived learning of the nursing students. DesignThis manuscript addressed the quantitative aspect of a doctoral thesis study in which both quantitative and qualitative methods were used. A pre-test and post-test were employed in the quantitative analysis in a randomized and controlled study design. ResultsThe motivation scores, and interim and post-test scores for perceived learning were higher in the experimental group compared to pre-test scores and the scores of the control group. The students in the experimental group reported that they felt more competent about practical training in clinical psychiatry, as well as in performing interviews with patients having mental problems, and reported less anxiety about performing an interview when compared to students in the control group. ConclusionIt is considered that the inclusion of standardized patient methodology in the nursing education curriculum in order to improve the knowledge level and skills of students would be beneficial in the training of mental health nurses.

Griffith Edwards' work on the life course of alcohol dependence.

In 1976 Edwards & Gross proposed the concept of the alcohol dependence syndrome, based on the clinical observation that heavy drinkers manifested an inter-related clustering of signs and symptoms. That this modest 'provisional description' turned out to be so significant and influential is perhaps unsurprising when the context in which it was made is appreciated. Griffith Edwards and his colleagues at the Maudsley Hospital had undergone a rigorous 3-year training in clinical psychiatry, during which they had been taught to think critically and were grounded in the art of clinical observation. As he assessed patients for various alcohol research studies he realized that there was a clustering of certain elements. Thus clinical observation and an appreciation of the patient's drinking history contributed to the genesis of the concept. This paper reflects on the integration of his rigorous training at the Maudsley, his enquiring mind and encyclopaedic knowledge of the historical and research literature which enabled him to formulate a testable hypothesis about the alcohol dependence syndrome.

CHILDHOOD STRESS AND RISK FOR LATER MENTAL DISORDER

Jeremy Hall is Professor of Psychiatry and Scottish Senior Clinical Fellow. He is an Honorary Consultant Psychiatrist in General Adult and Liaison Psychiatry, and works both at the Royal Edinburgh...

Influence of contact with schizophrenia on implicit attitudes towards schizophrenia patients held by clinical residents

BackgroundPatients with schizophrenia and their families have suffered greatly from stigmatizing effects. Although many efforts have been made to eradicate both prejudice and stigma, they still prevail even among medical professionals, and little is known about how contact with schizophrenia patients affects their attitudes towards schizophrenia.MethodsWe assessed the impact of the renaming of the Japanese term for schizophrenia on clinical residents and also evaluated the influence of contact with schizophrenia patients on attitudes toward schizophrenia by comparing the attitudes toward schizophrenia before and after a one-month clinical training period in psychiatry. Fifty-one clinical residents participated. Their attitudes toward schizophrenia were assessed twice, before and one month after clinical training in psychiatry using the Implicit Association Test (IAT) as well as Link’s devaluation-discrimination scale.ResultsThe old term for schizophrenia, “Seishin-Bunretsu-Byo”, was more congruent with criminal than the new term for schizophrenia, “Togo-Shitcho-Sho”, before clinical training. However, quite opposite to our expectation, after clinical training the new term had become even more congruent with criminal than the old term. There was no significant correlation between Link's scale and IAT effect.ConclusionsRenaming the Japanese term for schizophrenia still reduced the negative images of schizophrenia among clinical residents. However, contact with schizophrenia patients unexpectedly changed clinical residents’ attitudes towards schizophrenia negatively. Our results might contribute to an understanding of the formation of negative attitudes about schizophrenia and assist in developing appropriate clinical training in psychiatry that could reduce prejudice and stigma concerning schizophrenia.

AD 2 Disruption of brain connectivity in schizophrenia

Ed Bullmore trained in clinical medicine at the University of Oxford and St Bartholomew9s Hospital in London, then worked as a Lecturer in Medicine at the University of Hong Kong, before specialist clinical training in psychiatry at St George9s Hospital and then the Bethlem Royal & Maudsley Hospital London. His research career started in the early 1990s as a Wellcome Trust Research Fellow and was initially focused on mathematical analysis of neurophysiological time series. Since moving to Cambridge as Professor of Psychiatry in 1999, his interest in systems-level analysis of brain function and structure has increasingly focused on using tools drawn from wavelet analysis and graph theory to investigate complex brain networks identified in human neuroimaging data (fMRI, MRI and MEG). Since 2005, he has worked half-time for GlaxoSmithKline as Head of GSK9s Clinical Unit in Cambridge and Vice-President, Experimental Medicine. He is Deputy Director of the Wellcome Trust/GSK funded training programme in Translational Medicine and Therapeutics, Clinical Director of the Wellcome Trust/MRC funded Behavioural & Clinical Neuroscience Institute, and an honorary Consultant Psychiatrist and co-director of CAMEO in Cambridgeshire & Peterborough Foundation NHS Trust. He has published about 270 peer-reviewed articles and his h-index is 67. The idea that schizophrenia reflects a disruption of brain connectivity dates back to the founding fathers of neuropsychiatry. Recent neuroimaging studies have provided fresh evidence for models of psychosis as disconnexion syndromes. I will review MRI studies of abnormal brain connectivity in schizophrenia with a focus on recent work using graph theory to measure the complex topological properties of human brain networks in healthy and psychotic individuals. These data clearly demonstrate abnormalities of the connectome in schizophrenia: they also raise questions for future research. In particular, how can we reconcile genetic and developmental models of pathogenesis with network abnormalities in schizophenia?

Attitudes of medical students in Ireland towards psychiatry: comparison of students from 1994 and 2010

Aims and methodWe assess and compare: (a) the attitudes of final-year medical students in 2010 to their 1994 counterparts; (b) the attitudes of third-year medical students with those of their final-year colleagues; (c) the impact of two different teaching modules on students' attitudes. All students completing the year 3 psychiatry preclinical module and the final-year clinical clerkship were asked to anonymously complete three well-validated attitudinal questionnaires on the first and final day of their module in psychiatry.ResultsThese data indicate that Irish medical students have a positive attitude to psychiatry even prior to the start of their clinical training in psychiatry. This attitude is significantly more positive now than it was in 1994. A positive attitudinal change was brought about only by the final-year psychiatric clerkship. Students who have completed a degree prior to medicine are less likely to express an interest in a career in psychiatry.Clinical implicationsIf we are to address the recruitment difficulties in psychiatry we need to look at innovative and specific ways of translating these positive attitudes into careers in psychiatry.

Emergency medicine training programs' educational requirements in the management of psychiatric emergencies: current perspective.

The purpose of this study was to determine the extent of training in clinical psychiatry that is provided and/or required by emergency medicine (EM) residency training programs and pediatric emergency medicine (PEM) subspecialty residency training programs. A questionnaire was mailed to 114 EM residency directors and to all 50 PEM fellowship directors. Each director was asked to indicate the amount of psychiatric training that was required of residents or fellows in his or her program. Details concerning the exact structure of psychiatric training were solicited from those offering such training. There was a 76% response rate (n = 88) among EM programs, and 76% (n = 59) of the respondents reported no formal training in the management of acute psychiatric emergencies. Only 14% (12 programs) provide a 1-month rotation in psychiatry. Of the 3-year programs, 14% (n = 11) offer 2-week psychiatric electives, and 9% (n = 8) offer some training. There was a 72% response rate among the PEM training programs. Only one of the 36 respondents provided a required 1-month rotation in psychiatry. Six programs stated the availability of a 1-month elective in psychiatry. Two programs reported 2 to 3 hours per year of core lecture time dedicated to psychiatric emergencies. Standardized psychiatric training is not required of most trainees in EM and PEM. Few (24%) training programs provide formal psychiatric training for their EM residents, and even fewer (< 3%) provide such training for their PEM fellows.

Training osteopathic medical students in behavioral medicine and psychiatry.

Medical students need more comprehensive training in behavioral sciences to cope with the increasing acuity of patients seen in an ambulatory-care setting. Present-day psychiatry teaching and clinical rotations emphasize severe psychopathologic disorders and inpatient care. Colleges of osteopathic medicine should integrate behavioral sciences into the preclinical curriculum and clinical training. Clinical psychiatry training should prepare students to care for patients with the kinds of behavioral difficulties seen in primary care settings in an integrated manner.

Research and clinical training in psychiatry: Inputs and outputs

The interactive relationship between scientific advance and clinical training is increasingly important and complex in the field of psychiatry. Advances in the biological and behavioral sciences offer an unprecedented wealth of research opportunities in an atmosphere of increasing public and political support for psychiatric research. The continuing diminution of resources for clinical training in psychiatry adds to the complexity of this relationship. By discussing the diverse research opportunities and their impact on clinical training, reviewing science policy issues and support for research over the past several decades, and suggesting strategies for recruitment of psychiatric researchers, this paper highlights psychiatry's need to define new methods for training clinicians who can understand and utilize research findings, as well as create a conduit for recruitment of a new generation of psychiatric investigators.

Telephone Associated Pathology: Clinical Case Studies and Discussion

The advancement of modern technology shapes a nd deve lops new expressio ns of psychopathology and accompanying treatments. This is most apparent with the telephone, an instrument ofcontact and communicati on fo r th e pat ie n t , and assessment and intervention for the therapist. T he telephone both const rains and creates unique constellations of patient sym pto matology . T his paper will examine one suc h te lephone symptom complex-the habitual over use of the telephone by non-bipolar patients. T he frequent monopolization of th e phone seen in some b ipolar patients will not be considered, th ough the e lements of in t rusion a nd aggression d iscussed in this paper are probably shared by manic patients . A review of the psychiatric literature reveal s a sur pr ising pau cit y of wr iting about the psychodynamic significance of patient 's use of th e telephone , even in the area of sexual paraphilias and sexually obscene phone ca lls. Freud describes th e telephone as a representation of the body, and as a metaphor for psych oa na lysis (1,2). Stekel (3) discusses the telephone as a se xua l sym bol, a nd Har r is (4) relates phobic anxiety of the telephone to castration anxiety. Fliess (5) is th e first to write of telephoning as a sym bo l for masturbation , an idea elaborated by Shengold in his paper The Symbol of Telephoning (6). Alman si, Soca rides, and others have written of the use of the telephone in sexua l paraph ilias (7 ,8) . The bulk of writing in the mental health literature, however, focu ses o n th e use of th e te lephone in counseling services and suicide hotlines. With th e ever increasing utilization of the te lephone by patient and therapist alike , thi s limited analysis of the meaning and uses of the telephone in the psychi atric literatu re is a n intriguing deficiency in the understanding of patient behavior. Throughout two yea rs of residency training in clinical psychiatry in inpatient and outpatient sett ings, I have treated two patients whose sole presenti ng complaint was the overuse or abuse of the telephone. These patients would make upwards of fifty ca lls a day to their parents, spouse, or th erapist. This beha vio r was independent of manic or psychotic symptoms, and without over t sexual deviancy or perversion . Such an affinity for the telephone is not un common among psych iatric patients, as many psychiatrists a nd their sec reta r ia l staff can attest. Some possible meanings and the various expressions of this behavio r will be examined in these two case stud ies. Mrs. Z is a thirty-three year old, married, Jewish mother of two children who presented to the ew York Hospital-Westch ester Division Outpatient

The making of the psychiatrist-executive.

The authors reviewed the literature on the factors influencing the development of psychiatrist-executives. The results indicate that personality traits, clinical psychiatry training, training in administration, mentors, and administrative experience have an impact on the making of the psychiatrist-executive. On the basis of these findings, the authors make recommendations for further research.