Canadian Psychiatry Research Articles

Considerations for continuing professional development in the post-pandemic era: national experiences from psychiatry

Introduction: COVID-19 led to rapid innovations in continuing professional development (CPD). We surveyed Canadian Psychiatry CPD directors to understand the pandemic’s impact and to identify effective practices. Methods: In fall 2021, an online 31-item survey was created iteratively based on discussions among CPD educators and disseminated to CPD program leaders at 17 Canadian medical schools through the Council of Psychiatry Continuing Education (COPCE). We collected information on each CPD program, adaptations associated with pandemic restrictions, and intentions regarding future delivery of CPD. Results: Nine responses were received. COVID-19 led to a shift to virtual CPD delivery, with creative and transformative strategies to maintain engagement and online security. Virtual CPD was associated with an increase in attendance and decrease in costs. Many respondents anticipated that virtual or hybrid modalities would continue post-COVID-19. Conclusion: The pandemic led to a pivot to virtual delivery of Psychiatry CPD programming. Hybrid delivery will likely be the prevalent mode of future CPD programming, requiring more technological, financial, and human resources to tackle potential challenges. In times of rapid adaptation, a national network of CPD directors can provide an important venue for knowledge exchange about innovations and effective practices and build capacity of expertise.

Gender disparity among psychiatry departments awarded Canadian Institutes of Health Research grants: a retrospective study

ObjectiveAlthough medical institutions aim to promote equity within the workplace, gender disparities persist in academic psychiatry. Previous evidence indicates that women in psychiatry encounter gender-based barriers to career advancement, resulting...

Spirituality and Religion in Canadian Psychiatric Residency Training: Follow-up Survey of Canadian Psychiatry Residency Programs.

This study assesses the availability and nature of psychiatry resident training in religion and spirituality across Canada. Evidence shows that religious and spiritual topics are important to psychiatric patients and that psychiatrist competence in approaching these topics is correlated to whether they have had previous training in them. Prior studies have shown a lack of training in religion and spirituality in Canadian psychiatry programs and recommended incorporation into psychiatry residency curricula. A survey was conducted, asking questions about the amount and type of training in religion and spirituality that was accessible to psychiatry residents in the 17 psychiatry residency programs in Canada. One response was sought from each institution by reaching out to the institutions' program directors and requesting that a knowledgeable faculty member complete the survey. Out of 14 responding psychiatric residency programs, 2 reported no training opportunities in religion or spirituality, 4 reported only voluntary training opportunities that were largely resident directed, and 8 reported mandatory training. The number of Canadian psychiatry residency programs providing mandatory training in religion and spirituality has increased since the prior published survey in 2003 and there are fewer programs reporting no training at all. However, overall, Canadian psychiatry institutions still place less emphasis on religious/spiritual education than recommended by the international psychiatric community. Several Canadian institutions report well-received implementation of curricula on religion and spirituality that could inform other Canadian institutions.

A Qualitative Investigation of Burnout and Well-being Among Faculty and Residents in a Canadian Psychiatry Department.

This study used semi-structured interviews with faculty and residents in psychiatry to inform a qualitative, process-based understanding of well-being and related concepts, as well as to identify and critically explore strategies for maintaining well-being in psychiatry. Using interpretive description as a qualitative research methodology, semi-structured phone interviews were conducted with 12 faculty (nine clinical and three non-clinical) and five residents in a Canadian psychiatry department between September and December 2019, prior to the onset of the COVID-19 pandemic. Interviews were transcribed, coded, and subsequently analyzed for themes by the research team. Fourteen women and three men completed the study, consisting of nine faculty members, five psychiatry residents, and three non-clinical PhD scientists. Four themes were developed from the interview data: (1) The nature of working in academic psychiatry, (2) professional identity as a double-edged sword, (3) feelings of isolation and powerlessness in the system, and (4) strategies to support well-being. In the absence of many qualitative perspectives on well-being in academic psychiatry, the findings of this study can be used as a first step to inform future interventions and meaningful institutional change around well-being in psychiatry. The findings may help to enable conversations about well-being that embrace humanity and vulnerability as essential components of professional identity in psychiatry and provide opportunities for open discussion and support.

Assessing research competency development in Canadian psychiatry residency programs: A systematic review and future directions.

We aimed to conduct a systematic review to identify curricular and educational interventions to build research competency among Canadian psychiatry residents and fellows transitioning to the competency-by-design framework. The PRISMA guidelines were followed, searching five databases from their inception to February 2023 for relevant evaluation-type studies exploring research competency among psychiatry residents and fellows. We appraised thestudy's quality using the Joanna Briggs Institute's risk of bias tool for observational designs. Overall, 36 original articles met our inclusion criteria. Surveys (n = 10) showed that participation in scholarly research, quality improvement, or educational projects relevant to psychiatry is needed in most residency programs. However, these vary significantly across programs; few need direct research experience for residency completion. The interventions spanned four categories: externally funded comprehensive research training programs (n = 5); resident research tracks (n = 11); workshops and seminars (n = 7); and specific modules (n = 3). Reported outcomes included overall program ratings, research output, and career trajectory. The quality of most studies was low because of the lack of controls or validated metrics for evaluating outcomes. While many studies have explored best practices in research curricula, the current literature does not inform competency-based models for Canadian psychiatry residency programs incorporating research training requirements. Further description is needed from Canadian psychiatric training bodies regarding appropriate curricula, milestones, and metrics for evaluating research competencies.

Interest in Rural Training Experiences in a Canadian Psychiatry Residency Program.

With the large majority of mental health professionals concentrated in urban settings, people living in rural and remote areas face significant barriers to accessing mental health care. Recognizing that early exposure is associated with future practice in rural and remote locations, we sought to obtain baseline data regarding interest in expanded rural residency training opportunities and academic teaching. In March 2021, all psychiatry residents at the University of Alberta (UofA) were invited to complete a 19-question survey that included both closed-ended (age, gender, year of study, rural experience, interest in rural training, etc.) and open-ended questions (challenges, barriers, academic training, and other comments). A reflexive thematic analysis using an inductive and semantic approach was completed on the comments. 36 residents completed the survey (response rate, 75%). Significant associations were identified between previous rural training experience and interest in rural psychiatry training and practice. Female residents and junior residents were significantly more interested in rural training experiences than their counterparts. Thematic analysis noted concerns with the financial costs of accommodation and transportation, high service burden, continuity of care and isolation from their cohort. Many were interested in academic sessions on the realities of rural practice; approaches to collaborative care; and strategies on culturally relevant care; specifically Indigenous health. The University of Alberta has highlighted a focus on improving equity and accountability; and with a large rural catchment region; the residency program is well positioned to make training adjustments to diversify training. Based on our findings we have incorporated rural rotations for incoming residents and have developed further rural academic content to support our responsiveness and accountability to the rural and northern communities we are committed to serving. Future research should review the impact of rural training exposure in medical specialties on recruitment and retention as well as on healthcare outcomes.

Innovations in Mentorship: Implementation of a Mentorship Program in Psychiatry That Encourages Reflection on Intersectionality and Wellness

AimsMentorship supports professional development, academic outcomes, and wellness. Effective mentorship can develop careers of faculty through greater access, and equity, diversity, and inclusion (EDI). At a Department of Psychiatry in Canada, a recent survey showed more than 60% faculty were without mentors and would like to have one; and 75% mentors received no training nor resources to support mentorship. The aims of the Psychiatry Mentorship Program are to facilitate sharing of expertise, self-reflection, and career growth among faculty.MethodsA Mentorship Working Group was formed in 2020–2021. The Mentorship Program design was evidence-informed by a literature review and consultation with other mentorship programs. While a traditional primary mentor-mentee relationship is at the core of the program, the mentorship dyad will be further supported by mentorship groups focused on academic roles, areas of scholarship and career development (e.g., clinician scientists; wellness) or specific groups (e.g., members of a minority group). The program offers an online mentor/mentee matching process, based on faculty self-reported scholarship interests, academic roles, and preferences related to social identity. A three-year evaluation strategy, guided by a logic model, is integrated throughout program implementation. Mentees and mentors are expected to complete a baseline assessment upon program enrolment and annual follow-up questionnaires. Continuous quality improvement of the Mentorship Program will be based on user experience collected via focus groups and interviews where perception and concepts, such as intersectionality, wellness, and EDI, will be explored.ResultsThe Mentorship Program pilot was launched in fall 2021 with mentor and mentee virtual orientation workshops offering best practices and opportunities for reflection on challenges that may be encountered during a mentoring relationship. Thirty-six faculty mentors and 60 newly appointed faculty mentees attended the orientation workshops respectively. Workshop evaluations were positive. For example, 93% participating mentors indicated that the workshop met its learning objectives; 80% rated the workshop as excellent. Eighty-seven percent of mentor participants reported increased awareness of best practices to support successful mentorship, including the use of contracts and developmental plans, and indicated the workshop stimulated reflection and learning.ConclusionThis preliminary positive feedback suggests faculty found the orientation workshops on mentorship to be useful and thus represents an effective mode of facilitating implementation of a department wide mentorship program. We anticipate the implementation of our mentorship program could be adapted to other academic settings.

Senior Residents' Perceived Competence in Evidence-Based Treatments for Major Depressive Disorder.

The current study aims to assess the self-reported competence of graduating psychiatry residents in Canada to provide pharmacotherapy and psychotherapy for major depressive disorder as recommended in national practice guidelines. Canadian psychiatry residents who participated in an optional national review course to prepare for licensing were anonymously surveyed regarding their experience and competence in providing treatments recommended by the 2016 Canadian Network for Mood and Anxiety Treatments guidelines. The majority (89%, 130/146) reported competence in ≥ 5 medication monotherapies (e.g., selective serotonin/norepinephrine reuptake inhibitors, bupropion, mirtazapine) and ≥ 3 adjuncts (e.g., mirtazapine, second-generation antipsychotics). While 76% expressed interest in practicing multiple psychotherapeutic modalities, only 47% reported self-assessed competence in delivering multiple modalities. Only 42% reported pharmacological competence (≥ 5 monotherapies, ≥ 3 adjuncts) and competence in ≥ 2 psychotherapies. Only 9% reported competence in offering medication, psychotherapy, and electroconvulsive therapy. Less than two-thirds endorsed sufficient didactic teaching (58%) or supervision in pharmacotherapy (50%) for treatment-resistant depression. Canadian psychiatry residents report competence in prescribing many first-line medications. However, only a minority report competence in prescribing medications and competence in psychotherapies and/or electroconvulsive therapy. Given known biases in assessments by self-report, real-world competence may be even lower. This study identifies gaps between national practice guidelines and the comfort of the emerging psychiatric workforce in delivering recommended treatments. These gaps in resident competence may lead to under-use of effective treatments for depression. Residency programs should consider how to improve resident competence in providing the full range of evidence-based treatments for depression.

Educating Residents About Cannabis: Results of a Needs Assessment.

Cannabis use by people receiving mental health services is increasingly common, yet many psychiatrists have limited knowledge about the pharmacology of cannabis or its clinical effects. Though clearly relevant to residency training, there is little information on unmet needs and current teaching practices to guide educators who wish to develop a cannabis curriculum. To address this, the authors interviewed key informants and surveyed Canadian psychiatry program directors and residents about cannabis education seeking to determine appropriate content and approaches to inform curriculum development. The authors conducted semi-structured interviews with 7 experts in addictions and psychiatry education. Findings were then used to develop a needs assessment survey about cannabinoid teaching in residency education. Residents and program directors from psychiatry training programs in Canada were invited to complete the online survey. Key informants believed residents are not adequately prepared to manage substance use disorders and recommended additional training be dedicated to cannabinoid education, including cannabis use disorder. Seven program directors and 27 residents completing the survey made recommendations for curriculum content and design. Pharmacology, neurobiology, and managing cannabis use disorders were identified as the most important topics for inclusion. A majority of respondents rated 5 of 8 proposed learning objectives as not supported by existing curriculum and supported an integration of key topics across training years. Respondents identified an urgent need for programs to offer an integrated cannabis curriculum. As cannabis use increases internationally, these findings may be useful to inform curriculum development in other countries.

Psychiatry and mental health in the medical community

Dr Varapravan completed medical school in Bangalore, India, then continued her medical training in Canada and finished her residency at Western University for psychiatry. Originally interested in ENT, her exposure to psychiatry in Canada caused her to change tracks and to pursue psychiatry. She is currently a part of the Assessment Unit at Parkwood Institute and Healthcare, had previously worked as UGE Psychiatry Clerkship Coordinator, and is heavily involved in exposing the students of Schulich to psychiatry. We had the opportunity to talk to Dr Varapravan about psychiatry as a field, the psychiatry clerkship program, and about burnout in the medical community.

Pharmacogenetic Testing Options Relevant to Psychiatry in Canada: Options de tests pharmacogénétiques pertinents en psychiatrie au Canada.

To identify and assess pharmacogenetic testing options relevant to psychiatry in Canada. Searches of published literature, websites, and Standard Council of Canada's Laboratory Directory were conducted to identify pharmacogenetic tests available in Canada. Identified tests were assessed on 8 key questions related to analytical validity, accessibility, test ordering, delivery of test results, turnaround time, cost, clinical trial evidence, and gene/allele content. A total of 13 pharmacogenetic tests relevant to psychiatry in Canada were identified. All tests were highly accessible, and most were conducted in accredited laboratories. Both direct-to-consumer and clinician-gated testing were identified, with turnaround times and cost ranging from 2 to 40 days and CAD$199 to CAD$2310, respectively. Two tests were supported by randomized controlled trials. All tests met minimum gene and allele panel recommendations for psychiatry, but no 2 panels were identical. No test was unequivocally superior to all other tests. Pharmacogenetic testing in Canada is readily available but highly variable in terms of ordering procedures, delivery of results, turnaround times, cost, and gene/allele content. As such, it is important for psychiatrists and other health-care providers to understand the differences between the available tests to ensure appropriate selection and implementation within their practice.

The Hidden Curriculum in Ethics and its Relationship to Professional Identity Formation: A Qualitative Study of Two Canadian Psychiatry Residency Programs

The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within all postgraduate specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation.

Attitudes of Psychiatry Residents in Canadian Universities toward Neuroscience and Its Implication in Psychiatric Practice.

Despite recent advances in neuroscience highlighting its potential applications in the assessment and treatment of psychiatric disorders, the training of psychiatrists in neuroscience is lacking. However, it is not clear to what extent Canadian trainees are interested in further learning and using neuroscience in their daily clinical practice. This study explored the attitudes of Canadian psychiatry trainees with regard to neuroscience education and training by asking them to assess their own understanding of neuroscience and the perceived relevance of neuroscience knowledge to effective psychiatric practice. An online questionnaire was sent to psychiatry residents at Canadian universities. This questionnaire consisted of self-assessments of neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics. One hundred and eleven psychiatry residents from psychiatry residency programs at Canadian universities responded to this survey. Participants represented trainees from all 5 years of residency. Almost half of all trainees (49.0%) reported their knowledge of neuroscience to be either "inadequate" or "less than adequate," and only 14.7% of trainees reported that they feel "comfortable" or "very comfortable" discussing neuroscience findings with their patients. 63.7% of Canadian trainees rated the quantity of neuroscience education in their residency program as either less than adequate or inadequate, and 46.1% rated the quality of their neuroscience education as "poor" or "very poor." The vast majority of participants (>70%) felt that additional neuroscience education would be moderately-to-hugely helpful in finding personalized treatments, discovering future treatments, destigmatizing patients with psychiatric illness, and understanding mental illness. Canadian trainees generally feel that their neuroscience knowledge and the neuroscience education they receive during their psychiatry residencies is inadequate. However, as the first step for any change, the majority of future Canadian psychiatrists are very motivated and have a positive attitude toward neuroscience learning.

Euthanasia requests in a Canadian psychiatric outpatient clinic: A case series part 2 of the McGill University euthanasia in psychiatry case series

The Canadian province of Quebec enacted in 2014 a legislation that permitted medical assistance in dying (MAID) under specific conditions and the rest of Canada followed suit in June 2016. In this article, which is the second in a set of case series of requests for MAID in Canadian psychiatry, we present the cases of two patients who made a request for MAID to their treating psychiatrist in an outpatient clinic. While one is advanced in age and suffering from intense physical and psychic pain with little if any psychiatric comorbidity, the other is a young and medically healthy woman who nonetheless suffers from extensive psychiatric comorbidity. This article discusses both cases in light of recent scientific literature and case law that is slowly emerging in Canada, focusing on the concepts of the end of life and its legal definition as well as psychic suffering and its management in those wishing to receive physician-assisted dying. In our conclusion, we stress the need to clarify the definition of treatment resistance, the necessity to determine each physician's role when many are involved, as well as the importance of treating psychic pain holistically, which can sometimes require going beyond standard psychiatric care.

Reflections on the Life and Career of Émigré German-Canadian Psychiatrist Sebastian Klaus Littmann (1931-1986).

This article explores the life and career of Sebastian K. Littmann. He was a foundational figure of the University of Calgary's Department of Psychiatry in his role as its second chair and, before this, as an influential administrator at Toronto's Queen Street Mental Health Centre and Clarke Institute during a transitional period in the 1970s-1980s. According to McGill University's Heinz Lehmann, this transitional period was when the field of psychiatry underwent an identity crisis that threatened to dissolve the discipline and see its functions increasingly filled by counsellors, neurologists, and primary physicians. Littmann's professional background and training in Edinburgh was followed by periods of community work in New York, which-by the time he immigrated to Canada-predisposed him to favour a humane and community-based approach to psychiatric work; this approach encompassed the cultural variations that were increasingly characterizing North America's urban social landscape. His compassionate and progressive approach to treatment was remarkable in light of his troubled and deprived upbringing in Nazi-era Germany. The present sketch of Littmann's personal and professional biography serves to highlight the ways that major historical events and large-scale migration movements, which affected Central Europe, impacted the development of Canadian psychiatry and, by extension, individual Canadians in the twentieth century.

Gender Differences in Research Productivity among Academic Psychiatrists in Canada.

Gender inequity in academic medicine persists despite increases in the number of women physicians. We sought to explore gender differences in research productivity for academic psychiatrists in Canada. In a cross-sectional study of the 3379 psychiatrists in all 17 university departments of psychiatry in Canada, research productivity, as measured by the h-index and number of publications, was compared between women and men using a negative log binomial regression model to generate relative rates (RRs), adjusted for career duration (aRR). Findings were stratified by academic rank, institution region, and institution size. A subanalysis of those with 10 or more publications was conducted as a proxy for identifying physicians on a research track. Women (43% of the sample) had a lower mean (standard deviation) h-index than men (2.87 [6.49] vs. 5.31 [11.1]; aRR, 0.62; 95% confidence interval [CI], 0.54 to 0.72). Differences were significant only for junior faculty and not for associate and full professors. Comparison by number of publications followed a similar pattern (aRR, 0.46; 95% CI, 0.39 to 0.55). Among those with 10 or more publications (n = 721), differences between men and women were smaller than in the overall cohort for both the h-index (aRR, 0.77; 95% CI, 0.68 to 0.87) and number of publications (aRR, 0.62; 95% CI, 0.53 to 0.72). Gender differences in research productivity at the national level in academic psychiatry in Canada support a call to adopt a more systematic approach to promoting equitable opportunities for women in research, especially in early career, to improve diversity and enhance future psychiatric research and discovery.

Attitudes to antipsychotics: a multi-site survey of Canadian psychiatry residents

PurposeThe purpose of this paper is to identify the training needs of the next generation of psychiatrists, and barriers in prescribing first-generation antipsychotics (FGAs), long-acting injectable (LAIs) antipsychotics and clozapine.Design/methodology/approachAn electronic survey was sent to psychiatry residents (N= 75/288, 26 percent) at four Canadian residency programs in late December 2017. The survey was based on an instrument originally developed at the University of Cambridge and consisted of 31 questions in 10 content domains.FindingsNearly 80 percent of residents were aware that FGAs and second-generation antipsychotics (SGAs) have similar efficacy. However, extra-pyramidal symptoms and lack of training experience were the leading concerns associated with the prescribing of FGAs. Although over 90 percent of residents felt confident about initiating an oral SGA as a regular medication, only 40 percent did so with FGAs. Confidence with initiating LAIs and clozapine was 60 and 61 percent, respectively.Practical implicationsThe survey highlights the need for better training in the use of FGAs, clozapine and LAIs. These medications can be effectively used in providing patients with the most appropriate evidence-based treatment options to improve treatment outcomes, while ensuring that these resources are not lost to the future generations of psychiatrists.Originality/valueThe survey may be the first of its kind to assess antipsychotic prescribing attitudes in Canadian psychiatry residents in multiple sites.

Advancing Integrated Care through Psychiatric Workforce Development: A Systematic Review of Educational Interventions to Train Psychiatrists in Integrated Care.

Integrated or collaborative care is a well-evidenced and widely practiced approach to improve access to high-quality mental health care in primary care and other settings. Psychiatrists require preparation for this emerging type of practice, and such training is now mandatory for Canadian psychiatry residents. However, it is not known how best to mount such training, and in the absence of such knowledge, the quality of training across Canada has suffered. To guide integrated care education nationally, we conducted a systematic review of published and unpublished training programs. We searched journal databases and web-based 'grey' literature and contacted all North American psychiatry residency programs known to provide integrated care training. We included educational interventions targeting practicing psychiatrists or psychiatry residents as learners. We critically appraised literature using the Medical Education Research Study Quality Instrument (MERSQI). We described the goals, content, and format of training, as well as outcomes categorized according to Kirkpatrick level of impact. We included 9 published and 5 unpublished educational interventions. Studies were of low to moderate quality and reflected possible publication bias toward favourable outcomes. Programs commonly involved longitudinal clinical experiences for residents, mentoring networks for practicing physicians, or brief didactic experiences and were rarely oriented toward the most empirically supported models of integrated care. Implementation challenges were widespread. Similar to integrated care clinical interventions, integrated care training is important yet difficult to achieve. Educational initiatives could benefit from faculty development, quality improvement to synergistically improve care and training, and stronger evaluation. Systematic review registration number: PROSPERO 2014:CRD42014010295.

The evolving considerations of psychiatry in Canada

The evolving considerations of psychiatry in Canada

From foundations to frontiers: the status and perception of formulation teaching in Canadian English-speaking psychiatry residency programs

Aim of the studyFormulation is considered a key competence that should be taught during psychiatry training in residency. The scientific literature indicates shortcomings in teaching this clinical skill such as a lack of standardization and clear guidelines. The main objective of this research was to examine psychiatry residents’ perception regarding teaching of formulation in Canadian psychiatry residency programs.Subject or material and methodsAll Canadian psychiatry program directors in English programs were emailed a link for the study survey. The survey had a mix of closed and open-ended questions. With the exception of one Program Director, the survey link was distributed by all of the Program Directors. 116/661 (17.5%) of residents completed the survey.ResultsOverall, results of this survey indicated that residents did not feel very competent in their formulation skills, although they felt this was an important ability. Residents mostly learn it through individual supervision or through mentoring with a senior resident.DiscussionResidents suggested a more structured approach in teaching formulation, as well as adding a small group format or workshops.ConclusionsThis research could provide guidance to educators in developing new curricula in the context of the upcoming transition to the competence-based framework by the Royal College of Physicians and Surgeons of Canada.