Psychiatry Fellowship Research Articles

1.55 Child and Adolescent Psychiatry Fellowship Program Directors: A Descriptive Analysis

1.55 Child and Adolescent Psychiatry Fellowship Program Directors: A Descriptive Analysis

3 My BURMESE DAYS

This presentation explores the implementation in 2019 and 2020 of a child and adolescent psychiatry fellowship in Myanmar, a developing country with no children’s mental health training or formal resources.

33.5 CBT Supervision in Child and Adolescent Fellowship Training: A Milestone-Based Competency Model

The Accreditation Council for Graduate Medical Education (ACGME) mandates CBT training during child and adolescent psychiatry fellowship. Despite the training requirement, there is a lack of universally accepted standard methods for CBT supervision and training of psychiatrists. The high variability of CBT supervision across programs poses a challenge in meeting the milestone competencies designated by the current accreditation system for child and adolescent fellowships. We will share the milestone competency-based model for CBT training developed using well-defined principles of adult learning.

63.4 Functional Neurologic Disorders: A Child and Adolescent Psychiatry Fellow’s Experience in a Unique Clinical Elective

Although common in the pediatric patient population, there lacks a formalized clinical curriculum for child and adolescent psychiatry fellows to learn how to recognize, diagnose, and treat those with functional neurological disorders (FNDs). As a result, fellows graduate with limited comfort in assessing and treating this patient population who respond well to treatment. This presentation will: 1) discuss the current state of education of FNDs in clinical education during child and adolescent psychiatry fellowship; 2) explore the challenges and opportunities of an FNDs elective from a fellow’s perspective; and 3) identify the essential skills that a child and adolescent psychiatry fellow should learn to be comfortable in the evaluation and treatment of FND cases.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

51.2 Improving Access and Quality of Psychodynamic Psychotherapy Supervision for Child and Adolescent Psychiatry Fellows at Oregon Health & Science University: Follow-up Report

This presentation will provide an overview of the incorporation of psychodynamic psychotherapy supervision at a child and adolescent psychiatry fellowship training program, highlighting the benefit of a quality improvement process addressing new and ongoing challenges during the second year of this project.

3.51 School-Age Diagnostic ASD Assessments: A Pilot Clinic for Child and Adolescent Psychiatry Fellows

The supply of providers with adequate knowledge and training in ASD is failing to meet the current demand. This leads to long waits for diagnostic assessment and medical diagnosis and a delay in the provision of services. We piloted a diagnostic clinic for school-aged children with low-complexity, clinically unambiguous ASD to expedite access to services ahead of full neuropsychological testing. This process included creating a workflow, training tools, and documentation templates to facilitate learning during rotations at the Center for Autism Spectrum Disorders (CASD) and to improve the skill set and confidence of providers to perform diagnostic assessments of ASD.

63.3 Functional Neurological Disorders: Clinical Training for Child and Adolescent Psychiatry Fellows

The increase in youth with functional neurologic symptom disorders (FNSDs) during the COVID-19 pandemic has highlighted the need to increase psychiatrist training in FNSD treatment to meet community needs. Struggles in identifying psychiatrists who treat FNSDs are reported by both pediatric neurologists and patients’ families. Child and adolescent psychiatry fellows and fellowship programs have expressed an interest in more FNSD education beyond the consult liaison services experience. One of the most expedient ways to address these multiple challenges is to create specific FNSD training opportunities for child and adolescent psychiatry fellows.

14.3 Training Child and Adolescent Psychiatry Fellows to Care for Youths With Neurodevelopmental Disorders

There is an increasing need to provide evidence-based psychiatric care for youth with neurodevelopmental disorders and mental illness (NDDs/MI). MI occurs at a high rate in youth with NDDs, with estimates ranging from 30% to 50%. Rates of NDDs in the psychiatric setting are unknown, although studies suggest they are elevated while also representing underutilization of care due to a dearth of mental health services for this population. The interplay of NDDs, comorbid medical complexity, and mental illness impacts both presentation and treatment, making management more difficult without appropriate training.

1.49 Diversity, Equity, and Inclusion (DEI) Quality Improvement (QI) Toolbox as an Actionable Means to Effect Justice-Oriented Clinical Change

1.49 Diversity, Equity, and Inclusion (DEI) Quality Improvement (QI) Toolbox as an Actionable Means to Effect Justice-Oriented Clinical Change

James C. Harris, MD (1940-2021).

Sadly, Dr.James C. Harris passed away at his home in April 2021, peacefully and in the presence of his loving wife Catherine DeAngelis, MD, shortly after he was diagnosed with pancreatic cancer. He was born in Birmingham, Alabama, and received his medical degree in 1966 from the George Washington University School of Medicine in Washington, DC. This followed a year of internship at the Children's Hospital of Los Angeles in California and a residency in Pediatrics at Strong Memorial Hospital University of Rochester in New York State. He came to Johns Hopkins as a Senior Assistant Resident in Pediatrics in 1972, and it is then that Hopkins became his professional home, which he never left. He proceeded to complete his general psychiatry residency and child and adolescent psychiatry fellowship at Johns Hopkins as well. Dr.Harris was Professor of Psychiatry and Behavioral Sciences, and of Pediatrics, former Director of Child and Adolescent Psychiatry, founding director of the Developmental Neuropsychiatry Program at Hopkins and the Kennedy Krieger Institute, and a beloved mentor to so many of today's leaders in child and adolescent psychiatry. Jim was indeed a distinguished clinician, educator, scholar, investigator, and advocate; he was also my training director, mentor, and friend.

A Pregnant Pause: System-Level Barriers to Perinatal Mental Health Care.

Perinatal mood and anxiety disorders, defined as mood and anxiety disorders during pregnancy and the year following birth, affect one in five pregnant and postpartum individuals in the United States and are associated with substantial morbidity and mortality for both pregnant individuals and their infants. Despite this tremendous prevalence and associated disease burden, the overwhelming majority of those affected do not receive treatment. Although prior research has identified several patient-level barriers to effective treatment, the contributions of system-level factors have been underappreciated. We present a pilot study using a simulated patient approach to describe the accessibility and affordability of mental health care through the 18 clinics affiliated with U.S. reproductive psychiatry fellowship programs. Based on our experience, a prospective patient seeking care from these 18 clinics without a prior referral would only have been successful half of the time-and even then may have to wait as long as 2 months for an initial appointment. These data underscore the need for clinicians, public health professionals, and institutions to address system-level barriers that undermine effective referrals for care, including implementing "warm-handoffs" to mental health providers and ending practices that restrict appointments to existing patients within a health care system. They also reinforce the importance of contemporary federal policy efforts to address maternal health, particularly among low-income and racially minoritized communities. Key policies include expanding postpartum insurance coverage, which plays a critical role in reducing insurance disruptions that can undermine the accessibility of mental health care and other vital health services.

Psychodynamic Child and Adolescent Psychiatry and the Future of Our Field

The Accreditation Council for Graduate Medical Education (ACGME) requirements for child and adolescent psychiatry training require that child and adolescent psychiatry fellows demonstrate competence in psychodynamic psychotherapy.1 Child and adolescent psychiatry educators may turn to JAACAP to find up-to-date advances in psychodynamic psychotherapy to teach. However, the term psychodynamic appears to be hard to find, literally. A search on https://www.jaacap.org/ of past issues for psychodynamic2 resulted in 4 articles published in the past year, but none have the word psychodynamic in the title. Three articles describe newer evidence-based forms of psychotherapy: brief focused parent-infant psychotherapy, adolescent-focused therapy, and mentalization-based treatment. These are are described in their respective articles as "psychodynamic-based," as "psychodynamically informed," and having "historical roots in psychodynamic psychotherapy." As none are specifically titled psychodynamic therapy, it is unclear whether teaching these modalities would satisfy the ACGME requirement of competence in psychodynamic psychotherapy. Comparatively, this linguistic dilution does not seem to affect cognitive-behavioral therapy (CBT), another psychotherapy required by the ACGME1: specialized branches such as trauma-focused CBT, CBT for psychosis, and CBT for insomnia all retain the parent name of CBT. Therefore, it is important to define psychodynamic.

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

Two APA Members Selected for Fellowship in Japanese Psychiatric Organization

Two APA Members Selected for Fellowship in Japanese Psychiatric Organization

Addressing Health Equity and Racism Through a Hispanic Psychiatry Fellowship.

The scarcity of bilingual psychiatrists, as well as appropriate mental health services for populations with limited English proficiency, has led to inequitable health outcomes. A fellowship program was developed, which draws from a clinical model staffed by bilingual (Spanish-English) professionals from racial-ethnic minority groups, to address access to care and the structural determinants of health. This new Hispanic Psychiatry Fellowship focuses on health inequality and racism in policy and leadership, clinical care for Spanish-speaking patients, cultural psychiatry, recovery, forensics, substance use, and education. This column describes the program's development, first 2 years of implementation, and feasibility indicators for use in creating similar programs.

Sessions Reflect Intersection of New Orleans History and Plight of Vulnerable Citizens

Sessions Reflect Intersection of New Orleans History and Plight of Vulnerable Citizens

MAINTAINING ROBUST SERVICE UTILIZATION IN GERIATRIC PSYCHIATRY DURING THE PANDEMIC: SUPPORT FOR THE FEASIBILITY OF TELEMEDICINE

<h3>Introduction</h3> Background: Since the beginning of the COVID-19 pandemic, telemedicine became ubiquitous. Telemedicine is defined as the use of information technology to provide the delivery of health care from a distance [1]. The World Health Organization (WHO) has defined it as critical to the delivery of health care services, including when distance is a limiting factor to obtain care [2], and there is evidence that telemedicine in a geriatric population is equivalent to in-person care [3]. Since COVID-19, HIPAA approved telemedicine platforms have provided a viable alternative to traditional face to face appointments. In particular, with the growing elderly population especially affected by the virus, there has been an increase in the use of telemedicine, which is a critical adaption for a geriatric population. For example, telemedicine removes barriers related to transportation (geriatric patients are more likely than general adult patients to rely on caregivers for transportation) and more easily facilitates caregiver reporting of collateral information (geriatric patients are more likely to have loved ones involved in their care and care decisions). Importantly, there has been a misconception that elderly patients would find the technology itself to be a barrier to care [4] – though in this new era of COVID-19, most patients, including geriatric patients, are now "Zoom" competent. Aims/Objectives: To examine the feasibility and potential sustainability of a geriatric telemedicine psychiatry practice, it is important to compare the rates of utilization before and after this surge in telemedicine in March 2020. This comparison is an important first step, as decreased rates of utilization subsequent to the ubiquity of telemedicine would be suggestive of systemic barriers to care (e.g., technology). If, on the other hand rates are comparable, then this would begin to shed light on telemedicine services sustaining beyond the pandemic. Therefore, we compare the number of clinical service encounters provided in a Geriatric Psychiatry Fellows' Clinic, specifically comparing the total number of visits in the year prior to the pandemic, and the total number of visits in the same timeframe that includes the onset of the pandemic. <h3>Methods</h3> The Emory productivity dashboard was utilized to determine the number of geriatric patients that arrived in the Geriatric psychiatry fellow's clinic in the academic periods before and during the pandemic for outpatient medication management and follow up visits. <h3>Results</h3> The geriatric clinic maintained a robust outpatient service. Review of the data showed that during the pre-pandemic months of February 2019 to January 2020, the number of patients that visited the geriatric psychiatry clinic in-person was 247. Consistently, during the pandemic year from February 2020 to January 2021, the number of patients that arrived in the same clinic and saw the same providers as the transition to telemedicine was in progress, was 297. <h3>Conclusions</h3> Our geriatric service continued to deliver services via telemedicine during the pandemic despite the assumed challenges, particularly related to technology, among elderly patients. Future research can continue to examine rates of utilization into 2021 and 2022 and incorporate patient ratings of satisfaction, to continue to examine if the benefits of a geriatric telemedicine practice are at least equivalent, if not potentially superior to, traditional in-person medicine. <h3>This research was funded by</h3> There are no funding to report

A Survey of Geriatric Psychiatry Fellows and Program Directors: Specialty Choice, Program Choice, and Program Quality.

This study explored factors influencing a physician's choice to pursue geriatric psychiatry fellowship training from fellow and program director perspectives to improve recruitment into this critical need specialty. Questionnaires were sent to the 54 fellows and 79 fellowship program directors of programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) available through the American Association for Geriatric Psychiatry (AAGP) listserv. A 5-point Likert scale (strongly disagree, disagree, neutral-undecided, somewhat agree, strongly agree) was used to score and rank these questionnaires. Thirty-three program directors (42%) on the AAGP listserv and 24 (44%) of all ACGME accredited fellows responded. The clinical quality of the faculty (Fellows 92%, Program Directors 92%) and the fellowship's national reputation (Fellows 75%, Program Directors 88%) were most highly ranked by both. Fellows ranked proximity to family (79%) high (2nd) in their program choice, while ranking workload, salary, and visa issues as low. This study emphasizes that family and cultural/ethnographic considerations, along with the core values of a training program, remain highly valued by trainees, and should inform structural changes to incentivize training, and enhance the inherent quality of fellowship programs.

Gender and Racial Disparity Among US Forensic Psychiatry Fellows: Broken System by Default.

Diversity enhances the performance of the healthcare system by providing better patient outcomes and reducing physician burnout. In this study, we explored the gender and racial trends in the recruitment of women and racial minorities into forensic psychiatry fellowship programs in the US. Retrospective data analysis was performed by utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME)'s annual Data Resource Books from the year 2007 to 2021. Demographic data, including gender and race, were extracted for forensic psychiatry fellows. The number of female trainees increased significantly to become a majority, i.e., 58.8% of all forensic psychiatry trainees in 2020-2021 were female compared to 27.78% of women forensic psychiatry fellows in 2007-08. Between 2011-12 and 2020-2021, there was a relative increase in White (Non-Hispanic), Asian/Pacific Islander and Black (Non-Hispanic) forensic psychiatry fellows, by 54.75%, 114.4%, and 0.36% respectively. Despite the overall increase in the numbers of ethnic minorities in US psychiatry residency and fellowship programs, racial minorities remain significantly under-represented in forensic psychiatry fellowship programs. We need to revise policies to promote underrepresented minorities in medicine (URMM) in forensic psychiatry.