Psychiatry Residency Training Programs Research Articles

Burnout Among Psychiatry Residents and One Program's Approach to Creating a Culture of Wellness.

Psychiatry residency training includes unique characteristics that can predispose trainees to burnout, including vicarious traumatization, prevalence of patient suicide and violence in the workplace, and social stigma surrounding mental health. For the purposes of this article, the authors examine these contributing factors and address how psychiatry residency training programs, specifically the Kaiser Permanente Oakland program, are responding to these unique challenges with wellness initiatives. Initiatives to promote wellness at Kaiser Permanente Oakland include a resident and faculty-led wellness committee, work-hour limits, reasonable call schedules, a robust mentorship program, funded social and networking events programs, and comprehensive mental health services.

Preliminary Program Guide: Sunday, May 21, 2023

Preliminary Program Guide: Sunday, May 21, 2023

Cleveland’s Safety Net Hospital Builds 112-Bed Psychiatric Facility

Back to table of contents Previous article Next article ProfessionalFull AccessCleveland’s Safety Net Hospital Builds 112-Bed Psychiatric FacilityMark MoranMark MoranSearch for more papers by this authorPublished Online:9 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.35AbstractThe new hospital and an enlarged training program mark the largest expansion of behavioral health services in northeast Ohio in 30 years.MetroHealth Hospital in Ohio, founded in 1837, is the safety net hospital for Cleveland and Cuyahoga County, serving more than 300,000 patients, two-thirds of whom are uninsured or covered by Medicare or Medicaid. Last October, the hospital opened the MetroHealth Behavioral Health Hospital to replace the 20-bed psychiatric unit in the old hospital. The Cleveland MetroHealth Behavioral Health Hospital opened last October and will eventually have 112 inpatient beds, cutting the region’s inpatient deficit by more than 50%.Cleveland MetroHealth HospitalThe psychiatry residency training program at MetroHealth received approval from the Accreditation Council for Graduate Medical a (ACGME) to add three new training slots per year, which will increase the total number of residents from 20 to 32. Like the state-funded expansion of the training program at the University of Iowa (see “Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations”), the developments at MetroHealth are evidence that states and municipalities are responding to the shortage of mental health professionals and the need to invest in expanding the psychiatric workforce. Last November, the Cuyahoga County Council approved the use of $5 million from its Opioid Mitigation Fund to construct the $42 million hospital. The council’s $124 million fund is derived from settlements with opioid manufacturers. According to the U.S. District Attorney’s Office for Northeastern Ohio, the county saw a 1,000% increase in opioid deaths between 2007 and 2016. There were 653 overdose deaths in the county in 2022, according to the County Medical Examiner’s Office. Cheryl Wills, M.D., director of child and adolescent psychiatry at MetroHealth, said the new hospital and the expansion of the training program are the result, in part, of a 2018 needs assessment conducted by the hospital’s strategic team. Taking into account existing resources in the region, the assessment showed that Cuyahoga County was short 200 inpatient psychiatric beds. The new hospital is expanding incrementally—40 adult beds became available when the hospital opened in October. Separate 20-bed units for adolescents, patients with substance use disorders, and geriatric patients are expected to open this year.Cleveland MetroHealth Hospital“MetroHealth has a rich history of serving all people, regardless of ability to pay,” said Wills, who is also APA’s Area 4 trustee. “But we were consistently referring people out for mental health treatment because we had only 20 beds. By expanding with the new hospital to 112 beds, we are addressing 50% of the deficit, a huge step.” Raman Marwaha, M.D., the residency training director at MetroHealth, said the developments there mark the largest expansion of behavioral health services in northeast Ohio in 30 years. “When I joined MetroHealth eight years ago, I had a waiting list of 18 months,” said Marwaha, who is president of the APA Caucus of International Medical Graduates. He said the new hospital is moving incrementally toward reaching the total of 112 beds—40 adult beds became available when the hospital opened last October, and at press time a psychiatric-medical unit and a four-bed psychiatric intensive care unit were expected to open. “The plan is in the next six months to open more beds—a 20-bed adolescent unit, a 20-bed addiction unit, and a 20-bed geriatric unit.” Marwaha said that residents in the expanded program, which will be located at the new hospital, will have training rotations in schools, integrated group practices, and the county correctional facility. Attracting residents and, importantly, faculty to help supervise residents is critical. Wills did some detective work and discovered an Ohio state loan repayment program for which physicians who work at MetroHealth would qualify—a lesson, Wills said, for other institutions and localities. “It’s important to think creatively and strategically and to learn about existing available resources,” she said. “When I started at MetroHealth in March last year, one of my concerns was recruitment of the best faculty possible. I felt we had to have something to offer people, to make it attractive to work here. We are hoping to attract psychiatrists invested in working with underserved and safety net populations who will be involved for the long haul.” ■Ohio Physician Loan Repayment ProgramThe Cuyahoga County Medical Examiner’s Report on opioid deathsCuyahoga County Opioid Mitigation FundHeroin Epidemic, U.S. Attorney’s Heroin and Opioid Task Force ISSUES NewArchived

Longitudinality Matters: Qualitative Perspectives on a Longitudinal Clinical Experience in a Psychiatry Residency Training Program.

Longitudinal models of clinical care and education can positively impact the patient and provider experience in terms of health outcomes, satisfaction, and motivation. While residency programs have seen an increase in primary care longitudinal clinical experiences (LCEs), defined as outpatient clinics in which patients are seen by residents over the course of their entire training, less is known about such opportunities in psychiatry residency programs. This qualitative study explores the impact of a longitudinal training model on psychiatric resident skill development, relationships in the clinical learning environment, and professional identity formation. The authors conducted 24 semi-structured interviews of residents, graduates, and faculty in three well-established LCE clinics in a single, multi-site, academic psychiatry residency program. Transcripts were analyzed using inductive thematic analysis techniques. Themes were categorized into benefits and challenges. For benefits, themes included longitudinal relationships, improved feedback, near-peer teaching, early outpatient exposure, graduated independence, skill development, patient population expertise, and solidification of professional identity. For challenges, themes included system logistics, offsite panel management, and intermittent presence of junior trainees. Results suggest that overall, residents and faculty find the LCE a positive learning opportunity that has contributed to their professional development. LCEs do appear to have distinct challenges, largely logistical in nature, which can interfere with the favorability of residents' experiences. Developing strategies up front to minimize these logistical challenges will support the success of a longitudinal program.

MANAGING INTRAFAMILIAL CONFLICT: “CATCHING THE BULLET” FROM EMOTIONALLY FOCUSED THERAPY

Family engagement and intervention have been associated with improved mental health treatment outcomes for patients of all ages. However, methods by which to prepare psychiatrists to effectively work with families have presented a challenge. Early career psychiatrists reported that family skills were the least taught during residency and among the skills most needed after graduation. To teach a circumscribed, clinically practical family skill with which to more effectively manage intrafamilial conflict, the NewYork-Presbyterian Child and Adolescent Psychiatry Residency Training Program developed a “catching the bullet” workshop, based on emotionally focused therapy (EFT).

A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study.

Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03),assessment of a patient's digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed "somewhat comfortable" on any of the above measures. Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum.

Setting Common Standards for Reproductive Psychiatry Education: Effectiveness of the National Curriculum in Reproductive Psychiatry.

The National Curriculum in Reproductive Psychiatry (NCRP) provides standardized education for psychiatry residency training programs. The authors hypothesized that residents' preparedness to treat reproductive psychiatric concerns and their medical knowledge would improve following teaching with the NCRP. Pre- and post-assessments were administered to residents enrolled in two waves of pilot NCRP training (Early-Modules and All-Modules). Data were collected by individual survey, and pre- and post-responses matched via anonymous ID. Statistical analyses were conducted using R version 3.5.3 and included paired Student's t-tests and a chi-square test. Thirty-eight residents completed the Early-Modules survey and 16 the All-Modules survey. In both groups, there was significant improvement in preparedness to treat pregnant and postpartum women with mental illness (p<0.05). Scores on the 29-point knowledge test rose by 2.5 points in the Early-Modules group and 4.3 points in the All-Modules group (p<0.001 for both). In both cohorts, a majority of residents felt reproductive psychiatry was among the top three specialties needed to become competent independent adult psychiatrists. Classroom training with local faculty using a standardized curriculum is feasible and results in substantial and significant improvements in both feelings of preparedness and medical knowledge. Psychiatry trainees view training in reproductive psychiatry as an important and missing aspect of their education. Dissemination of a standardized curriculum may help to forge a path toward subspecialty certification for reproductive psychiatry, and can be used as a model for other specialties.

Sharing perspectives on feedback: a combined resident-faculty workshop

BackgroundFeedback is essential to medical education. Although the need for effective feedback delivery is well known, more recent focus is on understanding and strengthening the faculty-trainee relationship within which the feedback process is carried out. The authors developed and implemented a combined resident-faculty feedback workshop within a psychiatry residency training program to enhance participants’ understanding of challenges residents and faculty experience with the feedback process.MethodsThe one-hour workshop consisted of small group activities and large group discussions, focused on (i) feedback challenges for both residents and faculty and (ii) potential ways to address identified challenges. Participants completed pre-and post-workshop questionnaires to rate their level of understanding of, and answer open-ended questions regarding, feedback challenges. Mixed-methods assessment of questionnaire responses examined quantitative rating changes from pre- to post-workshop, as well as emergent qualitative themes from the open-ended responses.ResultsFrom a pool of 30 workshop participants, 26 completed each of the pre- and post-workshop questionnaires. Overall, participants were satisfied with the programming. Important considerations for the feedback process were (i) specific/constructive/timely feedback, (ii) meeting logistical/administrative feedback requirements, (iii) setting norms/expectations of effective/routine feedback, and (iv) relational/emotional considerations surrounding feedback. It appeared both faculty and residents were able to increase perspective taking about how the other group perceived the feedback process.ConclusionsThis pilot project is one of the first to examine a joint resident-faculty workshop focused on understanding how faculty and residents can interact to better understand each other’s perspective on the feedback process. Further work in this area is needed to identify common misperceptions and design programming to help correct them. Further research is also needed to examine the impact of such programming on the feedback process.

Improving Pharmacologic Management of Behavioral and Psychological Symptoms of Dementia (BPSD): An Algorithm for Real-World Care

The Psychopharmacology Algorithm Project at the Harvard South Shore Psychiatry Residency Training Program (www.psychopharm.mobi) aims to capture the essence of the available evidence on pharmacotherapy treatment of various psychiatric disorders. This presentation focuses on our recently published BPSD algorithm which will be updated to the time of the meeting. Major factors considered in the review included efficacy, side effects, and amount of evidence supporting the medication. Speakers will explain how this algorithm should be interpreted and utilized. Ample time will be available for questions and answers.Geriatric patients with dementia frequently present to psychiatrists and geriatricians with agitation, aggression, psychosis, and other psychological symptoms of dementia. We present an update of our previously published algorithm for the use of psychopharmacology in these patients, taking into account more recent studies and recommendations from meta-analyses, reviews, and other published algorithms. We propose three algorithms: one for BPSD in an emergent setting, one for an urgent setting, and another for non-emergent settings. In the emergent setting, the clinician, patient, or others are in imminent danger due to behaviors related to BPSD and rapid response is required. In the urgent BPSD setting, the patient is symptomatic, but there is the potential to wait for a few days to weeks for improvement. In the non-emergent setting, the patient does not appear to be at imminent risk of putting him/herself or others at harm but has a history of such behaviors which interfere with care or quality of life.Emergency management often requires intramuscular medication (IM) administration., Our first-line recommendation is olanzapine (IM aripiprazole, favored in our previous version, is no longer available). Haloperidol IM is the second choice, followed by consideration of IM benzodiazepine. In the urgent algorithm, when oral treatments are possible, first line recommendations are the second-generation antipsychotics (SGAs) aripiprazole and risperidone. We review the evidence for also considering prazosin and electroconvulsive therapy as alternatives. There are hazards associated with all of these agents, including increased risk of mortality, which are discussed. Dosing strategies, discontinuation considerations, and side effects will also be discussed. In the non-emergent setting, we recommend first decreasing anti-cholinergic load, optimizing pain management, and improving sleep. Medication options are proposed for use in the following order: trazodone, donepezil and memantine, the selective serotonin reuptake inhibitors escitalopram and sertraline, SGAs (aripiprazole and risperidone), prazosin, and carbamazepine. Finally, other emerging options with insufficient evidence to include in the algorithms but with potential future promise are also discussed.

The conceptualisation of educational supervision in a National Psychiatry Residency Training Program

Introduction: Development of expertise and counselling skills in psychiatry can be mastered only with effective supervision and mentoring. The conceptualisations of educational supervision amongst supervisors and residents were explored in this study to understand how supervisory roles may have been affected by the adoption of competency-based psychiatry residency training. Methods: A qualitative research approach with thematic analysis was adopted. Individual in-depth interviews using a semi-structured interview guide with a purposive sample of six supervisors and six newly graduated residents were conducted. Transcripts of the interview were analysed and coded using the Atlas Ti software. Results: Four major themes emerged from analysis of the transcripts: (1) Meaning and definition of supervision; (2) Expectations and responsibilities of the educational supervisor; (3) Elusiveness of mentoring elements in educational supervision and (4) Personal and professional development of residents in supervision. Supervisors and residents perceived educational supervision narrowly to be transactional with acquisition of knowledge and skills, but residents yearned for more relational interactions. Conclusion: This study showed that the roles and functions of supervisors in educational supervision were unclear. It also highlighted the lack of a mentoring orientation in supervision in the psychiatry residency training program. An emphasis on assessment of competencies might have contributed to tension in the supervisory relationship and lack of a mentoring role, with concerns on residents’ personal and professional identity development in their psychiatry training.

Development and Implementation of a Chief Resident for Research Role in a Psychiatry Residency Training Program.

Psychiatry residency programs with robust research training can prepare physician-scientists to make contributions that advance the mental health field. Our psychiatry residency developed a chief resident for research position to help provide mentorship, community building, and advising around scholarly activities for residents. We present the process of implementing this new position in our residency to offer a model for engaging psychiatry residents in research.

65.1 PSYCHODYNAMIC PSYCHOPHARMACOLOGY CURRICULUM FOR CHILD AND ADOLESCENT PSYCHIATRY

The phenomenon of polypharmacy or inadequate treatment with psychotropic medication is not an uncommon issue in child and adolescent clinical practice. Using psychodynamic theory can guide psychopharmacology treatment, especially when dealing with treatment-resistant patients or when the formulations are very complex. This raised questions about the best way to integrate psychodynamic concepts into psychopharmacology. Through the AACAP Psychodynamic Faculty Training and Mentorship Initiative (PFTMI), the presenter collaborated with his mentor, Horacio Hojman, MD, MBA, Associate Professor at Alpert Medical School at Brown University, Faculty at Boston Psychoanalytic Society and Institute, to develop a psychodynamic psychopharmacology curriculum for children and adolescent psychiatry residency training programs. This curriculum emphasizes the importance of establishing a therapeutic alliance and recognizing the meanings, both conscious and symbolic, of medication to everyone in the system of prescribing medications. Applying psychodynamic understanding and techniques can help child and adolescent psychiatry residents become effective prescribers; the residents will maintain their self-esteem and may experience less burnout. In this way, they can become increasingly motivated to learn psychodynamics and to apply this psychodynamic knowledge in their daily practice in a variety of clinical settings, especially in psychopharmacology. A psychodynamic approach to psychopharmacology can enhance the comprehensive biopsychosocial formulation and may result in better clinical outcomes for children and families.

65.3 DELIVERING PSYCHODYNAMIC PSYCHOTHERAPY SUPERVISION IN CHILD AND ADOLESCENT PSYCHIATRY FELLOWSHIP PROGRAMS

In this presentation, attendees will learn practical approaches to assess and/or improve the quality of psychodynamic supervision within child and adolescent psychiatry residency training programs. Attendees will also identify potential barriers to providing psychodynamic supervision in child and adolescent psychiatry training programs and engage in a discussion about creative solutions to remove these barriers.

Promoting intern wellness within a psychiatry residency training program: A process of regular check-ins by chief residents.

Wellness in residency is increasingly considered a vital part of medical training. Yet to be widely explored are efforts that focus particularly on 1st-year residents (i.e., interns), who likely experience unique professional changes. We developed and implemented, within a psychiatry residency training program, a process of individualized wellness check-ins with interns by chief residents throughout an academic year. At the beginning of the academic year, a one-page baseline questionnaire was completed by interns anticipating how the chief residents can best support them. During check-ins, the chief residents asked about interns' residency experiences and wellness. The check-ins were conducted at frequencies requested by each intern. Chief residents sought open verbal feedback from the interns, and more structured feedback was collected 6 months into the academic year, using a brief four-question mid-year questionnaire. Check-ins were conducted with all eight interns in the program. Baseline questionnaire responses indicated interns' preferences for more mentorship, communication across the program, and socialization. Regular check-ins started at intern-desired frequencies, and their content was guided by individual interns' questionnaire responses. Feedback from interns shaped the frequency/content of subsequent check-ins. This regular check-in process is an early attempt to explicitly delineate what chief residents can do to support intern wellness. This process can be adapted to meet specific individual/program needs. Further work is warranted to rigorously (i) examine measurable impact of the process on intern wellness and (ii) compare the impact to those of other emerging practices that use regular check-ins to target intern wellness.

Building for the future: the creation of a residency training track to foster innovation through clinical informatics in psychiatry.

Early clinical informatics (CI) education provides an introduction to CI methodologies for resident physicians to apply within their boarded specialties. A specialty notably absent from the effort to train residents in CI is psychiatry. We present a novel means of integrating CI exposure into a structured educational track within a psychiatry residency training program. The clinical informatics track at the University of North Carolina Department of Psychiatry is a 3-year, longitudinal experience open to residents starting in postgraduate year 2. To our knowledge, this is the first track of its kind within a psychiatry residency training program.

COVID-19: From Psychological Distress to Neuropsychiatric Manifestations

Back to table of contents Previous article Next article Clinical & ResearchFull AccessCOVID-19: From Psychological Distress to Neuropsychiatric ManifestationsFarah Zaidi, M.D.Farah ZaidiSearch for more papers by this author, M.D.Published Online:30 Jul 2020https://doi.org/10.1176/appi.pn.2020.7b10AbstractThe neuropsychiatric picture of COVID-19 is not fully known yet. Better understanding and prospective monitoring of the neuropsychiatric manifestations related to COVID-19 can inform early detection and treatment planning.In the six months since COVID-19 has transformed life across the globe, there has been a marked increase in psychological distress stemming from fear of this viral illness and the stigma associated with it, challenges related to sheltering in place and physical distancing, financial strain, isolation, and exacerbation of mental illness (including increased risk of death by suicide) and new barriers to care. Shelter-in-place rules have also raised alarms about domestic violence and child abuse.A growing literature is helping us to better understand the virus and its impact beyond the respiratory system, neurotropic potential, and possible mechanisms of underlying pathology. The volume of the National Institutes of Health’s LitCovid has increased from 40 publications in late January 2020 to approximately 1,970 publications in early July. LitCovid is a curated literature site of the National Institutes of Health and the National Center for Biotechnology Information that tracks up-to-date scientific information about COVID-19.Though relatively limited, articles and reports are emerging about acute neurological and neuropsychiatric manifestations of COVID-19 and possible neuropsychiatric sequelae. For example, a retrospective chart review of 214 patients in Wuhan, China, found that approximately 36% of patients had neurological manifestations such as cerebrovascular disease, impaired consciousness, and skeletal muscle injury. Other symptoms of drowsiness, edema, stroke, convulsions, and coma are also reported in literature.An article by Troyer et al. in the July issue of Brain, Behavior, and Immunity described the emergence of neuropsychiatric symptoms such as anxiety, depression, trauma, insomnia, psychosis, delirium, and suicidality related to past viral pandemics, appearing long after the acute viral spread was over. The authors argued persuasively that physicians and health systems should monitor patients exposed to COVID-19 for neuropsychiatric sequelae.Another recent systematic review and meta-analysis by Rogers et al. in Lancet Psychiatry reported the prevalence of delirium in the acute stage of COVID-19 infection. The authors encouraged clinicians to monitor for the emergence of depression, anxiety, posttraumatic stress disorder, and other neuropsychiatric disorders post infection.There are also reports of anosmia/hyposmia and ageusia in patients infected with COVID-19. As such, in late March, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) launched a COVID-19 Anosmia Reporting Tool. The tool is designed to submit data confidentially to AAO-HNS for anosmia and dysgeusia related to COVID-19. Preliminary findings collected from this tool showed that “anosmia was noted in 73% of patients prior to COVID-19 diagnosis and was the initial symptom in 26.6%.” Based on these findings, it appears that anosmia may be a presenting symptom in COVID-19 before other more commonly known symptoms appear.Proposed mechanisms for pathogenesis of neurological and neuropsychiatric manifestations related to COVID-19 include hypoxic brain injury; interaction of the COVID-19 virus spike protein with ACE-2 receptors of the cerebral capillary endothelium, resulting in damage to the endothelial lining and access to brain; cerebral edema; post-infectious autoimmunity; and immunomodulatory treatments.As the global community continues to learn about and adjust to many emerging aspects of COVID-19, its multisystem impact is increasingly known. Awareness about neuropsychiatric manifestations related to COVID-19 could prepare the psychiatric community in managing at-risk populations. ■LitCovid can be accessed here.Farah Zaidi, M.D., is an inpatient and psychiatric emergency services psychiatrist in a community hospital in San Mateo County. She is on the teaching faculty for the psychiatry residency training program at San Mateo Behavioral Health and Recovery Services. She is also vice president of the Northern California Psychiatric Society and co-chair of its Professional Education Committee. ISSUES NewArchived

Taking the Lead: Lessons Learned by a Resident President.

Taking the Lead: Lessons Learned by a Resident President.

Exploring Residents’ Experience of Career Development Scholarship Tracks: A Qualitative Case Study Using Social Cognitive Career Theory

Problem: Trainees enter graduate medical education with professional aspirations that often extend beyond the role of clinician to roles such as educator, innovator, leader, advocate, or researcher. Many residency programs have implemented academic tracks to support career development in these areas. With the exception of research tracks, these tracks generally do not include significant longitudinal protected time and often rely upon ‘extra-curricular’ effort and possess insufficient structure, mentorship, and accountability. Most prior studies of non-research scholarship tracks have not been theory driven and do not explore in depth the experience of residents who participate. Approach: To address this gap in the literature, we conducted a qualitative case study informed by Social Cognitive Career Theory to explore the professional identity development of residents who participated in a non-research scholarship track that incorporates recommended best practices. The track, Pathways to Expertise Program, incorporates features of successful research tracks: protected time, longitudinal experience, mentorship, platforms for recognition, and accountability. Participants from the first three cohorts were interviewed at the time of their graduation (2017–2019). Semi-structured interviews were conducted, transcribed, and independently coded. Social Cognitive Career Theory informed the organization of codes into themes. Context: The Pathways to Expertise Program was implemented in a psychiatry residency training program in a large urban academic teaching hospital. Impact: Fifteen residents entered Pathways to Expertise Program during the study period and all 15 participated in the study. Fourteen completed the program and presented their projects at the department grand rounds. For dissemination, 12 presented their project findings at one or more national meetings in the form of a poster (20 distributed across 11 residents), workshop (six distributed across four residents), or presentation (two across two residents). Six residents accounted for a total of seven first author publications in peer reviewed journals. All participants described how their self-efficacy increased as a result of new skills (e.g., content, methodology, and scientific communication), mentorship (e.g., content and process guidance), peer and broader support (e.g., small group supervision), persuasive communications (e.g., recognition both locally and nationally), and positive emotional reactions (e.g., triumph). The residents also described expecting compelling benefits (e.g., stronger application for fellowship and expanded career opportunities). Participants indicated that the experience influenced their career goals and how they perceived their professional identities. Lessons Learned: These findings suggest that a longitudinal academic track that incorporates features of successful research tracks (protected time, mentorship, peer support, and accountability for deliverables) can be instrumental in forming and maturing professional identities for non-clinical roles. These tracks can accomplish several important goals, including enhancing resilience via identity formation around passion and purpose and meeting society’s need for physicians who are engaged in inquiry and innovation. Implications for the design of academic tracks in general are explored.

Understanding Assessment Systems for Clinical Competency Committee Decisions: Evidence from a Multisite Study of Psychiatry Residency Training Programs.

This multisite study examines how clinical competency committees in Psychiatry synthesize resident assessments to inform milestones decisions to provide guidelines that support their use. The study convened training directors and associate training directors from three psychiatry residency programs to examine decision-making processes of clinical competency committees. Annual resident assessments for one second year and one third year resident were used in a mock clinical competency committee format to assign milestones for two consecutive reporting periods. The committees reflected on the process and rated how the assessment tools impacted the assessment of milestones and evaluated the overall process. The authors compared reliability of assessment between the mock committees and examined both reliability of end of rotation assessments and their composite scores when combined with clinical skills evaluations. End of rotation evaluations were the most informative tool for assigning milestones and clarifying discrepancies in performance. In particular, the patient care and medical knowledge competencies were the easiest to rate, while the systems-based practice and practice-based learning and improvement were the most difficult. Reliability between committees was low although higher number of available evaluations improved reliability in decision-making. The results indicate that the medical knowledge and patient care competencies are the easiest to rate and informed most by end of rotation evaluations and clinical skills examinations. Other evaluation tools may better capture performance on specific sub-competencies beyond workplace-based assessment, or it may be helpful to reconsider the utility of how individual sub-competencies are evaluated.

Resident-led organizational initiatives to reduce burnout and improve wellness

BackgroundProfessional burnout among medical trainees has been identified as a national concern in need of attention. A significant challenge for residency programs is designing and implementing effective strategies to promote resident wellness and reduce burnout. Emerging evidence highlights the importance of developing organizational changes targeting physician burnout.MethodsTo address this critical need, Harvard South Shore (HSS) Psychiatry Residency Training Program aimed to assess burnout among residents, identify areas for wellness-related growth, and implement strategies for organizational change to reduce burnout and increase wellness. We aligned closely to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines to systematically approach planning, conducting, and evaluating this quality improvement effort. We developed a wellness action team and assessed burnout using the Copenhagen Burnout Inventory (CBI). We also conducted a survey to investigate high opportunity areas for wellness-related growth and using this data we designed and implemented four organizational initiatives to (i) improve residents’ on-call experience, (ii) increase social activities, (iii) support preventative care, and (iv) promote wellness education. We then re-assessed burnout 1 year after implementation and performed two-sample t-tests to compare CBI scores. We additionally gathered and analyzed feedback from residents on the implemented organizational initiatives’ relevance to wellness and their well-being.ResultsThere was an overall clinically meaningful reduction in burnout averaged among all residents that participated. Participants indicated that fitness-oriented activities were most likely to lead to change in wellness habits.ConclusionOur implemented wellness program was resident-led and involved continuous feedback from both residents and leadership. Given that there may be multiple factors that affect resident burnout, future studies involving a control group could help reveal whether our intervention contributed to the change in burnout scores we observed.