Psychiatry Training Research Articles

Factors Contributing to Stress and Well-Being Among Trainee Psychiatrists in Victoria, Australia.

Doctors in training experience stress, as they balance the demands of working and studying at the same time. As evidenced by reports of suicides among trainee doctors, it is clear that the level of stress they experience is dangerously high. Long working hours, which can lead to exhaustion, burnout, and time taken away from meaningful activities and relationships outside of work, are a large contributor to trainee stress and increase the likelihood of mental illness and suicidal ideation. For psychiatry trainees, this workload burden is also compounded by a high emotional burden associated with the nature of their work, including patient suicides, aggression, and threats. This study sought to investigate the factors that contribute to the stress and well-being of psychiatry trainees, through in-depth interviews analyzed via qualitative, template analysis. The main sources of stress identified were workload, aspects related to the psychiatry training program, and workplace-based aggression. Supervision, external supports such as family and health professionals, and distraction or "switching off" were the main sources of well-being support. Overall, this study highlighted the importance of structural factors in the workplace and training program in psychiatry trainee stress and well-being levels. Workload and training commitments limited the amount of time trainees could devote to well-being-related activities, despite their awareness of these. This study contributes useful insights into how we can better look after the mental health and well-being of psychiatry trainees, as future leaders of our mental health system.

Editorial introductions.

Editorial introductions.

Balint grupni trening - teorija i praksa

With regard to the many years of cooperation between the Balint Society of Serbia and the Faculty of Medicine in Belgrade (which, in recent years, has been realized through a promotional Balint workshop for GP residents), we believe that the application of the Balint method in continuous education would contribute to the improvement of doctors' professional performance. Balint education has shown excellent results for physicians of all medical specialties as well as for other healthcare professionals and associates (psychologists, special pedagogues, social workers, special education teachers, nurses) who want to improve their relationships with health care users, and it is especially helpful in the acquisition of skills necessary for working with "problem clients" as well as in the prevention of job burnout syndrome in healthcare professionals. The primary objective of this paper was to offer and present arguments on the importance of educational programs applying the Balint methodology, which is focused on the client-therapist relationship, and founded on psychoanalytic ideas. The secondary objective was to enhance awareness of the exceptional importance of the client-therapist relationship, which is of major therapeutic interest and essential to any treatment, and through participation and work in Balint groups, group members learn to understand and skillfully utilize the professional client/patient relationship. With its specific goals and methods, the education is beneficial to therapists, clients as well as health care institutions. A literature review was carried out regarding the previously published studies on the development, growth, and work dynamics of Balint groups and therapists i.e., counselors. Special attention was given to the discussions included in these studies, pertaining to the consequences of weaknesses, but also of strengths in the performance of Balint therapists. Attention was also paid to the issues related to the insufficient number of Balint groups and therapists that apply this practice in education, as well as to the support and assistance they are provided in regard to their work. The efficiency of Balint groups was also considered, including their contribution published in the literature, in addition to recommendations for overcoming this problem in the future. The founding father of this method, Michael Balint, a psychiatrist, started a training program for general practitioners (family physicians) more than 70 years ago, since he believed that they were specially overworked and burdened with a large number of patients and that improving doctors' knowledge in the field of psychology would facilitate their work. Later, this training program expanded, becoming more and more present in other branches of medicine. Today, Balint education is an integral part of medical studies and specialist training in psychiatry, gynecology, endocrinology, and family medicine in many European countries. Balint groups are intended for practitioners who professionally recognize the value of developing and deepening an empathic emotional relationship with their clients. These groups help doctors to reach a better understanding of a patient's overall condition, which in turn enhances the doctor's creative capacities to engage in the therapeutic process. In addition, the group process leads to a reduction in professional isolation that prevails among healthcare workers, contributing to the job burnout syndrome. Balint education enables a better connection between practitioners from different disciplines participating in the treatment. Thus, the Balint group members gain experience on the importance of alliance and cooperation in the treatment of their patients. Balint groups usually meet twice a month, during the academic year, giving participants the opportunity to become aware of what prevents them from having a better relationship with their clients as well as to find authentic answers that will reduce misunderstandings. Numerous studies have confirmed the importance of empathic relationships with clients in the provision of effective health care, and professionals also consider such relationships essential to their work. Balint groups are focused on reaching a better understanding through various associations, guided by a Balint leader, rather than on presenting ready-made solutions to a problem, which makes them applicable to a myriad of treatment situations.

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

Psychiatry training in India – A resident's perspective

Psychiatry training in India – A resident's perspective

English Language Medical Schools in China: An Analysis of International Medical Graduates Practicing in the UK.

From 2006, the Ministry of Education in China has approved universities to provide undergraduate medical training in English, targeting fee-paying international students. Students on these courses can face challenges in their clinical training, particularly in the domains of communication and professionalism. This study examines the proportion of doctors qualified from such medical schools who are currently listed on the UK medical register. The UK General Medical Council register of medical practitioners was searched to identify doctors qualified from 33 Chinese medical schools who provide education in the English language. As of February 2022, 502 doctors whose primary medical qualification is from a university offering English language education in China were registered on the UK medical register. Four hundred twenty-five (84.7%) of these doctors were aged 39 and under, approximately double the proportion of doctors in this age bracket overall. Three hundred forty nine (69.5%) were staff grade and associate specialist doctors, 109 (21.7%) were doctors in training, 36 (7.2%) were on the General Practitioner (GP) register, and 20 (4.0%) were on the specialist register. Among doctors in training, the most common specialty areas were in general practice and psychiatry that are both facing recruitment shortages in the UK at present. A small but significant number of graduates whose medical training was in the English language in China are practicing medicine in the UK. These doctors are in younger age groups than the overall medical workforce, and are less likely to be in training, and specialist or GP posts. Among those in training, a high proportion are in GP and psychiatry training and could contribute to alleviating UK medical workforce shortages. Policymakers and educators should be mindful of the growing numbers of doctors qualified from these schools, and the additional support they may require considering the unique training environments they have encountered.

Personal Recollections about the Development of Bipolar II Disorder

Background: This paper reviews the development of Bipolar II disorder, defining the development of diagnosis and the current state of the art in treatment. Methods: Through his training and working in psychiatry, the author recounted the early days when Bipolar II disorder was conceptualized and developed as a separate clinical entity at the Department of Psychiatry at Washington University, US National Institute of Mental Health, and New York State Psychiatric Institute/Columbia University. The author also participated in the process leading to the inclusion of Bipolar II in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) in 1994. In this review, the author presents his recollections how bipolar II disorder came about and entered the diagnostic criteria that we now use in psychiatry. Results: The diagnostic criteria of Bipolar II disorder in DSM-IV and DSM-5 were reviewed. Then, the author stressed the importance of differentiating Bipolar II disorder clinically, how to make the diagnosis of Bipolar II disorder, differentiating mania from hypomania, differentiating hypomania from unipolar depression (i.e., major depressive disorder), and provided useful clinical tips related to ascertaining this diagnosis. Then, he reviewed and raised some issues in treating Bipolar II disorder. The neuroscience-based nomenclatures were given for all drugs used in treating Bipolar II disorder in this review. Conclusion: Bipolar II disorder has come a long way to be accepted as a valid clinical entity. The author believes that more clinical knowledge can further improve the diagnosis and treatment for patients with Bipolar II disorder.

СУЧАСНИЙ СТАН ДИТЯЧОЇ ПСИХІАТРІЇ В УКРАЇНІ: ОСВІТА ТА ПРАКТИКА

The article discusses the challenges that Ukrainian paediatric mental health services faced during the COVID-19 pandemic and the full-scale invasion of military forces to Ukraine. The features of the psychiatric service organization, such as the concentration of these services in large cities exacerbated by the staff shortages, lowlevel telehealth facilities development, and lack of mental health education on the community level that were exacerbated by stigma in the society negatively affected the access to specialized child mental health services during the pandemic. The situation significantly worsened due to war, that was related to the unprecedented rate of violence toward the civil population, destruction of critical infrastructure, lack of access to medication, and evacuation of medical personnel that in turn resulted in a crisis in Ukrainian child and adolescent psychiatry To address these challenges, a recent paper highlight the need for systemic reforms and collaboration among experts in the field of child healthcare, medical education, social services, and government agencies. The author recommends creating a comprehensive training program for child psychiatrists and incorporating child psychiatry into the postgraduate training of medical professionals, providing training in child psychiatry for pediatricians and family doctors and promoting digital services. Furthermore, the authors propose deinstitutionalization for child psychiatric services and their movement to multidisciplinary childcare facilities with the developing of community- based forms of psychiatric and psychological care for children to ensure better access to mental healthcare services and their destigmatization.

Medical Humanities in Undergraduate Psychiatry Teaching: Learner Assessment and Mediators of Better Learning Outcomes.

Previous studies have found that the inclusion of medical humanities in medical education was associated with improvements in learner reflectivity and empathy. There is less data, however, on the impact of medical humanities on perceived patient care and mediators of learner outcomes. Our study aimed to determine the impact of medical humanities on perceived learner well-being and patient care, and the mediators of these outcomes in medical undergraduates undergoing psychiatric training. This cross-sectional study was conducted from August 2021 to December 2022 within undergraduate medical students undergoing psychiatry rotations and who attended sessions entitled "Humanities in Psychiatry." Both quantitative and qualitative data were obtained through anonymized online feedback forms. Path analysis was performed to examine the relationship between learners' perception of the medical humanities writing activity and its potential to improve their well-being, patient care, as well as mediators of these outcomes. Overall, 97 medical undergraduates (response rate 67.4%) participated in the study and more than four-fifths reported improvements in listening, reflection, empathy, personal well-being, and perceived patient care. Males showed more interest in additional medical humanities sessions (mean rank 57.9 vs 42.5, P = .005) and greater improvements in personal well-being (mean rank 55.1 vs 44.5, P = .044). Path analysis showed that reflective capacity of learners mediated the relationship between reflective writing and perceived improvements in learner well-being (β = 0.596, 95% CI = 0.409-0.737) and patient care (β = 0.557, 95% CI = 0.379-0.702). Our study found that the majority of learners responded positively to the medical humanities sessions, which suggests that its use could be beneficial in fostering empathy, reflection, learner well-being, and improved patient care. Using the PRISM model, we present practical implications for educators to consider when using medical humanities in relation to psychiatry training.

A journey of holistic research and training in mental health

My early exposure to mental illness in our community, the plight of mentally ill people and their families drove me to seek postgraduate training in psychiatry in India. I realized early on that only research could make an impact on the scale that was needed. My contacts with thoughtful scientists and mentors helped me understand that by training enthusiastic individuals – especially women, multi-focussed research could make a substantial impact and have a multiplier effect. I thus devoted my life not only to research, but research-based training. I outline below our training programs and their outcomes.

Downstream effects of high patient volume pressure on PHPs: A child psychiatry trainee's perspective

Rhode Island boasts some of the most robust access to specialized child and adolescent mental health care across the country, with one of the highlights being the unique access to various levels of care. Child and adolescent psychiatry applicants from across the country are attracted to the breadth of program variety. In particular, Rhode Island uniquely possesses a significant number of specialized partial hospitalization programs (PHP) for children and teens, some of which are nationally recognized and appeal to patients and families throughout the United States.

Lacunae in Addressing Sexual Problems in Postgraduate Psychiatry Training in India

Lacunae in Addressing Sexual Problems in Postgraduate Psychiatry Training in India

Effectiveness of blended versus fully digital training in primary care psychiatry: A retrospective comparison from India.

We compared effectiveness of blended mode (consisting of traditional classroom teaching and e-learning sessions) and fully digital mode (e-learning sessions alone) of primary care psychiatry training for primary care doctors in Chhattisgarh. We retrospectively compared the engagement in training, knowledge (K), attitude (A), and practice (P) in primary care psychiatry, and patient identification by primary care doctors (n = 941) from Chhattisgarh region who underwent training through either blended training mode (n = 546) or fully digital training mode (n = 395) for 16 h each, using Clinical Schedules for Primary Care Psychiatry based modules between June 2019 and November 2020 with a tertiary care center (NIMHANS, Bengaluru) as hub. The Statistical Package for the Social Sciences version 27 was used to analyze the data. Continuous variables were analyzed using the independent samples t-test, and discrete variables were analyzed using the Chi-square test. A repeated measures analysis of variance (ANOVA) (two-way mixed design) was used to see the interaction of training type and time of pre- and post-KAP measurement while controlling for years of experience. The number of patients identified by both training groups over 8 months was also compared using the repeated measures ANOVA (two-way mixed design). Engagement inferred by the number of participants completing pre-KAP forms (75%), post-KAP forms (43%), post-session assessments (37- 47%), case presentation (33.9%), and certification (32.1%) was better in the blended group (P < 0.05). The mean gain in KAP scores was significantly higher in the blended group controlling for the years of experience as primary care doctor (PCD) (F = 30.36, P < 0.001). PCDs in the blended training group consistently identified a higher number of patients with mental illness over 8 months of follow-up (F = 6.21, P < 0.001). The blended mode yielded better results in primary care psychiatry training compared to fully digital mode. In-person interactions while provided for a very brief proportion of the training seem to have an unmistakable imprint on the outcomes and seem critical for better consolidation and assimilation of information, which translates into better practice.

A better way of life: The role of leisure activities on self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support in psychiatrists and psychiatry trainees in Mexico.

Psychiatrists are at high risk of developing burnout and mental health problems mainly due to their emotionally demanding jobs, difficult working conditions, long working hours, and poor work-life balance. As leisure activities are associated with better physical and mental health, engaging in these activities has been recommended as a measure to improve the wellbeing of healthcare workers. However, it is unclear the extent of which psychiatrists and trainees are involved in leisure activities, what type of activities they prefer, or how these impact their self-perceived health, stress, confidence in stress management, and satisfaction with their social support. The aim of this study was to identify differences in self-perceived health, perceived stress, confidence in stress management, and satisfaction with social support, between psychiatrists and trainees who engage in different leisure activities, compared with those who do not. This was a cross-sectional study, including Mexican psychiatrists (n = 355) and trainees (n = 330) who agreed to participate through an online survey. 73.1% of participants engaged in some leisure activity, being solitary-passive activities the most reported. Those who have a leisure activity reported lower stress, greater confidence in stress management, and more satisfaction with their social support. Passive-solitary activities were associated with less perceived stress and better confidence in stress management, while active-solitary and social activities were associated with better satisfaction with social support. Psychiatrists' and trainees' wellbeing benefits from engagement in leisure activities, which should be part of their daily schedules to reduce stress, and potentially improve their mental health.

Implications of postmaterialist theories of consciousness for psychiatry: towards an integral paradigm

Abstract Mental health professionals can help patients understand exceptional and paranormal experiences, integrate them into day-to-day life, and cope with confusion and anxiety that sometimes accompany them. However, a broader clinical perspective and specialized training in clinical parapsychology is needed. In the first part of the paper I argue that psychiatry as currently practiced is limited because it embraces a strictly materialist paradigm, emphasizes treatment over prevention, and relies principally on pharmaceuticals that are often ineffective and/or unsafe. A paradigm shift in psychiatry is taking place that will soon lead to novel concepts of energy and innovations in therapeutic approaches. In the second part of the paper I review the ongoing debate over consciousness, implications of novel understandings of energy for psychiatry, and research findings in physics, neuroscience and parapsychology that are contributing to a postmaterialist paradigm in psychiatry. I comment on an important problem in the philosophy of science called Hempel’s dilemma and argue that future scientific theories of consciousness will probably encounter similar conceptual limits to those faced by current theories. Following Beauregard, Trent and Schwartz (2018) I argue that different categories of theories may be needed to adequately explain the variety of human experiences and I propose an integral paradigm that acknowledges the validity of both conventional scientific explanations and postmaterialist theories of consciousness. Finally, I discuss implications of postmaterialism for research, education and training in psychiatry.

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

A different state of mind: developing a mental health simulation programme for foundation doctors in Scotland

The new Foundation Curriculum 2021 for Doctors in Training (DiT) in the United Kingdom calls for an increased focus on developing mental health-related skills [1], bringing them into parity with physical health. The importance of developing the core clinical skills needed to work with patients who have mental illness is now well-recognised within medical education [2,3]. In collaboration with NHS Education Scotland (NES), we piloted a half-day programme of immersive high-fidelity simulation in Psychiatry for foundation year one (FY1) doctors working in NHS Lothian. Scenario design was by a core group consisting of simulation faculty and Foundation programme directors who were consultant psychiatrists and acted as content experts. The intended learning outcomes (ILOs) for these sessions were constructively aligned with key presentations set out in the revised Foundation Curriculum. The scenarios considered the limitations of practice for an FY1, particularly in regard to mental health law. The three immersive scenarios developed included management of an aggressive patient with delirium, challenging communication with relatives, and management of a depressed patient. Scenarios were based in general wards to maximise fidelity with FY1 experience. 18 sessions were run for FY1 doctors at the three main acute hospital sites in NHS Lothian to ensure equitable access. Participants completed a pre-session evaluation to determine their perceived ability to perform key skills, including assessment of a patient who has self-harmed, a patient with depressive symptoms, assessment of capacity and use of mental health legislation, use of verbal de-escalation, safe sedation, and how to take a collateral history. Assessments were made on a Likert scale and were repeated immediately following the session. We plan to repeat this questionnaire three months following the session. A total of 68 FY1 doctors attended the pilot sessions. When considering the percentage of participants who felt prepared or very prepared, substantial improvements were seen in all assessed domains following the session ( Percentage of candidates who reported feeling either prepared or very prepared to carry out they key skills included in the pilot sessions We have demonstrated that immersive simulation-based education can be used to improve knowledge and confidence in core aspects of psychiatry. With support from NES, we aim to offer this session to all FY1s in Scotland. 1. UK Foundation Programme (2021) UK Foundation Programme. 2. Piot MA, Dechartres A, Attoe C, Jollant F, Lemogne C, Layat Burn C, Rethans JJ, Michelet D, Cross S, Billon G, Guerrier G. Simulation in psychiatry for medical doctors: a systematic review and meta‐analysis. Medical Education. 2020;54(8):696–708. 3. Piot MA, Attoe C, Billon G, Cross S, Rethans JJ, Falissard B. Simulation training in psychiatry for medical education: a review. Frontiers in Psychiatry. 2021;12:658967.

Rural workforce challenges: Why not rural psychiatry?

The Australian psychiatry workforce is under-subscribed and highly urbanised. Currently, 90% of psychiatrists work in the cities, and there are significant projected workforce shortages of psychiatrists throughout Australia, particularly in rural and remote locations. This qualitative study explores factors influencing medical students and junior doctors' decisions to pursue a career in rural psychiatry. Using a phenomenological approach, data were collected through semi-structured interviews and focus groups and subjected to thematic analysis. Sixteen participants were interviewed, 11 interviewees and five participants from two focus groups. This study identified enablers and challenges in pursuing rural psychiatry training in Australia. Clinical exposure to rural psychiatry, personal factors, rural lifestyle and workforce shortage awareness were identified as enablers. The lack of rural infrastructure, the attractiveness of urban psychiatry and the stigma toward rural psychiatry were identified as barriers. Australian rural psychiatry workforce remains a complex issue. Reinforcing enablers and addressing barriers identified in this study would benefit future rural workforce initiatives.

Forcibly displaced persons and mental health: A survey of the experiences of Europe-wide psychiatry trainees during their training.

Many European countries have seen increasing refugee populations and asylum applications over the past decade. Forcibly displaced persons (FDPs) are known to be at higher risk of developing mental disorders and are in need of specific care. Thus, specific training for mental health professionals is recommended by international health organizations. The aim of this exploratory study was to assess the experience of clinical work with FDPs among psychiatric trainees in Europe and Central Asia as well as their interest and specific training received on this topic. An online questionnaire was designed by the Psychiatry Across Borders working group of the European Federation of Psychiatric Trainees (EFPT) and was distributed via email through local networks among European trainees from 47 countries between March 2017 and April 2019. Answers of 342 psychiatric trainees from 15 countries were included in the survey analysis. A majority of trainees (71%) had had contact with FDPs in the last year of their clinical work. Although three-quarters expressed a strong interest in the mental health of FDPs, only 35% felt confident in assessing and treating them. Specific training was provided to 25% of trainees; of this subset, only a quarter felt this training prepared them adequately. Skills training on transcultural competencies, post-traumatic stress disorder, and trauma management was regarded as essential to caring for refugees with confidence. Although psychiatric trainees are motivated to improve their skills in treating FDPs, a lack of adequate specific training has been identified. The development of practical skills training is essential. International online training courses could help meet this pressing need.

Integrated Care for Complicated Patients: A Role for Combined Training and Practice

Patients with chronic medical disease frequently have comorbid psychiatric illness, yet mental and physical healthcare is frequently siloed in the United States. Integrated behavioral healthcare models, such as medicine-psychiatry services, are feasible, improve patient outcomes, and reduce costs. The Duke University Hospital medicine-psychiatry service provides holistic patient care and serves as a model for those interested in developing combined services or training programs elsewhere. Combined residency training in psychiatry is a way to provide a workforce of physician-scientist educators adept at providing coordinated, integrated care for complex patients with comorbid illness.