Psychiatry Residents Research Articles

Commentary: Educating the next generation of psychiatrists in the use of clinical neuromodulation therapies: what should all psychiatry residents know?

Commentary: Educating the next generation of psychiatrists in the use of clinical neuromodulation therapies: what should all psychiatry residents know?

ЭМПАТИЯ И ЗАЩИТНЫЕ СТРАТЕГИИ В ОБЩЕНИИ ВРАЧЕЙ-ОРДИНАТОРОВ С РАЗНЫМ УРОВНЕМ ПЕРФЕКЦИОНИЗМА

The paper presents the results of a study of associations between empathy and defensivecoping communication in medical residents with different level of perfectionism. Psychiatry and neurology residents (n = 100) aged 22–29 filled out the following validated instruments: “Three-Factor Perfectionism Inventory” (Garanyan N. G., et al.); “The Interpersonal Reactivity Index (IRI)” (M. Davis); “Diagnosis of the dominant strategy of psychological defense in communication” (V. V. Boyko). The sample was divided into three groups with high (n = 37), medium (n = 33) and low (n = 30) levels of perfectionism. The obtained data indicate a positive correlation between empathy factor “Perspective taking” and strategy of defensive communication “Peacefulness” in all the three groups of residents with different levels of perfectionism. In residents with medium level of perfectionism “Peacefulness” also correlated with “Empathic concern”, and “Avoidance” correlated with “Personal distress”. In residents with high level of perfectionism “Aggression” negatively correlated with “Perspective taking” and “Empathic concern”. The collected data contribute to a more complete understanding of associations between empathy and defensive communication in psychiatry and neurology residents and can be applied to specify psychological targets of residents training.

IMPACT OF CREATING MENTAL HEALTH HELPLINE AT A TERTIARY CARE PSYCHIATRIC SET-UP IN PAKISTAN DURING THE COVID -19 PANDEMIC

Objectives The objectives of this study were to analyze the calls received at a 24-hour helpline service set up at the Institute of Psychiatry during the first wave of the COVID-19 pandemic for the demographics of the service users, the reasons for calling the helpline phone, and the guidance provided. Design Descriptive retrospective clinical audit Place and Duration of Study The Institute of Psychiatry, from June 2020 and February 2021 Patients and Methods The entries made detailing the call records by psychiatry residents managing the helpline were analyzed. Data was extracted regarding age, area of residence, and reasons for calling by the service users of the helpline, as well as the advice given by the resident on call. The statistical analysis was performed using SPSS version 26, and findings were evaluated in terms of age, geographical distribution, reasons for seeking assistance, and the type of guidance provided thereof. Results Of the 102 calls analyzed, most of the callers were between 30 to 39 years of age (33.3%), and hailed from Rawalpindi (78.4%), followed by Kashmir (5.9%), Chakwal (4.9%) and Murree (3.9%). The most frequently stated reasons for calling were to ask about availability of out-patient services (36.3%), to have medication revised (23.5%), and to enquire about the side effects of medication (11.8%). Other reasons included recurrence of symptoms or lack of improvement in patients already taking treatment (15.7%) and to seek help regarding new psychiatric symptoms (12.7%). The responses given to the callers were invitation to come to the hospital (44.1%), provision of relevant information about the particular questions asked (for example, relating to hospital timings) (36.3%), adjustment of medications (11.8%), and prescribing medication with advice of physical follow-up (7.8%). Conclusion Despite psychiatric out-patient department being temporarily closed down during the initial waves of the COVID 19 pandemic, efforts were made to continue service provision through innovative means, like the 24-hour helpline service. There is a need to further incorporate the use of technology in the delivery of psychiatric services.

Perceived Disruption of COVID-19 on Medical Education in Incoming Psychiatric Residents.

In 2020, the global COVID-19 pandemic caused educational disruptions to many medical students nationally. Societal and hospital guidelines, including social distancing protocols, resulted in the cancellation or postponement of many elective procedures. A shortage in personal protective equipment also contributed to restrictions in clinical experiences for trainees. The purpose of this study was to determine resident-perceived preparedness in core clinical competencies and evaluate the disruptions to core clerkships. A survey was developed to assess self-perceptions of clinical competencies and disruptions to core clerkship experiences. It was distributed to 63 incoming psychiatric residents who matched to training programs in the United States. The survey response rate was 97%. The majority of respondents achieved self-expected levels of proficiency in clinical skills. Deficits were greatest for pelvic/rectal exams and transitions of care. Most students did not experience disruptions to clerkships. Internal medicine, obstetrics, and gynecology clerkships reported the highest rates of virtual completion. Procedures with the lowest reported perceived preparation were arterial puncture, airway management, and IV placement, respectively. Our survey results indicated that most learners did not perceive disruptions to their medical education and incoming psychiatry residents felt well-prepared to start residency. Some specific procedural skills appear to have been affected. Attempts to mitigate these specific inadequacies may help mitigate disruptions due to future events.

Virtual Interviewing and Diversity Among Psychiatry Residents.

Psychiatry residency program directors were surveyed regarding their impression of the impact virtual interviewing had on the perceived and actual diversity of individuals selected for interviews and residency training. A link to an anonymous survey was sent to 299 psychiatry residencies. Psychiatry program directors provided information about their programs and rated their perception of the impact of virtual interviewing on candidates they interviewed and matched. They also reported the demographic information of incoming residency classes for 2020-2023. This data was assessed for differences in the average number of residents by each diversity category and interview format (i.e., in person or virtual) and between diversity categories and cohorts. A linear trend analysis assessed whether the number of residents in each demographic category had a significant change over time. Sixty-five program directors (21.7%) provided at least partial data. Half of the responding program directors believed that virtual interviewing had increased the diversity of interviewed applicants, but there were no statistically significant differences in the average number of incoming residents who were identified as women or were in an Underrepresented in Medicine category when comparing the in-person interview year (2020) and the virtual interview years (2021-2023). The analyzed data demonstrated that the type of interview (in-person vs virtual) did not appear to affect the diversity of incoming psychiatry residents. Ongoing efforts to increase diversity, equity, inclusion, and belonging should be paired with measurements of their impact.

The European psychiatric association (EPA) – early career psychiatrists committee survey on trainees’ and early-career psychiatrists’ attitudes towards therapeutic drug monitoring (TDM) use and utility during antipsychotic treatment

Objectives This survey assessed psychiatry residents’/early-career psychiatrists’ attitudes towards the utility of therapeutic drug monitoring (TDM) of antipsychotics. Methods A previously developed questionnaire on attitudes on TDM utility during antipsychotic treatment was cross-sectionally disseminated by national coordinators between 01/01/2022–31/12/2023. The frequency of using TDM for antipsychotics other than clozapine was the main outcome in a linear regression analysis, including sex, clinical setting, caseload, and factors generated by an exploratory factor analysis. Comparisons between residents and early-career psychiatrists, respondents working in in- and outpatient settings, and low-/middle- and high–income countries were performed. Results Altogether, 1,237 respondents completed the survey, with 37.9% having never used TDM for antipsychotics. Seven factors explained 41% of response variance; six of them were associated with frequency of TDM use (p < 0.05). Items with highest loadings for factors included clinical benefits of TDM (factors A and E: 0.7), negative expectations for beliefs of patients towards TDM (factor B: 0.6–0.7), weak TDM scientific evidence (factor C: 0.8), and TDM availability (factor D: −0.8). Respondents from low-/middle-income countries were less likely to frequently/almost always use TDM compared to high-income countries (9.4% vs. 21.5%, p < 0.001). Discussion TDM use for antipsychotics was poor and associated with limited knowledge and insufficient availability.

Nicolas Garel: Combining psychoactive molecules and psychotherapy for patients suffering from mood and substance use disorders: a new therapeutic paradigm

Dr Nicolas Garel is an Assistant Professor in the Department of Psychiatry and Addictology at the University of Montreal and a junior investigator at the Research Center of the Centre Hospitalier de l'Université de Montréal. Dr Garel did his psychiatry residency at McGill University before completing the Clinician-Investigator Program and a Master's degree at McGill University, studying the potential role of ketamine in the discontinuation of benzodiazepines and related drugs. Dr Garel then completed a clinical fellowship in Addiction Medicine at Stanford University. His research program focuses on the integration of psychoactive molecules in conjunction with psychotherapy as a unique potential treatment approach for patients with comorbid mood and alcohol/sedative use disorders. In this “Innovators &amp; Ideas” section, we are excited to feature Dr Garel in our latest Genomic Press Interview. We are thrilled he took the time to answer our questions and share his valuable insights with our readers.

Breaking Silence, Building Resilience: Outcomes of a Course on Navigating Patient Suicide in Psychiatry Residency.

Breaking Silence, Building Resilience: Outcomes of a Course on Navigating Patient Suicide in Psychiatry Residency.

Psychiatry Residents' Views on Quality of Psychotherapy Training in Pakistan: A Cross-Sectional Survey

Psychiatry Residents' Views on Quality of Psychotherapy Training in Pakistan: A Cross-Sectional Survey

Stakeholders' perspectives on adverse effects of ECT: A qualitative thematic analysis.

In the Indian context, published systematic research on the opinions of mental health professionals and other stakeholders (patients and caregivers) regarding the different adverse effects of electroconvulsive therapy (ECT) is not available. This type of study allows for an in-depth exploration of complex phenomena, such as the perspectives of mental health professionals, which can provide a rich understanding of their experiences regarding ECT and also helps to understand the views of mental health professionals regarding the adverse effects of ECT during the post-ECT recovery period and its management. Conversely, the perception of patients and caregivers regarding the adverse effects of ECT can provide a more comprehensive understanding of the treatment and its impact on the patients who receive it. To explore the understanding of participants about the various adverse effects following ECT and their perception of managing different adverse effects of ECT during the post-ECT recovery period. A qualitative approach using focus group discussion (FGD) was used. A convenience sampling technique was followed for selecting the participants. FGDs were conducted with stakeholders including mental health professionals, patients, and caregivers. Five FGDs were conducted with psychiatry residents, nursing officers from the ECT suite, and different psychiatry wards at NIMHANS. Four FGDs were held separately for patients receiving ECT and their caregivers, admitted to various psychiatry wards at NIMHANS. A total of 28 mental health professionals, 20 patients, and 20 caregivers participated. The number of participants for FGDs was decided based on data saturation. The FGDs, lasting 30-40 minutes each, occurred between October 2022 and December 2022. The FGDs were audio-recorded with prior permission from the participants. All the participants were informed about the study. Written informed consent was obtained. All FGDs were transcribed. Thematic analysis was done using Atlas. ti software. The broad categories identified were adverse events associated with ECT during the ECT procedure, adverse events associated with ECT after the ECT procedure, prevalence of different adverse effects according to mental health professionals, effects of adverse effects on the continuity of ECT, and difficulties encountered by mental health professionals throughout the management. Other broad categories were found after conducting FGDs with caregivers and patients, which were patients' experience as per the caregivers over the course of ECT, caregivers' and patients' willingness to continue ECT, unfavorable impacts of ECT experienced by the patients immediately after ECT sessions, and, later till the end of that day, suggestions of the caregivers and patients to improvise the management of ECT-related adverse effects and management of adverse effects by the treating team. The findings will develop a standard operating procedure that may help nursing officers monitor and identify the adverse effects immediately after ECT and minimize the complications during the post-ECT recovery period.

Nutrition Education in Psychiatry Residency Programs: A Call to Action

The burden of disease attributable to mental health is expected to rise in the coming decades. Poor nutritional status is considered a modifiable risk factor for general mental health. In fact, nutrition interventions are now accepted as a core strategy in mental healthcare to combat physical health inequalities and life-expectancy gap in people with certain psychiatric disorders. However, most psychiatrists are not familiar with evidence for the potential therapeutic benefits of diet in psychiatric illness, and this may be related to sparse nutrition education for physicians. Thus, there is a need to integrate nutritional management in psychiatric practice, but there is a gap in medical education that would support this practice. Here, we discuss evidence for and challenges in 1) assessing diet quality in psychiatric illness, 2) recommending improvements in diet quality and specific dietary patterns in psychiatric illness, and 3) recommending dietary supplements in psychiatric illness. This discussion serves as a call to develop nutrition curricula within psychiatry residency programs.

Prescribing Habits for Elderly Patients in a Sample of Psychiatry Residents at Ibn Nafis Psychiatric Hospital: A Descriptive Study

Prescribing Habits for Elderly Patients in a Sample of Psychiatry Residents at Ibn Nafis Psychiatric Hospital: A Descriptive Study

Prescribing Habits for Pregnant Patients in a Sample of Psychiatry Residents at Ibn Nafis Psychiatric Hospital: A Descriptive Study

Prescribing psychotropics for pregnant women is a delicate issue as most drugs cross the placenta. There are concerns about possible hazards to the growing fetus and balancing the risk of malformation against the risk of a psychiatric condition relapsing is a common dilemma. To minimize the risks associated with polypharmacy monotherapy is typically the preferred approach. This study aimed to explore the prescription habits of psychotropic medications to pregnant women by residents at IBN NAFIS University Psychiatric Center and review it in the light of literature. 25 residents took part. We found that for agitation, 93% of residents prescribed classic antipsychotics. For major depressive disorder, 81% of residents prescribed selective serotonin reuptake inhibitors (SSRIs). For anxiety disorders, 68% of the sample prescribed SSRIs. For manic episodes, 50% of residents prescribed lamotrigine, 12% prescribed olanzapine, 6% preferred sodium valproate, 6% prescribed classic antipsychotics. For psychotic disorders, the vast majority of residents prescribed classic antipsychotics (88%), while 6% of them prescribed Risperidone and the remaining 6% preferred the use of Olanzapine. For insomnia, the majority of residents in the sample preferred prescribing hydroxyzine (69%). Oxazepam is considered a first-line anxiolytic because it doesn't create active metabolites. Classic antipsychotics like haloperidol and chlorpromazine are commonly prescribed during pregnancy due to their proven efficacy and safety. Atypical antipsychotics like olanzapine risperidone quetiapine and clozapine are used, with olanzapine being a first-line treatment due to reassuring data on fetal side effects. Thymoregulators like lamotrigine can be used but caution is advised due to potential risks. Antidepressants like tricyclics and SSRIs are commonly prescribed with SSRIs being preferred for pregnant women. The study emphasizes the importance of taking into account the particulars of the drugs such ...

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey.

Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency. We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians. A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents. Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001). Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

Educating the next generation of psychiatrists in the use of clinical neuromodulation therapies: what should all psychiatry residents know?

A variety of neuromodulation treatments are available today and more are on the way, but are tomorrow's psychiatrists prepared to incorporate these tools into their patients' care plans? This article addresses the need for training in clinical neuromodulation for general psychiatry trainees. To ensure patient access to neuromodulation treatments, we believe that general psychiatrists should receive adequate education in a spectrum of neuromodulation modalities to identify potential candidates and integrate neuromodulation into their multidisciplinary care plans. We propose curricular development across the four FDA-cleared modalities currently available in psychiatric practice: electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). With a focus on psychiatry residency training, the article delineates core learning components for each neuromodulation technique. For each modality, we review the clinical training status, the respective FDA-cleared indications, mechanisms of action, clinical indications and contraindications, adverse effects, informed consent process, dosing considerations, and clinical management guidelines. The approach outlined in this article aims to contribute to the development of a well-rounded generation of psychiatry trainees with the capacity to navigate the growing field of neuromodulation. Whether or not a psychiatrist specializes in delivering neuromodulation therapies themselves, it is incumbent on all psychiatrists to be able to identify patients who should be referred to neuromodulation therapies, and to provide comprehensive patient care before, during and after clinical neuromodulation interventions to optimize outcomes and prevent relapse.

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.

Applying a Competency-Based Medical Education Framework to Development of Residents' Feedback Skills.

Feedback is a critically important tool in medical education. This pilot program applies and evaluates a competency-based approach to develop residents' skills in providing feedback to medical students. In 2018-2019, a competency-based resident feedback skills program incorporating videorecording of skills, multi-source feedback using assessment tools with validity evidence, and sequential deliberate practice was piloted in a single-center, prospective study at the University of Rochester. Study participants included eight second-year psychiatry residents and 23 third-year clerkship students. After an introduction to foundational feedback concepts in didactic sessions, residents were videorecorded providing feedback to medical students. Recordings were reviewed with a faculty member for feedback. Skills were assessed by students who had received resident feedback, residents, and faculty utilizing a tool with validity evidence. Observations were repeated a total of three times. Mean feedback scores increased from 2.70 at the first feedback observation, to 2.77 at the second feedback observation, to 2.89 at the third feedback observation (maximum 3.00 points). The differences between the first and third sessions (0.19) and second and third sessions (0.12) were statistically significant (p values were < .001 and .007, with SE of 0.4 and 0.4, respectively). The observed competency-based feedback skills training program for residents using sequential, multi-source review and feedback was feasible and effective. Direct observation is a key component of high-quality feedback, and videorecording is an efficient methodology for observations, enabling both direct observation by the assessor and opportunity for enhanced self-assessment by residents viewing themselves in the feedback encounter.

Learning to observe art to better understand the patients: A pilot study

ObjectivesWe describe an artwork observation training program proposed to the first-year psychiatry residents in the school of medicine of Montpellier-Nîmes (Université de Montpellier). This course aimed at improving the ability to observe, tolerate ambiguity in healthcare, work as a team, communicate, and develop empathy. We also evaluated the impact of this program on the enhancement of emotional and communication skills in a pilot study. Materials and methodsThe artwork observation program based on Visual Thinking Strategies consisted of three sessions of ninety minutes involving two groups of eight medical students. First-year volunteer psychiatry residents were recruited. Before the sessions participants completed the Groningen Reflection ability Scale to evaluate reflection skills. Then, all the participants examined paintings and drawings of the Atger collection, were encouraged to observe carefully, and to engage in active group discussion by means of a structured questioning. Following the session, participants responded to a short survey to assess potential improvement of socio-emotional and communication skills. ResultsFifteen psychiatry residents participated in the pilot study, eight were males. The median age was twenty-five years. The artwork observation program was well accepted by the participants. All the respondents reported improvement of emotional and communication skills, except regarding three empathy items, including the ability to feel the suffering of others which was increased only for 62% of respondents. DiscussionOur program relying on Visual Thinking Strategies may improve the ability to observe carefully, to perceive the mental states of others, and to tolerate uncertainty. Training of such skills may encourage the adoption of self-reflective attitudes. ConclusionsSuch an artistic innovative program should be extended to undergraduate students in medical curriculum.

Collaboration Between Orthopedic Surgery and Psychiatry Residency Programs to Improve Education About Orthopaedic Pain Management for Patients With Mental Illness

Collaboration Between Orthopedic Surgery and Psychiatry Residency Programs to Improve Education About Orthopaedic Pain Management for Patients With Mental Illness

Beyond theoretical courses – A study of Swedish psychiatric residents’ collegial learning through conversations in the workplace

Background Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents’ opportunities for collegial conversations during and after national courses in psychiatry. Methods Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings. Results The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses. Conclusions This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents’ perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents’ lifelong learning and professional development.