Psychiatric Training Programs Research Articles

Psychiatry in the Land of the Sphinx: Is an Overseas Elective Justified?

The aim of this paper is to provide a descriptive account of a 6-month sabbatical in Egypt to highlight the diversity of benefits in incorporating such activities within psychiatric training programs. An overseas elective offers an exciting practical opportunity to broaden one's experience of transcultural psychiatry and obtain a perspective on mental illness and its cultural variations. It also promotes an understanding of health service management in low and middle income countries and offers the opportunity to contribute to their healthcare at minimal cost. However, the elective needs to be undertaken at an optimal period of a psychiatrist's career and with minimal disruption to local services. Training schemes and employers could provide more opportunities for interested trainees, with specified projects and aims in mind, to undertake such electives so that they can begin to develop expertise in treating a particular cultural group. In turn, this would go a long way to producing culturally capable psychiatrists for the wide range of ethnic minorities in Australia.

Learning by doing: a novel approach to improving general practitioners' diagnostic skills for common mental disorders

Two strategies have been proposed to increase the rather low recognition rate of common mental disorders in primary care: (1) the use of screening instruments and (2) extensive psychiatric training for general practitioners. We have chosen a "middle-of-the-road" approach to teach general practitioners by means of a time-saving psychiatric training programme how to make their own psychiatric diagnoses. This pilot study aimed at assessing the acceptance of this programme, its impact on general practitioners' knowledge of 12 ICD-10 disorders - depressive, anxiety and alcohol-related disorders - and the short-term persistence of the knowledge acquired. The training programme consisted of two 3-hour sessions four weeks apart. An educational instrument, a short interview named TRIPS (Training for Interactive Psychiatric Screening), a shortened and adapted form of PRIME-MD, was used to train single-handed general practitioners in Vienna, Austria. TRIPS had to be used by the participants in daily practice in between sessions. Five weeks after the second training session a follow-up evaluation was held to assess the persistence of the knowledge acquired. The perceived usefulness of TRIPS was assessed by a short questionnaire. Knowledge was assessed by a separate 15-item questionnaire. Of the 31 participating general practitioners 26 attended all three sessions. There was a significant increase in the mean number of correctly answered questions between baseline (5.5 of 15) and session two (9.8; p<0.0001), and a further increase between the second and the follow-up session (11.3; p<0.05). Also, general practitioners rated TRIPS as a practical and useful tool for family practice and stated that its use met with patients' approval. The format chosen was successful in its intended educational endpoints. According to participants TRIPS is appropriate for the family practice situation and is accepted by patients.

Psychiatric Disability Assessments

&lt;P&gt;Psychiatric disability evaluations or independent medical evaluations (IMEs) are performed for civil forensic purposes to address economic issues, or other concerns with economic consequences, including return to work vs. disability pension decisions, and appropriateness of treatment, safety, and discrimination issues. They are taught infrequently in general psychiatric residency training programs, and they occupy less than a page in standard textbooks of psychiatry. Specialized references contain a more complete examination of these issues.&lt;/P&gt; &lt;H4&gt;ABOUT THE AUTHOR&lt;/H4&gt; &lt;P&gt;Dr. Williams is in private practice. Address correspondence to C. Donald Williams, MD, CGP, 402 E. Yakima Ave., Suite 330, Yakima, WA 98901, or e-mail &lt;a href="mailto:cdonald@aol.com"&gt;cdonald@aol.com&lt;/a&gt;. &lt;/P&gt;&lt;P&gt;The author disclosed no relevant financial relationship.&lt;/P&gt;

Publication bias - a reason for the decreased research output in developing countries

Objective: The low level of mental health research from low and middle-income countries, as measured by the relative lack of publications in high impact journals is an inaccurate reflection of research being conducted in these countries. The number of manuscripts submitted for publication is a more accurate measure of the research activities. The study aimed to quantify the number of manuscripts submitted and accepted for publication in high impact psychiatric journals. Method: Editors of 8 psychiatric journals were requested information on the number of manuscripts submitted, the country of origin and the number of manuscripts accepted for publication from April to September 2005. Results: 5,2 % of all manuscripts submitted for publications were from low and middle income countries. The overall acceptance rate of manuscripts was 16,6 % but the acceptance rate for low and middleincome countries was 4,8 %. Manuscripts from high-income countries had a 5,8 times greater odds (2,5 - 4,9) of being accepted for publication than an article from a low and middle-income country. Conclusion: Both the quantity and quality of research from low and middle-income countries must be improved. Interventions to improve the quality of research must be directed towards capacity development, increasing international collaborations, mentoring of researchers and establishing formal psychiatric epidemiology training programs to equip researchers with skills to produce papers that meet the publication criteria of reviewers. Studies must become more innovative and include the changing paradigm in epidemiological research. Manuscripts that describe innovative studies have a greater chance of being published.

The community psychiatrist of the future

The potential contributions of the community psychiatrist are described, via the interdisciplinary team, to individuals and families dealing with mental illness, and to the communities of the future, along with the opportunities for, and barriers to, effective teamwork and community collaborations. Health and medical training systems still provide perverse incentives deterring psychiatrists from becoming adequately trained in community psychiatry and full members of interdisciplinary teams, and skilled partners in improving the mental health of the whole community. Sources of potential role conflict should be resolved, and advantages of community collaborations, interdisciplinary leadership, support of teamwork, division of labour, cross-fertilization and hybrid vigour should be realized. Truly essential and desirable roles and the skill base of community psychiatrists in interdisciplinary teams and local communities could be developed and strengthened by changes in basic and advanced psychiatric training, and by psychiatric professional bodies and training programmes placing greater emphasis and value upon the roles of a community psychiatrist.

Psychiatric Rehabilitation Course Content in Rehabilitation Counseling Programs

The number and level of psychiatric counseling training programs in 47 CORE-accredited programs across the country was examined in this study. Approximately 85% of the programs surveyed thought that graduates should provide information to consumers about the psychiatric rehabilitation process. With respect to an introductory course in psychiatric rehabilitation, sample results indicated that 40% programs offered a course, 36% offered related partial course content, and 19% offered no course or content at all. Results of studies indicate a need for more psychiatric counseling content. Suggestions are given to enable the inclusion of psychiatric rehabilitation content into existing rehabilitation counseling programs.

Challenges and Opportunities in Teaching Psychopharmacology During Residency Training

Article AbstractBecause this piece has no abstract, we have provided for your benefit the first 3 sentences of the full text.The rationale for a "model" psychopharmacologycurriculum is clear: (1) the knowledgeand skills of many recent graduatesof psychiatric training programs regardingclinical psychopharmacology leave room forimprovement; (2) the amount of new informationto learn is rapidly expanding; and(3) available resources to teach this materialare dwindling, as clinical and other academicdemands deflect faculty from their teachingroles. Hence, a model curriculum, includingactual teaching guidelines and materials developedby experts, that could be used in multipleeducational sites around the countrywould seem to be a natural evolution for thefield.1A "Model Curriculum" was developed inthe 1980s2 and updated and revised severaltimes in the 1990s3 and early 2000s.4,5†‹

Teaching Collaboration Between Pharmacotherapist and Psychotherapist

Collaborative treatment, in which psychotherapy provided by one clinician is integrated with pharmacotherapy provided by another clinician, has been explored from various angles. This article addresses the teaching of collaborative pharmacotherapy to psychiatric residents. The author's observations derive from a selective review of the literature and from conclusions drawn from practicing and teaching collaborative therapy in a psychiatric residency program. Limited formal attention has been given to defining the skills psychiatrists should acquire in order to collaborate effectively. The author describes the rationale for providing collaborative treatment, identifies the skill set that facilitates collaborative treatment, and outlines an approach to teaching and assessing these skills. The practice of collaborative treatment is an important psychiatric role. The core skills of collaborative treatment should be explicitly taught and residents' competency in these skills should be evaluated in psychiatric training programs.

Teaching Medication Compliance to Psychiatric Residents: Placing an Orphan Topic Into a Training Curriculum

Medication compliance is an orphan topic. Training in the understanding and management of noncompliance does not neatly fall within the domain of psychopharmacology, nor does it clearly fit into other core curricula areas, such as clinical interviewing or psychotherapy training. The objective of this article is to increase awareness about this vagueness among academic psychiatrists and to offer a suggested curriculum to facilitate implementation. The authors present a curriculum covering major aspects of the theory and practice of compliance. The proposed curriculum is divided into five core components that can be used together or separately. These components are: 1) definition of compliance and noncompliance; 2) understanding how compliance depends on efficacy; 3) assessment of compliance and noncompliance; 4) the importance of the therapeutic alliance; and 5) pharmacological and psychosocial strategies to improve compliance. These five sections can be modified into specific lectures that are added to ongoing psychopharmacology, psychiatric interviewing, or psychotherapy courses. A careful review of the American Board of Psychiatry and Neurology (ABPN) core curriculum found no mention of medication compliance/adherence as a specific training goal, and our residency program, like many others, did not have a specific course that focused on this issue. To address this omission, the authors designed and taught a five-session course for PGY-III and PGY-IV psychiatry residents that specifically addressed assessment and management of noncompliance. It was piloted in the 2003-2004 academic year. The course was very well received and formed the basis of this material presented in this review and discussion. The principles of understanding, assessing, and managing medication compliance should be a part of the core curriculum for every psychiatric residency training program.

Psychiatric Training Program Engagement With the Pharmaceutical Industry: An Educational Issue, Not Strictly an Ethical One

To analyze the educational and ethical issues involved in interactions between departments of psychiatry and the pharmaceutical industry. The author analyzes the history of attitudes toward pharmaceutical companies, various conflicting ethical principles that apply, and areas of confluence and conflict of interest between psychiatric education and the drug industry. These attitudes are applied to a variety of specific types of interactions with representatives of the pharmaceutical industry. A number of forms of interaction are found to be on balance, ethical, and productive, while others are found to be problematic. Careful analysis of both ethical and educational dimensions can produce meaningful and constructive involvement with the pharmaceutical industry, without inevitably corrupting psychiatric educators.

Warning

Warning

Time for change to a developmental perspective in the education and training of psychiatrists

The practice of psychiatry in the UK has for most of its existence been focused on the needs of adults, and it has been with this age group in mind that educational programmes and training needs have been formulated. It is not surprising, then, that the content and shape of psychiatric training programmes have followed this clinically-driven pattern. Trainees entering psychiatry begin their clinical careers working with adults or older people and are expected to obtain a grasp of the fundamental clinical tools of the trade working with these populations. Experience with younger people's mental health is explicitly excluded in the first year of training, emphasising the primacy of adulthood in the approach to learning clinical mental health skills.

Testing psychodynamic psychotherapy skills among psychiatric residents: the psychodynamic psychotherapy competency test.

Training in psychodynamic psychotherapy remains a core requirement of psychiatric residency training programs, yet no standard measures of competency exist to document residents' knowledge and skills in this area. To address this issue, the authors developed a written test of applied knowledge of psychodynamic psychotherapy technique and theory, the Psychodynamic Psychotherapy Competency Test. Their goal in this article was to evaluate the validity of this test. The test was given to a group of 36 psychoanalytic experts and 206 residents in their second, third, and fourth psychiatric postgraduate years from 10 programs located in different parts of the United States. Program directors provided information on the number of hours of psychodynamic didactic teaching, supervision, and resident-conducted psychodynamic psychotherapy and rated the psychodynamic psychotherapy skills of residents in their fourth postgraduate year on the basis of cumulative supervisor reports. There were significant differences in test performance between residents and faculty experts and between residents in their second and fourth postgraduate years: more advanced residents and experts had progressively better scores. The mean scores of fourth-year residents in different programs differed significantly, but the scores of second-year residents did not. Higher test scores were positively associated with both number of hours of resident-conducted psychotherapy and number of hours of supervision. Among fourth-year residents, test scores correlated significantly with program director evaluations. This initial study supports the validity of the Psychodynamic Psychotherapy Competency Test as well as the feasibility of testing psychotherapy skills in a standardized fashion.

How to make journal clubs interesting

Almost all psychiatric training programmes include a journal club. These clubs are experiencing a revival as a result of the introduction of a critical review paper into Part II of the MRCPsych examinations. Successful clubs are generally those with a single designated leader and mandatory attendance; provision of food is also helpful. A number of possible formats are discussed, designed to make the club an entertaining and stimulating experience.

Competency assessment in the McMaster Psychotherapy Program.

In January 2001 the Residency Review Committee (RRC) mandated that all psychiatric training programs must demonstrate competency in five forms of psychotherapy. Assessing competency in psychotherapy is a complex and difficult task, with many conceptual and practical issues needing consideration before programs are implemented. Existing competency-based programs can offer some assistance to institutions struggling with this issue. This paper discusses competency assessment in the McMaster Psychotherapy Program, paying special attention to instruments used in the evaluation process. Preliminary results with respect to resident satisfaction with the Program and resident competency in certain therapies are also discussed.

Psychiatry in La-La Land

Back to table of contents Previous article Next article LettersFull AccessPsychiatry in La-La LandHarvey R. Greenberg, M.D.Harvey R. GreenbergSearch for more papers by this author, M.D.Published Online:1 Aug 2003https://doi.org/10.1176/appi.ps.54.8.1166AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: I doubt that Hollywood is hell-bent on persecuting the psychiatrist more than other professionals. Just about every trade imaginable has been dismantled on the silver screen—for example, lawyers in All of Me, corporate leaders in Wall Street, even veterinarians in Beethoven and Beethoven's 2nd. Other medical specialties have been savaged in films such as Not as a Stranger, Arrowsmith, and Kings Row, the film in which a double amputation perpetrated by an unscrupulous surgeon provoked Ronald Reagan's famous wail, "What happened to the rest of me?"One of the principal reasons psychiatrists—and therapists of whatever stripe—are often meat for La-La Land's grinder is that we're used by screenwriters more often than any other type of doctor to advance a film's narrative. "Cinetherapists" enable flashbacks, set the scene for dramatic confrontation and revelation, illuminate motivation, and so forth.The difficulties posed by Hollywood's distorted views of psychotherapy for potential or current patients have been delineated at length by Krin and Glen Gabbard in their pioneering study, Psychiatry and the Cinema (1). The Gabbards speculate that positive stereotypes hold as many pitfalls as negative ones—expecting that a therapist will cuddle you when you're down, like the hugmeisters of Ordinary People and The Prince of Tides, or that a therapist will be instantly available to relieve your existential angst anytime and any place, with no other patients visible and with rarely a mention of fees."Applied psychoanalysis" has achieved a modest but significant role in film theory (2,3). Exploring a patient's associations to one movie or another can certainly be productive. Innovative techniques are being developed to employ cinema in therapy even as I write. So far, so good. But, pace Dr. Mark's ironic hopefulness, ham-fisted pictures like A Beautiful Mind are indeed now beginning to be used as a convenient means of teaching residents about "diagnostics, patient-clinician relationships, [and] treatment." I submit that it isn't by chance that this dubious and trivializing project arises at the very time when many psychiatric training programs seem more centered around molecules than the suffering psyches connected to them (2).

Teaching ethics of psychopharmacology research in psychiatric residency training programs.

American psychiatric residency training programs are now required to teach principles of research ethics. This task is especially pressing in light of evolving guidelines pertaining to human subjects, including psychiatric patients, especially when psychopharmacology is involved. Residents need to understand principles of research ethics and implications of roles of psychiatrists as investigators and clinicians. We consider major contemporary ethical issues in clinical psychiatric research, with an emphasis on psychopharmacology, and implications of addressing them within residency training programs. We reviewed recent literature on ethical issues in clinical research and on medical education in bioethics. This report considers: (1) an overview of current training; (2) perceived needs and rationales for training in research ethics, (3) recommended educational content and methods; (4) issues that require further study (including demonstration of acquired knowledge, practice issues, and the treatment versus-investigation misconception); and (5) conclusions. Recommended components of residency training programs include basic ethical principles; scientific merit and research design; assessment of risks and benefits; selection and informed consent of patient-subjects; and integrity of the clinical investigator, including definition of roles, conflicts-of-interest, and accountability. Evaluation of educational effectiveness for both trainees and faculty is a recommended component of such programs. We recommend that psychiatric training include education about ethical aspects of clinical research, with a particular emphasis on psychopharmacology. These activities can efficiently be incorporated into teaching of other aspects of bioethics, research methods, and psychopharmacology. Such education early in professional development should help to clarify roles of clinicians and investigators, improve the planning, conduct and reporting of research, and facilitate career development of much-needed clinical investigators in psychiatry.

Effectiveness of a Psychiatric Rehabilitation Training Program for Community Services Staff

Abstract The implementation of a pilot-project for training community services staff in empirically-validated psychiatric rehabilitation techniques is described. Thirteen staff from six community settings were trained in how to conduct the UCLA Social and Independent Living Skills modules and Personal Effectiveness Training (PET) groups. The investigators report on the effectiveness of utilizing a brief seminar-type training format with one-year consultation follow-up. Results provide evidence for the effectiveness of such a training procedure. Specifically, results indicated that participants' knowledge of materials taught in the course increased and that during a three to twelve month post-training follow-up period, the number of new groups implemented increased substantially. The importance of designing similar training programs to disseminate psychiatric rehabilitation technologies to community settings is emphasized.

A psychiatric training programme for general practitioners in primary health care in Egypt

A psychiatric training programme for general practitioners in primary health care in Egypt

Psychodynamic Psychiatry in Clinical Practice, 3rd ed.

Psychodynamic Psychiatry in Clinical Practice, 3rd ed.