Psychiatry Residency Training Research Articles

Role of digital learning in addiction psychiatry

The context of current education is quickly evolving. The traditional design and delivery of interventions for learning are being challenged and outdated to meet the needs of today’s learners. Formal education should provide more versatile learning systems to accommodate the varying needs and demands of students. A global change is urgently required to implement a fundamental shift in the learning paradigm for the technologically driven millennial learners. This is a well-known fact, but the challenge is to explore innovative methods to use technology to attain the actual needs and expectations of these learners. With the increasing problem of substance use disorders as a public health problem and scarcity in the availability of resources for providing adequate treatment, we propose to explore the role of digital technology as a training platform in addiction psychiatry. We have reviewed the currently available platforms which are using digital tools for training in addiction psychiatry. We have also shared our experience at NIMHANS in the use of various digital platforms for training medical officers, psychiatry residents and various health professionals in the area of addiction and we feel that it is having promising scope for expansion and upscaling to generate adequate facilities to provide best practices in addiction management to the rural, remote and underserved areas of the country. However, these digital tools should augment traditional teaching methods and cannot replace them.

The Integrative Psychiatry Curriculum: Development of an Innovative Model.

The Integrative Psychiatry Curriculum (IPC) was developed to train psychiatry residents and fellows to apply an Integrative Medicine (IM) approach for patients presenting with psychiatric disorders. Launched in 2015, IPC includes interactive online courses, in-person experiential sessions, and a clinical component with supervision. Twenty-one residents and fellows have completed the curriculum. The purpose of the IPC is 2-fold: to enhance patient wellness through training residents and fellows in evidence-based whole-person care and to improve physician well-being through enhanced stress management and self-awareness utilizing the practice of mind–body skills within a supportive small group setting. Course participants are trained in a broad range of prevention and treatment options and learn about their evidence base; they then practice incorporating IM into diagnosis and treatment plans through supervised clinical experience. This article describes the development of IPC and its elements. Efforts are underway to further develop and standardize the offerings and increase the portability of the course, making it easier for Psychiatry training programs with limited faculty expertise in IM to provide the curriculum for residents and fellows. To reach the goal of disseminating such a curriculum for integrative psychiatry, further funding and collaboration with multiple residency training programs is needed.

Moonlighting by Psychiatry Residents: a Survey of Residents and Training Directors.

This study sought to assess the prevalence of moonlighting among psychiatry residents; the perceived effects of moonlighting on resident recruitment, education, and liability; and policies and practices governing oversight. In 2013, surveys were emailed to all general psychiatry residency programs that were accredited by the Accreditation Council for Graduate Medical Education and had available contact information (n = 183). Resident surveys were emailed to program coordinators with a request to forward the survey link to their residents. Responses were received from 63 program directors (34% response rate) and 238 residents (about 5% of total general psychiatry residents). Most psychiatry program directors (95%) indicated that their programs permit moonlighting. Moonlighting participation increased with each year of training, culminating with 67% of fourth year residents. Most residents and faculty (87%) agreed that moonlighting enhanced resident education. Thirty-seven percent of program directors reported having no oversight procedures in place to monitor moonlighting activities. Thirty-nine percent of resident survey responders reported having no supervision for at least one of their moonlighting activities and only 9% reported always having access to on-site supervision. Though limited by a low response rate, this study found that moonlighting seems to remain prevalent among psychiatry residents and widely accepted by psychiatry residency training programs. There appears to be relatively limited program oversight for moonlighting activities, many of which seem to lack close supervision.

3.46 Assessing the Correlation Between Level of Training and Various Factors Attributable to Physician Burnout

There is limited evidence to support the impact of various facets of child and adolescent psychiatry residency and fellowship training on physician wellness and burnout. This study will help us assess those factors and implement better strategies for an overall improvement in both physician physical and mental well-being.

Psychiatry residency program to benefit rural communities

Mental Health WeeklyVolume 28, Issue 36 p. 8-8 State News Psychiatry residency program to benefit rural communities First published: 24 September 2018 https://doi.org/10.1002/mhw.31604Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Montana's first psychiatry residency program will launch at Billings Clinic, bringing trained psychiatric medical professionals to rural eastern Montana, The Associated Press reported Sept. 15. Operational costs for the program will be paid for in part by the Helmsley Charitable Trust, which is funding the program's first three years at Billings Clinic with a $3 million grant. The Helmsley Charitable Trust's Rural Healthcare Program is based in South Dakota and focuses on creating and supporting programs that build a strong professional medical workforce in the seven states of the upper Midwest, including Montana. Montana, which has the highest suicide rate in the nation, is one of three states that has no psychiatry residency program. The others are Alaska and Wyoming. Montana has seven psychiatrists for every 100,000 residents. “This is a transformational effort that will bring much-needed mental health resources to our region while training the next generation of highly-skilled psychiatrists,” Billings Clinic CEO Randall Gibb, M.D., said in a statement. Billings Clinic's program will be a regional track of the University of Washington Psychiatry Residency Training Program. Volume28, Issue3624 September 2018Pages 8-8 RelatedInformation

Missed opportunities: are residents prepared to care for transgender patients? A study of family medicine, psychiatry, endocrinology, and urology residents

The transgender (trans) population faces multiple barriers in accessing health care, with knowledge deficits of health care providers contributing substantially. Trans patients report having to teach health care professionals about their own health needs. We compared perceptions of trans-care education and training across family medicine, psychiatry, endocrinology, and urology residency training programs at the University of Toronto. We surveyed residents to assess their perceptions of and attitudes towards trans-care, exposure to trans patients, knowledge of trans-specific clinical care, and the state of trans-care education within their training. We used Likert scale data to identify patterns across residency programs. We collected open-ended responses to further explain quantitative findings where appropriate. Of 556 residents approached, 319 participated (response rate = 57.4%). Nearly all endocrinology and psychiatry residents agreed that trans-care falls within their scope of practice, while only 71% and 50% of family medicine and urology residents did, respectively. Though participants were at different stages of their postgraduate training when surveyed, only 17% of all participants predicted they would feel competent to provide specialty-specific trans-care by the end of their residency and only 12% felt that their training was adequate to care for this population. Though the study revealed a willingness to serve this population, there was a lack of clinical exposure and trans-related teaching within postgraduate curricula resulting in feelings of unpreparedness to meet the health care needs of this underserved population.

‘Structural Competency’ Approach Takes Into Account Patients’ World

‘Structural Competency’ Approach Takes Into Account Patients’ World

Corrigendum: Competency‐Based Psychiatry Residency Training Program Development in South Korea

Corrigendum: Competency‐Based Psychiatry Residency Training Program Development in South Korea

Primary Care and Neurology in Psychiatry Residency Training: a Survey of Early Career Psychiatrists.

A survey of recently certified psychiatrists was conducted to obtain their feedback about the contribution of the primary care and neurology components of residency training to their professional development and to their current needs as practitioners. A 22-item survey was developed based on issues discussed at a forum on residency competence requirements and administered electronically to four cohorts of recently certified psychiatrists. The response rate was 17% (1049/6083). Overall, the respondents described both their primary care and neurology experiences as helping them accomplish several goals for their professional development. The majority were satisfied with their primary care training and felt well-prepared to enter practice. The most common suggestions for improving the primary care component were better integration with psychiatry and providing longitudinal experiences and more outpatient experience. They were somewhat less satisfied with their neurology training, and only about half felt well-prepared for the neurologic aspects of psychiatry practice. The most common suggestions for improving neurology training were to provide more time in neurology with experiences that were more relevant to psychiatry such as outpatient and consultation experiences. Some also thought longitudinal experiences would be useful. These psychiatrists were generally satisfied with the primary care and neurology components of residency training and felt that they had contributed to their professional development. Their suggestions for improvement contribute to the rich discussion among training directors and other psychiatry educators about these components of residency training.

Role of Forensic Psychiatry in Legislative Advocacy.

Dr. Piel presents a model curriculum for elective legislative advocacy training of general psychiatry residents at the University of Washington. In this commentary, we discuss the role of the physician as a leader in legislative advocacy and emphasize the need for training in this neglected arena. We highlight the common ground between legislative advocacy and forensic psychiatry and make a case for increased involvement of forensic psychiatrists.

Editorial introductions

Editorial introductions

Competency‐Based Psychiatry Residency Training Program Development in South Korea

Psychiatry residency training in South Korea currently has many limits in developing proper competencies of residents. To address this problem, the Korean Neuropsychiatric Association has been developing a new competency-based training program since 2015, using the educational systems of advanced countries such as Canada, the United Kingdom, the United States, and Australia as references. It was found that within the referenced countries’ residency training systems, objectives based on competencies are stated in detail by psychiatric topics as well as various assessment methods and feedback about the resident’s competency level. In addition, we surveyed psychiatric resident training hospitals, and found that more than 80% of the respondents answered positively in reference to the new training program. This paper briefly reviews competency-based residency training systems of advanced countries and compares them to the current training program in South Korea. Many resources are needed to run a new competency-based training program, and governmental supports are essential to improve the quality of the residency training system.

What Is Fee Splitting and Why Is It Unethical?

Back to table of contents Previous article Next article Ethics CornerFull AccessWhat Is Fee Splitting and Why Is It Unethical?Claire Zilber, M.D.Claire ZilberSearch for more papers by this author, M.D.Published Online:26 Jan 2018https://doi.org/10.1176/appi.pn.2018.2a17Claire Zilber, MD, is a psychiatrist in private practice in Denver, Colo., a faculty member of the PROBE (Professional Problem Based Ethics) Program, chair of the Ethics Committee for the Colorado Psychiatric Society, and a corresponding member of APA’s Ethics Committee. She is the co-author of Living in Limbo: Creating Structure and Peace When Someone You Love Is Ill.A recent graduate of a psychiatry residency training program is invited to join a senior psychiatrist’s practice. The senior psychiatrist offers to refer patients to the new colleague as she builds her practice in exchange for 30 percent of the revenue from those patients. The senior psychiatrist will provide the junior colleague with a furnished office and receptionist support. This seems like a good deal to both psychiatrists, but just to be sure it’s acceptable, they ask their district branch ethics chair to approve it. The Merriam Webster Dictionary defines fee splitting as “payment by a specialist (such as a doctor or a lawyer) of a part of his or her fee to the person who made the referral.” Although referral incentives are a common business practice in other industries, in medicine they erode the fiduciary relationship, potentially elevating a physician’s financial interests above the needs of the patient. Rules about avoiding fee-splitting arrangements grew out of laws and government regulations concerning kickbacks. While blatant kickbacks are rarely seen in psychiatric referral patterns, the profession wants to guard against any arrangement in which a psychiatrist will receive compensation for making a referral, because such an incentive may compromise objectivity in deciding on the most appropriate treatment plan for a patient. “Referrals by the psychiatrist should be based upon the training, competence, specific skills, and ethical qualifications offered by the professional to whom a patient is to be referred” (letter to the editor in the January 3, 2003, Psychiatric News by Richard Milone, M.D., and Wade Myers, M.D.).Section 2 of APA’s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry concerns our duty to uphold the standards of professionalism. Article 7 states, “An arrangement in which a psychiatrist provides supervision or administration to other physicians or nonmedical persons for a percentage of their fees or gross income is not acceptable; this would constitute fee splitting. In a team of practitioners, or a multidisciplinary team, it is ethical for the psychiatrist to receive income for administration, research, education, or consultation. This should be based on a mutually agreed-upon and set fee or salary, open to renegotiation when a change in the time demand occurs.” The APA’s Ethics Committee expressed this from a different perspective in an opinion issued in 1976 and updated in 1978 and 1990: “A physician is licensed by the people of a state to provide medical care. He is not licensed to establish an entrepreneurial business when the care of patients is subordinated to profit” (Opinions of the Ethics Committee on the Principles of Medical Ethics, K.2.b., 2017). Although it is acceptable to receive compensation for providing office space and administrative support to other health care providers, the compensation should be negotiated as a fixed fee, not tied to referral volume. Alternatively, the health care colleague could be paid a salary if the psychiatrist wants to receive all the revenue from services billed by the colleague. The district branch ethics committee chair instructs the psychiatrists that they have two options that are ethical. The senior psychiatrist could hire the junior colleague as an employee. The senior psychiatrist would keep all the revenue generated by the junior psychiatrist, who would be paid a salary and perhaps an incentive bonus based on volume of billing. This is similar to how many clinical psychiatrists are paid in academic medical centers. Alternatively, the junior associate could pay the senior psychiatrist a fixed fee in return for the office space and administrative support, but not tied to referrals or billing revenue. In addition to avoiding fee splitting, the latter arrangement preserves the most autonomy for the junior colleague. Because the rent and administrative fee will be the same every month, the senior psychiatrist won’t have a reason to monitor how many patients are being seen or how many days off are taken. As is often the case, the ethical path works well for both patients and providers. ■APA’s ethics documents can be accessed here. ISSUES NewArchived

Gamifying education and mental health

Objectives: This article explores the advantages of using gamification in mental health, in addition to its potential use in training psychiatry residents by coupling it with the concept of digital andragogy, resulting in a prospective efficient teaching model for graduate and postgraduate medical education. Materials and Methods: Databases such as PubMed and Google Scholar were searched for articles using the keywords such as digital andragogy, gamification, innovation in medical education, medical education, and mental health. Results: Using leader boards, rewards, and a host of innovative testing methods, gamification offers increased student engagement and satisfaction along with improved objective academic results emphasizing competency-based medical education. It has also been used in the management of various psychiatric conditions, especially depression, eating disorders, schizophrenia, depression, autism spectrum disorders, substance use, dementia, and traumatic brain injury. It has been shown to alter user behavior positively, leading to better control over illness and improved quality of life among these patients. Conclusion: Gamification is an extremely efficient method, positively impacting the academic performance when used by students. While it cannot replace traditional methods, they can be blended into an efficient teaching model. It can also be used in the management of several medical and psychiatric conditions in a creative and effective manner, although further research is needed to evaluate this potential.

From Cultural to Structural Competency—Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism

From Cultural to Structural Competency—Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism

Help Wanted: Psychiatrist/Psychotherapist

Help Wanted: Psychiatrist/Psychotherapist

Development of a women's mental health curriculum and evolution to a Women's Mental Health Area of Concentration in a psychiatry residency program.

In 2014, the U.S. Department of Health and Human Services' Office on Women's Health emphasized the importance of women's health education, particularly in the realm of behavioral health. In order to support the professional interests of psychiatry trainees, a women's mental health study group (WMHSG) was developed and implemented. The WMHSG aimed primarily to supplement the resident curriculum and promote consideration of careers in women's mental health. After successful implementation, the curriculum was formalized into a Women's Mental Health Area of Concentration within the Department of Psychiatry's residency training program. Participants found the WMHSG to be interesting, to increase knowledge and improve clinical practice, and to facilitate mentorship opportunities. The creation and evolution of a WMHSG into an Area of Concentration offers an example for enhancing training in WMH topics and principles that can be extended to other medical specialties.

Training Psychiatry Residents in Patient Handoffs Within the Context of the Clinical Learning Environment Review.

Training Psychiatry Residents in Patient Handoffs Within the Context of the Clinical Learning Environment Review.

72.0 Implementing and Operating Pediatric Telepsychiatry Programs

Telepsychiatry is a much needed service that provides mental health care to the underserved. We describe the history, evidence base, current practice, and educational efforts in telepsychiatry. The experience of three academic centers with implementation of clinical care and training of psychiatry residents and fellows is detailed.

Confronting Despair on the Long-Term Care Unit

Back to table of contents Previous article Next article CommentaryFull AccessConfronting Despair on the Long-Term Care UnitDara Wilensky, M.D.Dara WilenskySearch for more papers by this author, M.D.Published Online:1 Oct 2017https://doi.org/10.1176/appi.ajp-rj.2017.121004AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article“Nancy,” at 75 years old, was among the younger patients I interviewed during my PGY-3 geriatrics rotation, but both her physical condition and her declining cognitive status belied her younger age. She was petite and frail, sitting plaintively in a wheelchair pointed toward a blank wall; she halfheartedly raised a vacant gaze in my direction when I sat beside her. Faint, crusted remnants of her lunch lingered on her shirt.I introduced myself as a psychiatrist, and Nancy told me she had once studied psychology, but this is where any coherent back-and-forth ended. Her lack of relatedness, as well as her semantic aphasia, made it seem as if we were talking in parallel, conversing near each other but not together. Despite her graduate-level education, she could tell me only that her children lived in “x or y, one of those towns around here,” and she had once worked “a job of sorts.” When I asked where she had gone to school, she launched into another perplexing speech, this time saying, “I had such high expectations, really wanted to be good in my field, good psychologist, good job, a real golden girl of psychology … now I just don’t know … looking at what I’m supposed to be doing and being now and that’s why.” An immense sigh escaped from her, causing her tiny body to visibly deflate. She looked and sounded so despondent but could not articulate what had disappointed her so. We sat in solemn silence for a moment before she said, “I don’t really have a sad tale; I’m just a sad person.” And later, “Nothing is really wrong, no, no nothing wrong, just nothing right either.”There was so much about my first encounter with Nancy that was captivating. Her speech had such a ruminative, stereotyped quality that it bordered on verbigeration, making palpable her struggle to communicate. I found myself thinking of Nancy in Eriksonian terms as she approached her final task of psychosocial development: retrospection. She was grasping for contentment or ego integrity, and even dementia could not suppress the powerful affect associated with this experience. As she attempted to be proud of a successful family, process professional disappointment, and understand her purpose in the milieu of a long-term care facility, she was wrestling with the existential question of “is it okay to have been me?” and coming up with a resounding “no” for an answer. She was truly in despair.When I left Nancy’s room after our first meeting, I was unsettled. After reflecting on the experience of seeing someone with so little ability to understand her own misery at the end of her life, it would be gratifying to say that I have gained new insight into, or appreciation for, my own burgeoning relationships, career, and identity. But I mostly feel sad. This sadness, though, might be what I am tasked with right now. I can hold Nancy’s hopelessness and despair along with her, allowing her space to continue to ask her own questions.Dr. Wilensky is a fourth-year resident at Harvard Longwood Psychiatry Residency Training Program, Boston.The patient’s name and identifying details in the above article have been changed to protect the patient’s privacy. FiguresReferencesCited byDetailsCited ByNone Volume 12Issue 10 October 01, 2017Pages 7-7 History Published online 1 October 2017 Published in print 1 October 2017