Psychiatry Residents Research Articles

Evaluation of Integrative Medicine in Residency-Psychiatry Curriculum.

This study describes knowledge change, self-assessed confidence in providing integrative medicine approach, and respondents' perspective on value and feasibility for the Integrative Medicine in Residency-Psychiatry (IMR-Psychiatry) curriculum, a 100-h elective offered during psychiatry training. Residents/fellows completed pre-post Medical Knowledge tests and self-assessment instruments tracking self-rated confidence. Participants were also interviewed for feedback about their experience using a semi-structured design after completion of the program. Thirty-five of 37 (94.6%) participants completed all elective requirements. Items on the self-assessment instrument with the greatest positive pre-post change (p < 0.001) included ability to identify authoritative sources about botanicals (Cohen d = 2.15), effectively respond to patients' questions regarding the use of herbs/supplements (Cohen d = 2.67), and interpret labels on nutraceuticals (Cohen d = 2.28). Mean score on the Medical Knowledge test (n = 30) increased from 64.7% correct at pretest to 81.6% at posttest. Responses tracking self-assessed confidence in providing an IM approach to address 18 common medical and psychiatric conditions all increased significantly pre to post (p < 0.001). Qualitative interviews provided important insights into challenges and recommendations for improvement, and all participants highly recommended the curriculum and found it feasible to complete during training. The IMR-Psychiatry curriculum provides trainees skills that promote comprehensive person-centered care; as a tool to optimize patient care and safety while enhancing physician well-being, wider-spread incorporation of the curriculum into psychiatry residency programs would be beneficial.

2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry

Despite rapid shifts in consultation-liaison psychiatry (CLP) training in residency, including increasing general residency training requirements from the Accreditation Council for Graduate Medical Education, greater utilization of advanced practice providers, and effects of the coronavirus-2019 pandemic, the Academy of Consultation-Liaison Psychiatry (ACLP) has not updated recommendations for residency training in CLP since 2014. A national survey of residency program directors in 2021 suggested many changes to the structure of CLP rotations at individual programs over the past decade. We convened a workgroup of 8 ACLP members holding leadership positions in residency and fellowship education on local and national levels. The project was approved by the ACLP Executive Council and conducted via a three-stage iterative process. Consensus was reached on 34 recommendations across four domains, including structural issues, faculty supervsion, formal curriculum and evaluations, and elective experiences. Residents must spend sufficient time on CLP rotations to achieve relevant milestones. Given that consultants are expected to offer unique insight, the ideal placement of core CLP rotations comes at a time in residency where residents are able to provide expert opinion and lead teams. Faculty expertise in CLP and availability to provide direct supervision and oversight to trainees is essential. A separate and formal CLP didactic curriculum should exist, and elective opportunities should be offered to supplement training. These recommendations are intended to guide residency program directors towards optimizing CLP training for all residents, including those who will eventually pursue CLP fellowship. Establishing a strong CLP foundation for all residents is essential for ensuring competency in providing psychiatric care for medically complex patients and collaborating with our colleagues in other specialties, as well as fostering trainee interest in pursuing a career in CLP.

Skills Acquisition and Engagement with the Use of a Structured Journal Club Curriculum.

Journal clubs are a common element of many residency programs. However, there is little data showing that they improve residents' ability to interpret and use the scientific literature. The authors developed a structured journal club curriculum intended to improve scientific literacy skills among residents and increase acceptability and participation in meaningful discussion of high-quality articles among both residents and facilitators. This study examined the impact of the curriculum on objective skills, subjective skills, and engagement. Psychiatry residents from three academic medical centers completed 10-12 virtual journal clubs during academic year 2022-2023. At the start and end of that year, residents completed a knowledge assessment and a self-rating of scientific literacy skills; at the end of the year, residents self-rated participation in, preparation for, and attitudes towards journal club sessions and assessment of scientific literacy skills. Twenty-seven residents completed self-reports at both time points. Performance on the objective skills assessment did not improve over the course of the year. Subjectively, residents reported increased understanding of common statistical techniques, ability to determine if techniques used in an article are appropriate, and the extent to which information learned from articles informs clinical practice. In the sample of 62 resident engagement surveys at follow-up, the journal club curriculum was well-received. Use of a structured journal club curriculum was associated with improvements in self-rated scientific literacy skills among residents and had high acceptability. More work is needed to understand the impact of teaching methodology on journal club success.

Psychopathology teaching in residency program – An art losing its shine: Psychiatry trainee residents’ experience

Abstract Background: Teaching psychopathology in a residency program is considered the “heart” of the training program. There is a lack of data on evaluating psychiatry resident training in psychopathology. Aim: The aim of this study was to evaluate residents’ experience and satisfaction in terms of training and teaching psychopathology during the psychiatry residency program. Methods: It was a mixed-method design study and was cross-sectional. A total of 53 psychiatry residents (pursuing postgraduate courses) participated. Participants were assessed using qualitative and quantitative questionnaires. Qualitative interviews consisted of open-ended questionnaires. The student satisfaction questionnaire was quantitative. Results: In terms of dissatisfaction with the teaching specific skills during postgraduation, the most common dissatisfaction reported was with the quality of the clinical environment (35.8%), psychopathology taught during the course of the training period (34.0%), and the teaching of skills of interview technique to elaborate and label the psychopathology during the course of the training period (32.1%). Conclusion: Most of the residents were not satisfied with the teaching of psychopathology. Supervision was not adequate from the seniors and teachers for teaching psychopathology. The most commonly emerged strategy to teach psychopathology was the supervision of clinical interviews with real patients, and the initial 1st year should be more focused on teaching psychopathology in clinical settings. It can be said that there should be some competency-based training programs for the residents.

Trends in gender and ethnic diversity among US psychiatry residents: A 5-year analysis.

This study aims to analyze trends in gender and ethnic diversity among incoming US psychiatry residents over the past 5 years. Physician diversity improves patient care as minority physicians often serve underserved communities and address health disparities. Increasing the representation of women and underrepresented minorities in medicine is essential for preparing a physician workforce that can effectively care for an increasingly diverse population. This study highlights the importance of efforts to enhance diversity within the field of psychiatry.

Bias related to overweight and obesity among French psychiatrists: Results of a national survey

BackgroundAccording to people with a higher weight, physicians are the second most stigmatizing group related to excess weight. As a result of these weight-related biases, the therapeutic relationship with the patient and the quality of care would be negatively affected. In addition, this stigma could negatively impact the clinical practice related to higher weight and avoidance of care. ObjectivesThe objective of this study was to assess the stigma of overweight and obesity among psychiatric residents and psychiatrists in France. Specifically, the study aimed to assess factors that may influence weight-related bias among psychiatrists, to explore the relevance of visual assessment of body mass index, and to determine how they this feature is integrated into their practice. MethodAn online questionnaire including sociodemographic items, the Fat Phobia Scale, the Beliefs About Obese Persons Scale, the Body Shape Scales, and questions about their clinical practice was distributed via national professional mailing lists and social networks. ResultsThe survey was answered by 271 seniors or residents in psychiatry. The results indicated a moderate level of weight-related bias among psychiatrists as assessed by the Fat Phobia Scale which was higher in residents than in senior psychiatrists. Over a third of the respondents had no material to assess their patient's weight, and two thirds did not systematically assess overweight or obesity. Finally, the results demonstrate that psychiatrists failed to accurately evaluate overweight or obesity based on male or female silhouettes. ConclusionIt appears that measures should be taken to raise awareness among psychiatrists of the stigmatization of individuals living with a higher weight, as well as to enhance the quality of weight gain care in psychiatry.

Teaching Psychiatry Residents Trauma Management Skills in a Workshop Utilizing Media and Standardized Patients.

Teaching Psychiatry Residents Trauma Management Skills in a Workshop Utilizing Media and Standardized Patients.

The COVID-19 American Association for Geriatric Psychiatry (AAGP) Online Trainee Curriculum: Program Evaluation and Future Directions

ObjectivesThe COVID-19 pandemic caused substantial disruptions in geriatric psychiatry education. In response, the AAGP created the “AAGP COVID-19 Online Trainee Curriculum” (Curriculum) a free online resource consisting of 33 recorded lectures. This study examined the uptake and impact of the Curriculum. MethodsAdministrative data established the number of unique users. Surveys assessed demographics, prior AAGP engagement, prior experiences working with older adults, and each lecture's impact on participant knowledge, enthusiasm and confidence related to the module's topic area. ResultsFrom May 2020 through April 2023, 860 individuals utilized the Curriculum. Of 251 survey respondents, 54% were general psychiatry residents (37%, n=91) or medical students (16%, n=41). Surveys from the two most-accessed lectures showed an increase in knowledge and confidence in clinical skills. ConclusionsThe Curriculum reached medical students and general psychiatry residents. Post-pandemic, the Curriculum may serve as a valuable resource to enhance geriatric psychiatry education and knowledge.

Psychedelic medicine in psychiatry residency training: a survey of psychiatric residency program directors

Objective The growth of psychedelic medicine creates new challenges in psychiatric education as physicians may soon be responsible for prescribing a number of psychedelic interventions. Despite this growing need for educated providers, very little is known about the training psychiatry residents receive in psychedelic medicine. We conducted a survey to determine the current educational opportunities as well as the priorities and concerns held by training directors about this emerging field. Methods We emailed an online survey to US psychiatry residency training directors. Respondents answered questions about current offerings in psychedelic medicine, as well as their interest, priorities, and concerns about curricular materials and their delivery. Results Sixty-one programs responded to our survey. The majority of respondents (64%) favored devoting additional time to psychedelic education, but many endorsed concerns about the dearth of educational materials (54%) and limited availability of faculty to deliver content (46%). The majority of programs (94%) expressed some interest in implementing a standardized curriculum in psychedelic medicine. Conclusion Training directors recognized that their current curricular materials are limited, and they appeared interested in additional support to meet the upcoming demand in psychedelic education. Further research can inform curriculum development and implementation of psychedelic education in residency training.

A scoping review on combating workplace violence against psychiatry residents

PurposeThis paper aims to illuminate the issue of workplace violence (WPV) against psychiatry residents. Workplace violence is known to negatively impact physical and emotional well-being, professional development and the quality of the care that mental health professionals provide to patients. The authors discuss the prevalence of, risk factors for and consequences of WPV against psychiatry residents, as well as the need for support and resources to help residents cope with the emotional challenges of their job.Design/methodology/approachThis paper is a review of the literature on WPV against psychiatry residents, and includes studies on its prevalence, associated risk factors and consequences.FindingsPsychiatry residents face a heightened risk of WPV, including physical and verbal attacks, which can harm their mental and physical health and disrupt their continuity of care. Factors that contribute to WPV against psychiatry residents include exposure to aggressive or violent behaviors, inadequate training in WPV, understaffing, the stigmatization of mental illnesses, and discriminatory treatment. Furthermore, psychiatry residents who encounter WPV may develop negative emotions and attitudes toward their patients, which can compromise the care they provide.Research limitations/implicationsThe inherent heterogeneity of study designs highlighted in this review could hinder the establishment of definitive conclusions about the impact of workplace violence on psychiatry residents. A focus on studies published in English may inadvertently exclude relevant literature in other languages, potentially limiting the comprehensiveness of study findings.Originality/valueThis paper highlights resident physicians’ personal experiences with and perceptions of WPV encountered during residency training. In response, potential solutions are proposed to address WPV, including increased support for resident physicians, mandatory reporting of WPV incidents, and a cultural shift toward zero tolerance for WPV. In addition, the paper raises awareness of the limited research on this topic and the importance of further investigation.

Theory of a Well Mind.

Description In psychiatry residency, we have a didactic within our curriculum that focuses on psychotherapy. This subject culminates in our third year when our program's psychotherapy supervisor asks each of us to create our own personal theory. It allowed us to explore and apply what we had learned up until this point and formulate our own understanding of why people are the way that they are, how people change, and how to facilitate that growth through our theory. Each of us chose to represent our theory in unique ways, reflective of our personalities. One tech-savvy resident used AI and images. Another used a relevant case involving themes of feminism and cultural competency. I represented my theory through poetry. This theory has elements of emotion-focused therapy, attachment theory, and cognitive behavior therapy. Engaging in this style of learning left me with fulfillment and a newfound satisfaction for what I had learned.

Evaluation of a Dialectical Behavior Therapy Didactic for Medical Trainees in an Acute Adolescent Inpatient Psychiatric Unit.

Dialectical behavior therapy (DBT) is an evidence-based treatment for patients with suicidality and emotion dysregulation. There is increasing evidence of using DBT in psychiatric inpatient units for youth. On inpatient units, the majority of treatment is provided by psychiatry trainees, often with limited therapy experience. The study's objective was to assess the impact of a 1-h weekly DBT training for a range of medical trainees rotating through a child and adolescent acute inpatient unit. Participants were 55 medical students, psychiatry residents, and child and adolescent psychiatry fellows who rotated on an inpatient unit for youth and participated in a 1-h DBT didactic. There was one group who attended less than four sessions and the other attended 5 or more sessions. A pre- and post-method design was used to collect data on participants' confidence, competence, and knowledge of DBT and working with suicidal youth. Comparing pre- and post-data for all participants, the DBT training was found to lead to significant benefits for trainees' comfort with therapy, prioritizing therapy during inpatient care, knowledge of DBT, comfort with DBT, and confidence in treating children and adolescents with suicidality. There were no significant differences in the type of trainee or dose of training. This study supports the benefit of a brief DBT didactic to provide training to a wide range of trainees to improve therapeutic care in an inpatient psychiatric unit for youth.

Training Psychiatrist-Scientists—Excellence on Both Sides of the Hyphen

This Viewpoint discusses why it is important for psychiatry residency programs to continue to prioritize the training of psychiatrist-scientists.

The Impact of Under‐Diagnosing ADHD in Young Females

When I was in adult psychiatry residency, I was shocked by the frequency of which young adult female patients would request evaluation for potential ADHD. Many of these young women presented as well with mood and anxiety symptoms, and it was imperative to determine whether the predominant impairment was secondary to untreated ADHD or other psychiatric conditions. In full disclosure, I was unfortunately primed to be skeptical of these college‐aged students who were seeking a diagnosis of ADHD, and I naively felt that their presenting concerns of inattentiveness, difficulty with concentration, and reduced motivation was more likely attributed to untreated depression in this population rather than an undetected ADHD. After all, I wondered, how would ADHD have gone unnoticed for all of their childhood and only now manifest in young adulthood? Oddly enough, I encountered very few young adult males with signs concerning for untreated ADHD; if anything, I saw more males on stimulants for ADHD than women, despite encountering more young women reporting concerns for untreated ADHD.

Euripedes C. Miguel: Risk factors for obsessive-compulsive and other mental health disorders and their treatment and public policy implications

Euripedes Constantino Miguel is a full, tenured Professor and Head of the Department of Psychiatry at the Faculty of Medicine, University of São Paulo (FMUSP), and an Adjunct Associate Professor at Yale University School of Medicine. He graduated from FMUSP and completed his Psychiatry Residency and PhD at the Institute of Psychiatry at the University of São Paulo. After a postdoctoral fellowship at Massachusetts General Hospital, Harvard Medical School, Professor Miguel returned to Brazil in 1994 to pioneer the Obsessive-Compulsive Spectrum Disorders Program. He leads the National Institute for Developmental Psychiatry www.inpd.org.br, focusing on early identification and intervention of mental health disorders. Since 2023, he has led the National Center for Science and Innovation in Mental Health (CISM) www.cism.org.br, enhancing mental health education and research through innovative solutions and public-private partnerships. This Genomic Press Interview features Professor Miguel's candid reflections on his professional achievements and life's journey.

Evaluating the Role of Objective Structured Clinical Examination as a Summative Assessment Tool in Undergraduate and Postgraduate Psychiatry Residents.

The Objective Structured Clinical Examination (OSCE) is the gold standard and universal format to assess medical students' clinical competence in a comprehensive, reliable, and valid manner. OSCE is gaining global popularity for assessing medical students in various specialties. Our country uses it in multiple disciplines, but its application in psychiatry remains limited. OSCE is a resource-demanding assessment method that can face numerous challenges. A comprehensive assessment of perceptions regarding OSCE can help identify areas that need improvement. Therefore, this study was conducted to assess the perceptions of students and examiners toward OSCE in psychiatry. This study aims to evaluate the role of Objective Structured Clinical Examination as a summative assessment tool in assessing competency in undergraduate (as part of their ward leaving examinations in psychiatry) and postgraduate psychiatry residents (as part of their six-monthly assessments) and analyze the perceptions of students as well as of the faculty members regarding OSCE. Six MD students and 49 MBBS students took the OSCE as part of their ward-level exams in psychiatry. In the presence of four faculty members of the psychiatry department, students completed their six-month summative exams. The OSCE was held at separate times for UG and PG students. UG and PG students utilized different stations (PG students had a harder level). A 10-item questionnaire was given to examiners and students at the end of the OSCE to get their opinions regarding the OSCE. Furthermore, data gathered from the faculty through an open-ended questionnaire was compiled and displayed thematically. Since the Likert scale survey generated ordinal data, the statistical analysis was conducted using the median, interquartile range (IQR), and chi-square test. The chi-square test was used to compare the variables. A P-value of less than 0.05 was deemed statistically noteworthy. Four faculty members and fifty-five students in all answered the questionnaire. Regarding the OSCE's characteristics, validity, reliability, and transparency, the majority of students expressed positive opinions. In a similar vein, most examiners had positive perceptions pertaining to OSCE's administration, structure, and procedures. Certain areas, such as "improved confidence in teaching clinical skills" and "improved confidence in giving students structured feedback," were also emphasized by thematic analysis of faculty members. In general, both students and examiners had extremely favorable perceptions of and embraced the OSCE. Improved faculty orientation and student preparation for the OSCE may help allay anxiety and overcome hesitation related to the exam.

How Many Is Too Many? Using Cognitive Load Theory to Determine the Maximum Safe Number of Inpatient Consultations for Trainees.

Cognitive load, specifically extraneous load (EL) reflective of distractions, may provide evidence of a lack of focus, potentially making additional work unsafe. The assessment of trainees performing inpatient consultations provides a helpful model for examining this question. The goal of this study was to provide useful information to clinical and educational leaders to optimize inpatient consultation services and rotations and mitigate potential patient safety risk. In 2019, using the Consult Cognitive Load instrument, the authors obtained EL data from inpatient consultations performed by internal medicine fellows and psychiatry residents across 5 University of California hospitals. In 2023, the authors constructed a Wright map to compare the participants' EL data with the number of prior initial consultations performed during the shift. Of 326 trainees contacted, 139 (43%) completed the EL survey items. The Wright map shows that trainees were estimated to agree that interruptions were already distracting at the first consultation of the shift. After 4 consultations, trainees were estimated to strongly agree that interruptions were distracting and to agree that emotions, extraneous information, and technology were distracting. The authors propose a quantitative, empirically driven, mean safety limit of 4 new inpatient consultations per shift for trainees to avoid cognitive overload, thereby potentially supporting patient safety. Clinical and educational leaders can adjust this limit to fit the unique needs of their practice setting. A similar approach using cognitive load and item response theory could be used to conduct patient safety research in other domains.

Neuroimaging education in psychiatric training.

As the histories of psychiatry, neurology, and neuroimaging interweave through time, psychiatry has only recently started to recognize the need to embrace neuroimaging like its sibling specialty. While imaging in psychiatric research is well accepted, there is current clinical utility as well. Standards for psychiatry residency and board certification in the USA and abroad have carved out a place for neuroimaging, but the implementation is variable and sparse in the USA. The few publications that describe neuroimaging teaching to psychiatrists have barriers to widespread adoption, and no comprehensive curricular solution has been developed. In this context, we describe some of the barriers and propose solutions to shape the future of neuroimaging education for psychiatrists.

Daniel H. Wolf: Understanding motivation impairment from clinical, behavioral, and neurobiological perspectives to pave the way for better treatments

Dr. Daniel Wolf grew up in Los Angeles, completed his BA at Harvard College, MD-PhD at Yale University, psychiatry residency at MGH-McLean, and neuropsychiatry fellowship at UPenn. He is an Associate Professor of Psychiatry at UPenn's Perelman School of Medicine. As head of the Laboratory for Motivation in Psychiatry, Dr. Wolf uses functional neuroimaging to study the neural mechanisms of amotivation and other symptom dimensions in psychosis and at-risk states, aiming to develop novel assessment biomarkers for early-stage drug development. Dr. Wolf also provides outpatient care to individuals with psychosis while supervising clinical trainees. As Director of the Clinical Neurosciences Training Program and Co-Director of the Psychosis T32, he provides seminars and mentoring to medical and graduate students and postdoctoral fellows; he earned the School of Medicine's teaching awards in both Basic Science and Translational Science. He is also an ACNP Fellow and member of the Neuropsychopharmacology editorial board. Dr. Wolf answered the Genomic Press Interview, providing our readers with reflections on his life and career.

Longitudinal Outcomes of a Resident Academic Administrator, Clinician Educator Track.

As clinician educator tracks continue to gain popularity in graduate medical education, this report aims to fill a gap in the literature by providing a 14-year update on professional outcomes of participants in a psychiatry residency academic administrator, clinician educator (AACE) track and to compare these outcomes to non-track participants. An anonymous web-based survey querying professional achievements was distributed to all graduates of a psychiatry residency training program from 2009 to 2022. Outcomes of AACE track participants and non-track participants were compared. Of 228 alumni contacted, 61% responded (n = 140). Eighty-seven percent of track participants responded (n = 74) while 41% of non-track participants responded (n = 45). Of track participants, 63% practice in academic settings with 57% having held administrative leadership roles, 49% educational leadership roles, and 39% national or regional leadership roles. Track graduates were academically engaged with 70% reporting at least one publication, 89% at least one presentation, and 93% attending at least one national meeting. In comparison, 31% of non-track participants practice in academic settings with 44% having held administrative, 29% educational, and 20% national or regional leadership roles. Thirty-nine percent have at least one publication, 75% at least one presentation, and 90% attended at least one national meeting. When compared to non-track participants, track participants were significantly more likely to have an academic affiliation and a higher number of publications and were more likely to hold national or regional leadership roles. Track participants demonstrate longitudinal career success as clinician educators and academic administrators more so than non-track participants.