Psychiatric Residency Education Research Articles

Videos for Psychiatric Education: Could Deidentification Technology Make it Possible to Use Video Recordings of Patients for Psychiatric Education?

The field of psychiatry has been limited in its use of patient videos for educational purposes because essential facial information must be obscured to protect patient privacy, confidentiality, and dignity. This article calls attention to emerging technologies for deidentification of patients in video recordings while still preserving facial expression. Fully anonymized videos could be used to augment the education of psychiatric residents and for continuing education of the psychiatric workforce. This article suggests projects that deidentification technology could make possible; it also outlines some complex problems that would need to be addressed before the field could use this potentially transformative technology.

Trends in Psychiatric Residency Education and Practice From 1944 to 2019: A Loving, Informal, and Highly Personal Review Served With Gently Roasted Sacred Cow.

In celebration of the American Psychiatric Association's 175th anniversary, the author presents an overview of major trends in psychiatric residency education over the past 75 years, from 1944 to 2019, using narrative review and personal perspectives infused with occasional irreverence. In both 1944 and today in 2020, psychiatric educators have been challenged by having too many patients, too few clinicians, too few teachers, and too little knowledge. Over the course of these years, psychiatric residency training has adapted and evolved in response to major ongoing shifts in psychiatric practice patterns shaped by economic, social, and cultural forces, academic regulations and processes, roles for psychiatry vis-à-vis other health and mental health professions, diagnostic and scientific models, psychotherapeutic, psychosocial, and biological treatment paradigms, methods of education, and methods of educational evaluation. Trends in psychiatric education have moved from loosely and irregularly structured clinical and didactic curricula to much more highly regulated and bureaucratized program requirements and processes, from faith-based beliefs and practices to increasing reliance on evidence-based faith, from the availability of Federal funds directly supporting stipends and teachers to the disappearance of those funds, from few to increasing numbers of women entering psychiatry (and all of medicine), and persistent concerns about recruiting excellent and diverse US medical school graduates into residency. Psychiatric educators will continue to help generate, synthesize, sustain, and disseminate meaningful narratives and to prepare future generations of psychiatric residents armed with iteratively better myths and conceptualizations about human nature, purpose, and our place in the universe-and about how to better confront and reduce psychiatric suffering through psychotherapeutic, psychosocial, and biological treatment strategies. Trends are onward and upward.

Hungarian Psychiatrists' Recognition, Knowledge, and Treatment of Catatonia.

DSM-5 introduced a number of modifications to the catatonic syndrome, which is now closer to Kahlbaum's original concept. The aim of the present study was to assess residents' and qualified psychiatrists' knowledge, experience and views about the treatment of catatonia in acute psychiatric care in Budapest, Hungary. Authors approached all psychiatric units that provide acute psychiatric care (N = 11) in Budapest and invited all psychiatrists and residents, who consented, to participate in the survey, completing a 13 items questionnaire. Ninety-eight fully qualified and trainee psychiatrists completed the questionnaire. Although 84.7% of the participants rated their knowledge of catatonia as moderate or significant, there were a number of obvious mistakes in their answers. Most catatonic signs and symptoms were not identified by almost 50% of the respondents and the frequency of catatonia was also underestimated. The views of the majority of the participants reflected the Kraepelinian concept, in which catatonia is primarily associated with schizophrenia. Although benzodiazepines are widely recommended as a first line treatment for catatonia, only 69.4% of participants chose them as a treatment option. In view of its clinical importance, catatonia deserves more attention in the education and training of medical students and psychiatric residents.

Cost-Containment: Impact on Psychiatric Residency Education

Cost-Containment: Impact on Psychiatric Residency Education

Education on Genetics for Psychiatric Residents

Two papers by Hoop et al. (1) and Winner et al. (2) in this issue of Academic Psychiatry call attention to the increasingly important need for psychiatric residents to receive a thorough grounding in the role of genetics and genomics in psychiatry as it will be practiced in the future. Taken together, the papers suggest that the topic of genetics is currently slighted in the curricula of many U.S. psychiatric residency training programs. An understanding of genetics will be critical to future psychiatrists not only for a fuller understanding of the etiology of disease entities, but also for an appreciation of the cause and treatment of psychiatric symptoms. Brain imaging techniques and genetics together are already providing correlative data to shed light on variability of presentation of some illnesses. For example, apolipoprotein E epsilon4 carriers with Alzheimer’s disease have been shown to have greater atrophy in the parietal cortex bilaterally and in the right hippocampus than noncarriers with Alzheimer’s disease (3). Surprising developmental discoveries involving the genetics of neurodegeneration are also being made. As an example, children and adolescents carrying the epsilon4 allele of the apolipoprotein E gene have been found to have, on average, thinner entorhinal cortices as demonstrated by MRI than do those carrying other alleles (4). Differences in the tendency to pay more attention to positive or negative elements in the environment have been shown to have a genetic basis. Individuals homozygous for the long allele for the promoter region of the serotonin transporter gene (5-HTTLPR) were recently found to show a marked bias to selectively pay attention to affectively positive material and to selectively avoid affectively negative material in their environment relative to those carrying at least one of the long alleles for the promoter region, meaning the homozygous long-allele carriers seem more likely to “look on the bright side,” which may explain their lower susceptibility to mood disorders than short-allele carriers (5). Research is ongoing on the interaction between trauma and genetic vulnerability to trauma. Variability in the promoter region of the serotonin transporter gene may be associated with the degree of emotional resilience shown by different individuals exposed to trauma (6). Integrating the most up-to-date scientific information into psychiatry training has been a priority since residencies in psychiatry were introduced. Genetics has been cited as a topic of critical importance in the curriculum of psychiatric residencies in several papers published over the past 15 years (7–9); the publication of two papers on the topic in this issue highlights the recognition of the need for the presence and standardization of a strong didactic curriculum in genetics in residencies. The Psychiatry Program Requirements of the Accreditation Council for Graduate Medical Education (10) currently state, “The didactic curriculum must include the following components: . . . the biological, genetic, psychological, sociocultural, economic, ethnic, gender, religious/spiritual, sexual orientation, and family factors that significantly influence physical and psychological development throughout the life cycle” (emphasis added). We believe that the professional associations of individuals involved in psychiatric residency education, including the American Association of Directors of Psychiatric Residency Training (AADPRT) and the Association for Academic Psychiatry (AAP) can play a useful role in helping to develop standard curricula in genetics by incorporating educational materials such as suggested readings, videos, and audiovisual presentations that training programs of all sizes could use to teach the fundamentals of psychiatric genetics to their residents. The two articles published in this issue of Academic Psychiatry together describe the opportunity that currently confronts residency training programs: to successfully educate psychiatrists about the rapidly expanding field of psychiatric Received and accepted November 6, 2009. The authors are affiliated with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee, Wisconsin. Address correspondence to Joseph B. Layde, M.D., J.D., Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, 8701 Watertown Plank Rd., Milwaukee, WI 53226; jlayde@mcw.edu (e-mail). Copyright © 2010 Academic Psychiatry

P02-212 Differences in the psychotherapeutic orientation among Dutch and Belgian psychiatric residents

The psychotherapeutic education of psychiatric residents remains a poorly studied area. Until now, there have been a few mainly theoretical or local researches, mainly rooted in a psychoanalytical descriptive framework, and many normative guidelines. One could almost believe that psychiatrists are spending very little time considering their own social determinations. So we did a large scale study in 2006, among Belgian and Dutch residents. This allows us to present a few first results: notably the difference in orientation according to some demographic variables (a.o. religious background and language) and major dissimilarities concerning referential authors for Dutch, Flemish and Walloon residents. These objective points corroborate the idea that psychiatry is not (yet) an homogeneous field in Europe, but is subject to considerable cultural variations.

Overcoming Stigma: Involving Families in Medical Student and Psychiatric Residency Education

The primary purpose of this article is to present a possible mechanism for increasing communication about psychiatric matters such as diagnoses, treatment, and stigma between the physicians, including psychiatrists, and the families of persons with mental illness through a NAMI presentation. Included are a description of a stigma-reduction presentation to junior medical students; information about an instrument to evaluate pre- and postclerkship student attitudes; and a discussion of consumer and family participation in the education of first-year psychiatric residents. Moving the NAMI presentation from the freshman year to the junior year rotation and first year resident experience has been more efficacious, possibly because clinically oriented students and medical and psychiatric residents seem more receptive to communication about stigma and the family situation. The educational collaborations between advocacy groups and academia show promise for increasing communication about psychiatric disorders, treatment, and stigma issues between families and psychiatric patients.

Reintegrating Family Therapy Training in Psychiatric Residency Programs: Making the Case

Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education. After reviewing recent trends in the field that call for a more prominent role for couples and family therapy in residency training, the authors summarize the literature on family therapy training in psychiatry over the past four decades. Because biopsychosocial systemic thinking provides a powerful framework for looking at multiple levels of systems and their interrelationships, developing a strong family-systems perspective and acquiring basic "family skills" represent the minimum requirement for general psychiatric training. The authors argue for the addition of couples and family therapy to the five required psychotherapy competencies defined by the residency review committee in psychiatry. A rationale for a family-systems training model is proposed with the objective of encouraging residency programs to integrate the family-systems model more fully into their curricula.

The Professor of Public Psychiatry Model in Ohio: The Impact on Training, Program Innovation, and the Quality of Mental Health Care

The Ohio Department of Mental Health and five of Ohio's University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio's mental health services. Strategies integral to Ohio's Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio's community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as "Coordinating Centers of Excellence" to accelerate adoption of evidence-based practices in community settings.

Clinical Methods in Transcultural Psychiatry

Back to table of contents Previous article Next article Book ReviewFull AccessClinical Methods in Transcultural PsychiatryCarl C. Bell, M.D.Carl C. BellSearch for more papers by this author, M.D.Published Online:1 Dec 1998https://doi.org/10.1176/ps.49.12.1630AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This book has a global perspective on transcultural psychiatry. It does not focus just on major U.S. minority populations. Accordingly, I recommend it. As human migration increases and international business continues to grow, American psychiatrists will need to become more versed in transcultural psychiatry.The text is chock-full of useful pearls and illuminating examples of how culture affects behavior and the treatment of mental illness. It includes meaningful paradigms that are easy-to-remember guideposts for transcultural psychiatric efforts. The book embodies the goals of transcultural psychiatry by seeking to explore the epidemiology of mental illness in different cultures, identifying cultural factors facilitating the development of mental illness, describing forms of treatment practiced in different cultures, and comparing different attitudes toward mentally ill persons in different cultures.The book's first section provides an overview of transcultural psychiatry, explores the relationships between personality and culture, and addresses mental health aspects of voluntary and forced immigration. Given the large numbers of refugees who are at risk because of traumatic experiences, clinicians need to know how to assess, formulate, and treat patients who are culturally different from themselves.Section 2 recommends, among other considerations, that practitioners attend to the cultural aspects of the spiritual realm. An outstanding chapter addresses mental health professionals' attitudes toward traditional healing. Curanderismo, espiritismo, santeria, umbanda, vodou, obeah, and Southern black rootwork are thoroughly explained. Further, the conceptual bases of alternative healing systems, covering natural, mystical, animistic, and magical causation, are discussed.Also in this section is a unique, exemplary chapter on how New Zealand Maori adapt to mainstream Western medicine. Another commendable original chapter, focusing on psychiatry in an English inner-city community, gives some poignant examples of how the culture of poverty and religion influences behavior. A third novel chapter focuses on psychiatry in Arabian Gulf communities. These contributions illuminate the stark contrasts between American culture and other cultural contexts. They heighten our awareness of our own culture and how culture influences behavior and the practice of psychiatry in various contexts. Another outstanding chapter points out how different ethnic groups respond to various medications. The section concludes with a chapter by authors who are appropriately critical of Western psychiatry's disdain for religion as a negative influence on mental health.Section 3 highlights the role of culture in psychiatric assessments and advises that the "patient's explanatory model" of the psychiatric problem be explored. Useful treatment approaches range from interpreting somatic symptoms using several different levels of meaning to establishing a therapeutic alliance across cultures. Section 4 has distinctive chapters on somatization patterns among Mediterranean migrants and on religion and magic in Italy.The following section, on education and training, presents curricula for transcultural training of mental health professionals. DSM-IV cultural formulations are highlighted in hopes they will provide leadership for psychiatric residency education in transcultural psychiatry. Section 6 explains how children and families in cultural transition are influenced by differential rates of acculturation, culture clashes, culture-bound developmental myths, cultural adaptation, and a culture's impact on identity. A model of transcultural family therapy is provided.The bottom line is that there is a lot to learn from this book.Dr. Bell is clinical professor of psychiatry at the University of Illinois and president and chief executive officer of the Community Mental Health Council in Chicago.edited by Samuel O. Okpaku, M.D., Ph.D.; Washington, D.C., American Psychiatric Press, 1998, 458 pages, $65 FiguresReferencesCited byDetailsCited byNone Volume 49Issue 12 December 1998Pages 1630-1630 Metrics History Published online 1 December 1998 Published in print 1 December 1998

Training psychiatric residents in addiction

Substance abuse is an undertreated and endemic condition among psychiatric patients. Despite this, psychiatrists historically have been poorly trained in the recognition and treatment of addictive disorders. Over the past 20 years, however, concerted efforts have led to improved substance abuse education for medical students, psychiatry residents, fellows in substance abuse, and teaching faculty. The urgency of recent changes in the health care system combined with trends in clinical research demands improved medical education on the outpatient management of substance abuse disorders. This paper reviews substance abuse training in psychiatric residency education, and our intended readers are faculty members responsible for teaching addiction psychiatry and residents interested in learning about the subject. In the Introduction, education of psychiatrists in addiction is briefly reviewed, and the relevant issues and societal pressures are identified. In the second section, topics and suggested educational strategies are presented for teaching psychiatric residents about the pathology and treatments associated with substance abuse. In the final section, some obstacles to addiction psychiatry training are addressed and conclusions are presented.

Redefining the Role of Family Therapy in Psychiatric Residency Education

In order to learn how psychiatry residents use family therapy training from residency in their clinical practices after graduation, the authors interviewed graduates from a large program in the metropolitan Northeast and a small program in the rural South. Graduates from both programs were using family therapy theory and skills to a greater extent than they had anticipated during residency. However, these skills were being used primarily to treat individual patients and to solve clinical and administrative problems in settings other than traditional couple and family therapies. Based on the findings, the authors suggest a restructuring of content and redefinition of role for family therapy training in psychiatry residencies.

Redefining the general psychiatrist: values, reforms, and issues for psychiatric residency education.

The structure and content of general psychiatric residency education must be redesigned to ensure the continued relevance of the profession of psychiatry as managed care and cost containment become more influential in the health care delivery system. The general psychiatrist in this new health care environment must be prepared to participate in a multidisciplinary team of health care professionals, have expertise in treating complex cases that often combine physical and psychological disorders, critically examine the role of psychotherapy, acknowledge patients as active participants in treatment, and integrate clinical and financial decision making. Reformed psychiatric residency curricula should include an expanded range of training settings, preparation for a variety of clinical roles, practice in developing strategies for improved service utilization, and opportunities to develop expertise in neuropsychopharmacology, to work with patients with serious mental illness, and to practice integration of psychotherapy with other core skills. In addition, redesigned curricula should enhance residents' appreciation of the interaction between patients' everyday behavior and mental illness and should provide training in supervision and in utilization review. Redefinition of the structure and organization of psychiatric residency education will depend on the resolution of several key issues such as length of training, financing of graduate medical education, and the role of subspecialization programs.

A ten-year update of administrative relationships between state hospitals and academic psychiatry departments.

In a follow-up to a survey ten years earlier, the authors investigated current administrative relationships between academic departments of psychiatry and state hospitals. A 20-item questionnaire was sent to the chairs of the 110 medical school departments of psychiatry with accredited psychiatric residencies. Eighty-two departments, or 75 percent, responded. Seventy-one percent of the respondents reported that their department had a relationship with a state hospital; 79 percent of these relationships involved the education of psychiatric residents. Most respondents rated the quality of the relationship favorably (4 or 5 on a 5-point scale). Almost all respondents believed that residents can obtain a high-quality education in a state hospital. More than half of the departments responding to a question about the importance of a state hospital rotation rated it of major importance in their residency program. Many medical school departments of psychiatry remain closely involved with state hospitals and recognize the hospital as an important part of residents' education. Administrators have gained much experience about how to develop and implement mutually beneficial relationships.

Administrative relationships between community mental health centers and academic psychiatry departments: a 12-year update.

The authors investigated the administrative relationships in 1990 between medical school departments of psychiatry and community mental health centers (CMHCs). A 20-item questionnaire was sent to the chairpersons of the 110 medical school departments of psychiatry with accredited psychiatric residencies. Sixty-nine percent of the chairpersons responded to the questionnaire. Sixty-eight percent of the responding chairpersons reported that their departments had relationships with CMHCs, and 90% of these relationships involved the education of psychiatric residents. Most responding chairpersons described the quality of their existing CMHC relationships as good to excellent. In the most common type of relationship reported the CMHC was used as a setting for resident education. The vast majority of responding chairpersons stated that quality resident education is possible in a CMHC, and about two-thirds of the responding chairpersons with CMHC relationships involving residency education rated the CMHC rotation as of major importance to their residency programs. CMHCs continue to be an important and valued component of the educational experience for many psychiatric residents, and many departments of psychiatry have recognized the advantages and benefits of CMHCs for residency training. There are now considerable data on how a relationship between a medical school department and a CMHC should be structured to achieve maximum benefit for both the department and the CMHC.

Outpatient consultation-liaison psychiatry: A valuable addition to the training of advanced psychiatry residents

With current health care reimbursement conditions and recent research denoting the important relationship between mental health status and poor functioning, especially in medically ill patients, one would think that consultation-liaison (C-L) psychiatry would have an increasingly viable role in the outpatient health care sector. However, only a small number of outpatient C-L clinics are reported and recently several of these have folded. These outpatient C-L clinics can follow different clinical models and have the potential, especially at the residency and fellowship training levels, for interesting and useful educational opportunities. This paper describes a recently founded outpatient C-L clinic—the Medical Illness Clinic—in a university medical center's department of Psychiatry. We highlight the structure of the clinic, the kinds of patients seen, and focus on the unique educational residency training opportunities this setting presents. The results of clinic rotation evaluations by residents are also presented. We conclude with recommendations for more exploration of this clinical model and evaluation of its utility in psychiatric residency education.

Geriatric Psychiatry: Training Guidelines and Their Application

Geriatric psychiatry is now a mandatory part of psychiatric residency education in Canada. Educational requirements in geriatric psychiatry were updated by the Royal College of Physicians and Surgeons of Canada in 1988, and guidelines were developed in more detail in 1989 by the Section on Geriatric Psychiatry of the Canadian Psychiatric Association (CPA). These guidelines are presented here together with a survey, conducted in the fall of 1991, of all 16 Canadian psychiatry residency programs. Thirteen of the training centres now require residents to have a formal rotation in geriatric psychiatry, generally three months in length. Residents are exposed to elderly patients in other services, such as consultation/liaison, but these services may not include formal teaching in geriatric psychiatry. Most programs have a seminar series in geriatric psychiatry and have training guidelines similar to those of the CPA. However, it is not clear how closely these are being followed, since it was felt in almost one-third of all programs that there was an insufficient number of teachers to fulfill the training requirements. In addition, a number of training directors felt that the objectives were too comprehensive to be met in the three month period. Earlier studies in the field are reviewed, implications of the current findings are discussed, and suggestions are made for further research.

The Role of Current Literature in Psychiatric Residency Education

Residents in 18 academic psychiatry residency programs were surveyed to assess the role of reading the current literature in residency education. Results are reported for 277 residents, a 39% response rate. Time spent on independent reading, use of the medical library, and use of computer searches of medical databases all reflected a relatively low level of autonomous educational activity. Reference to current literature was not an integral part of the educational climate of the residency programs surveyed. The implications of the findings, both for psychiatry residency education and for continuing medical education, are discussed.

New problems in changing state psychiatric hospitals.

This paper discussed the changing role of state psychiatric hospitals within the mental health system. Important factors included state demographics, the education and training of psychiatric residents, and the revolutionary changes taking place within the medical care system in America. The author emphasized the importance of viewing specific approaches to system problems from a total mental health system perspective.

Current Concerns in Psychiatric Residency Education: Education, Quality, Manpower, and Funding

Current Concerns in Psychiatric Residency Education: Education, Quality, Manpower, and Funding