Psychiatry Training Programs Research Articles

Teaching Artificial Intelligence from Conceptual Foundations: A Roadmap for Psychiatry Training Programs

Teaching Artificial Intelligence from Conceptual Foundations: A Roadmap for Psychiatry Training Programs

Developing a Diverse, Equitable, and Inclusive Curriculum for Trainees

The importance of diversity in medical education has become increasingly clear with strong evidence showing its benefits in helping to reduce healthcare disparities and mortality, increase access to medical care, increase the number of clinicians practicing in medically underserved and rural communities, increased patient trust, improvement in patient-physician relationships, and better financial outcomes for health systems. As leaders in graduate medical education, the Teaching and Training Committee of the American Association for Geriatric Psychiatry (AAGP) proposed the creation and development of a curriculum that fosters an inclusive learning environment for our fellows, promotes open dialogue among everyone involved in the clinical process, and establishes anti-bias principles as integral parts of geriatric psychiatry education. The AAGP Diversity, Equity, and Inclusion (DEI) Curriculum Development subcommittee was established to carry out this task. Themes to be explored include ageism, racism and bias, social determinants of health, cultural humility, ethics of decision making in older adults, substance use, neurobiology of stress, the mental health of minoritized older adults, psychosocial and cultural aspects of aging, and laws that impact this population.This session details the process of establishing this important curricular thread as a template or framework that can be used in Geriatric Psychiatry training programs throughout the country and, in acknowledgement of the importance of the workforce that cares for older adults, ensures that it is practical and applicable to clinicians in non-academic settings. The panelists will highlight DEI curricular development in one fellowship program from the view of a trainee, the impact on recruiting a more representative workforce, and how to improve trainee and faculty engagement within and across programs.This presentation is sponsored by the Teaching and Training Committee.

(208) Enhancing Opportunities for Sexuality Assessment During Initial Mental Health Assessments: Barriers and Enablers for Psychiatric Registrars

Abstract Introduction Assessments of sexuality and sexual wellbeing is recommended as “best practice” in psychiatric assessments, however, education opportunities on sexuality and sexual wellbeing do not feature prominently in the training curriculum of psychiatric trainees in Australia. Objective To explore the training experiences of psychiatric trainees and identify barriers and enablers to enhance human sexuality assessments within mental health assessments. Methods Qualitative inquiry was adopted to allow for exploration of the issues. Semi-structured interviews of psychiatric trainees based at a metropolitan hospital and health service were conducted and analysed with a thematic analysis approach. Results Seven emergent themes were identified: barriers and enablers, skills and competence, inadequate training within the psychiatry training program, the belief that human sexuality is important to psychiatry, and training needs. Conclusions Psychiatric trainees believe that human sexuality and sexual wellbeing are an important part of mental health assessments. Despite this belief, participants reported a lack of direct training in sexual history taking, treatment of sexual issues, and sexual wellbeing, leading to an overall lack of confidence in assessing patients’ sexuality within mental health assessments. Psychiatrists of all levels of training require specific, regular education regarding human sexuality to ensure sound knowledge and consistent patient care. Disclosure No.

Undergraduate Training in Psychiatry: Observational Perspective of Medical Officers Working at Primary Health-care Settings

Abstract Background: Primary care physicians are not adequately trained to tackle mental health problems. The study aimed to evaluate undergraduate training in Psychiatry: An observational perspective of medical officers. Materials and Methods: It was a cross-sectional study conducted in North India. Participants were assessed on a self-designed questionnaire developed by the Indian psychiatric society to assess various aspects of undergraduate training. Other questionnaires measured residents’ satisfaction with the quality of training programs and perceived need for psychiatric training in undergraduate courses. Results: The participant’s mean age was 32.4 years; majorities were male medical officers. About one-tenth reported that there were no separate psychiatry departments and designated psychiatry consultants in their college. Approximately 50% reported: No regular supervision by any psychiatric faculty or having psychiatric disorders discussions in clinical rounds. More than half (50.9%) were not confident enough to identify common signs and symptoms of psychiatric problems. From one-third to half of the participants were unsatisfied with various aspects of the training program, like teaching skills, diagnostic interviews, clinical posting, etc. Majority (77.3%–83.7%) agreed that there is a need to improve the psychiatry training program; during the clinic rounds, psychiatric diagnosis should be discussed, and psychiatry should be a separate subject in under-graduation. Conclusion: Primary health-care physicians were unsatisfied with an undergraduate psychiatry training program. Hence, psychiatry should be an independent subject during the undergraduate training program, with dedicated theoretical and clinical hours for psychiatry training and a separate paper for evaluation.

A Clinical Audit of Mental State Examination Documentation Among Psychiatric Residents in a Tertiary Care Hospital

Introduction: Modern psychiatry uses Mental State Examination (MSE) as a tool for collecting data and assisting a psychiatrist in developing patient’s working psychiatric diagnosis. There are currently no national criteria on a definitive format of MSE, nor do the bulk of psychiatry training programs insist upon it. However, to ensure proper documentation of MSE results, following a structured format is needed, ensuring that all relevant components of the examination are covered. For this, we conducted this clinical audit regarding proper MSE documentation within the Psychiatry department of a tertiary care hospital. Methods: The study was conducted in the Department of Psychiatry, Civil Hospital Karachi between 15-02-2023 till 15- 04-2023 after approval by Head of Department. A standardized MSE format consisting of 11 parameters of psychiatric analysis was prepared according to British Medical Journal (BMJ) and Oxford University Press guidelines. The parameters incorporated appropriate date, time, and signature of the examining doctor, in addition to proper documentation of appearance, behavior, speech, mood and affect, suicidal and homicidal risk, thought process, perception, cognition (Orientation, attention, concentration, memory and abstract thinking), insight, judgement, and event notes/progress notes sections. The study was divided into two cycles. A retrospective analysis to detect the shortcomings of MSE documentation was done (sample size n=30), followed by a second cycle, in which a standardized MSE template was provided to all psychiatric residents to examine patients prospectively for the next 4 weeks. Data was analyzed using SPSS software to compare the improved changes in MSE documentation. Results: The result showed that all 11 parameters were recorded correctly, however certain sub-parameters were recorded poorly. The least recorded parameters were date of examination (53.3%), Physical stigmata (43.3%), psychomotor retardation (16.7%), and signs of Extrapyramidal symptoms (10.0%), speech assessment (46.7%), suicidal risk (20.0%), and homicidal risk (13.3%), perception assessment [Illusion (16.7%), depersonalization (13.3%), derealization (16.7%) and memory assessment. Documentation of event notes/progress notes was also recorded poorly (33.3%)]. There was an overall improvement in the documentation pattern of all the 11 parameters of MSE during the second audit cycle. The parameters and sub-parameters with an improvement included physical stigmata (66.7%), psychomotor retardation (76.7%), signs of Extrapyramidal symptoms (83.3%), speech assessment (90.0%), suicidal risk (83.3 %%), homicidal risk (83.3%), perception assessment [Illusion (86.7%), depersonalization (86.7%), derealization (80.0%)] and memory assessment. Patient’s name and registration number were perfectly recorded with a percentage of 100% in the first audit cycle, however it declined to 86.7% in the second cycle. There were also marginal improvements in documentation of date of examination and examining doctor’s name. Conclusion: The introduction of an MSE format and consultant supervision of records improved the standard of MSE recording as well as basic medico-legal requirements by psychiatric trainees

10.2 Going Downstream to Enhance the Diversity of Child and Adolescent Psychiatry Training Programs: Lessons From the Canadian Experience

10.2 Going Downstream to Enhance the Diversity of Child and Adolescent Psychiatry Training Programs: Lessons From the Canadian Experience

Dual Residency Training in Neurology and Psychiatry: History and Current Practice.

In the early 20th century, neurology training included more experience in psychiatry, and psychiatry training included more training in neurology than what is currently required. After World War I, the increased need for differential diagnosis of what might now be called functional neurological disorders resulted in the military encouraging combined residency training in neurology and psychiatry and the promulgation of the term "neuropsychiatry" for this specialty. Thirty-six percent of physicians certified by the American Board of Psychiatry and Neurology in its first decade (1935-1945) held certification in both neurology and psychiatry. However, the term neuropsychiatry gradually became used interchangeably with general psychiatry-to distinguish it from psychoanalysis-and lost its specificity. It is widely held that the popularity of psychoanalysis resulted in psychiatrists perceiving less need for neurological knowledge, and inclusion of neurology content in psychiatry training decreased. Dual residency training programs in neurology and psychiatry began to increase in popularity again in the 1980s as advances in neuroscience, neuroimaging, and pharmacology, paired with the growth of behavioral neurology, laid the foundation for meaningful practice of neuropsychiatry. The author surveyed 207 physicians who graduated from both a neurology and psychiatry residency and 18 current trainees in combined neuropsychiatry residency programs to collect information on their current practice, academic activity, and opinions about their training. The response rate was 64%. Respondents' attitudes toward the value of their dual neurology and psychiatry training were overwhelmingly positive. Reasons for the lack of growth of combined residency programs in neurology and psychiatry are examined.

Building a postgraduate psychiatry training program in Liberia through cross-country collaborations: initiation stages, challenges, and opportunities.

About 80% of the nearly 2 billion people experiencing psychiatric conditions worldwide do not have access to quality, affordable mental health care. In Africa, there are 0.004 psychiatrists per 10,000 people, with the shortage exacerbated by a limited number of postgraduate psychiatry training opportunities. As of 2018, there were only two psychiatrists in Liberia. This paper aims to offer a framework for developing postgraduate (i.e., residency) psychiatry training in resource-constrained settings to disseminate best practices and lessons learned. This article describes the approach to developing the formal global academic partnership that supported the initiation of Liberia's first postgraduate psychiatry training program in July 2019. Authors describe strengths, challenges, and opportunities for improvement in the planning and initiation stages of the postgraduate program. Key strengths of the program planning process include: (1) collaboration with a coalition of local and national stakeholders committed to improving mental health care in Liberia; (2) early procurement of quality video conferencing equipment and internet service to facilitate remote learning and broaden access to digital materials; and (3) leveraging of intra-continental partnerships for subspecialty training. Challenges experienced include: (1) navigating the intricacies of local political and administrative processes; (2) recruiting candidates to a medical specialty with historically lower salaries; and (3) the added burden placed on the limited number of local specialists. Identified opportunities include building a monitoring, evaluation, and learning (MEL) framework, further diversifying subspecialty areas of psychiatric and neurological training, and obtaining full accreditation of the postgraduate psychiatry program through the West African College of Physicians (WACP). The successful launch of the postgraduate psychiatry training program in Liberia is attributed to several factors, including a long-standing academic collaboration of over 10 years and support for mental health capacity-building efforts at national and local levels.

Managing power and psychiatric training in the United States, 1945–1990

In the wake of their heightened role in addressing the emotional challenges of United States soldiers during World War II, American psychiatrists increasingly argued that their knowledge of human nature, based on interpretation of unconscious processes, was a powerful tool in effecting changes in society. As they turned to training an adequate supply of psychiatrists to meet expanding demand, educators in psychiatry residency programs faced questions about whom to entrust with the power of psychiatric interpretation, how educators’ knowledge about trainees’ own unconscious processes should be harnessed, and how much to adhere to strict psychoanalytic doctrine in training. During the 1970s, social and cultural upheavals outside and inside psychiatry began to dismantle the grand claims of the postwar generation of psychiatrists, while shifts in the 1980s led educators to focus more on seemingly objective educational measures. Trainees’ and critics’ serious questioning of authority and structures in American society, and within psychiatry training programs, was perhaps as much of a factor – if not more – in the shift away from an emphasis on the interpretive power of psychoanalysis in favor of more eclectic and ultimately biological approaches in academic psychiatry.

With End of PHE, States Begin Disenrolling Medicaid Enrollees

With End of PHE, States Begin Disenrolling Medicaid Enrollees

CMS Extends Virtual Supervision of Residents to End of Year

CMS Extends Virtual Supervision of Residents to End of Year

A 10-Year Follow-up Survey of Psychiatry Resident Education in Consultation-Liaison Psychiatry.

In 2010, the Academy of Consultation-Liaison (then Academy of Psychosomatic Medicine) surveyed US residency programs to understand training in consultation-liaison (CL) psychiatry, leading to recommendations in 2014. Since then, residency training in CL has evolved in the context of competing training demands, increased prioritization of electives, and reactions to coronavirus2019. To determine the current state of residency training in CL across the United States, including the structure of core and elective resident rotations in CL, attending physician staffing, presence of fellows and other trainees, didactic curriculum, and impact of coronavirus2019. Members of the Academy of Consultation-Liaison Residency Education Subcommittee designed and piloted an 81-question survey tool that was sent to program directors of 269 US general psychiatry training programs for voluntary completion. One hundred three of 269 programs responded to the survey, yielding a response rate of 38.3%. Responding programs were larger and more likely to have a CL fellowship than nonresponding programs. Of the 103 responding programs, 82.5% have more than the minimally required time on CL, with 46.6% reporting an increase in total CL time in the past decade. Since 2010, 18.4% of responding programs changed the placement of the CL rotation, with 43.7% now adherent to the 2014 Academy of Psychosomatic Medicine recommendation to include core CL training in the second half of residency. Thirty-five percent of responding programs require residents to rotate on more than 1 CL service, and 19.4% have a required outpatient CL component. Faculty full-time equivalent varies widely. Of all services included, 33.8% report that all CL faculty are board-certified in CL psychiatry, whereas 18.7% have no board-certified faculty. Of the 103 responding programs, 36.9% offer a CL fellowship, but 31.1% report no residency graduates pursuing CL fellowships in the past 5 years. Of the included programs, 77.7% have a formal CL curriculum for residents, with 34.0% reporting a separate didactic series during the CL rotation. Among the responding programs, the amount of time spent on core CL rotations has increased in the past decade, but programs have also shifted CL training earlier in the course of residency. Residency programs are increasingly challenged to provide an optimal CL experience, and updated guidance from Academy of Consultation-Liaison may be appreciated.

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

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.

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Content and process: using continuous quality improvement to teach and evaluate learning outcomes in quality improvement residency education

BackgroundPsychiatry has not prioritised quality improvement and patient safety (QIPS) to the same degree as other medical specialties. Professional capacity building in QIPS through the education of residents is essential...

A mindfulness-based cognitive therapy informed virtual psychiatry trainee wellbeing programme: Development and preliminary feedback.

To report the development and feedback on a newly created mindfulness-based cognitive therapy (MBCT) informed virtual wellbeing programme for psychiatry trainees. Thirteen of the 14 trainees participated in the programme provided feedback via an online questionnaire. Qualitative data was analysed using thematic analysis. Thematic analysis revealed three main themes: timing of the intervention in relation to the COVID-19 pandemic; trainees were connected to the facilitator, their peers and within oneself; and trainees were going through a transformative experience. Our findings support including an optional MBCT informed wellbeing programme in psychiatry training programmes. Future research could measure efficacy of this online programme by utilising pre- and post-outcome measures of dispositional mindfulness and stress.

Considerations for the Future: Family Planning and Infertility During Psychiatry Training

During medical school, residency, or fellowship, many trainees struggle to find balance between their careers and starting a family. While some may feel the optimal time for parenthood is after they’ve completed their training, the effect of increasing age on fertility is a real consideration for female physicians.1 Several studies have explored the impact of pregnancy during surgical residency, yet little has been published on parenthood during psychiatry training. This is surprising as psychiatry residents often address the challenges of integrating work and parenthood with their patients, yet it has not traditionally been within the culture of medicine to openly discuss this with colleagues. It is critical to address pregnancy and parenthood routinely during training and in the literature to reiterate the importance of work-life integration. In this paper, we discuss current practices for psychiatry residents and advocate for the development of a standardized policy across psychiatry training programs that covers multiple aspects of childbearing including maternal mental health, family leave, and infertility.

AADPRT Recommends Virtual Interviewing For 2022-2023 Recruitment Year

AADPRT Recommends Virtual Interviewing For 2022-2023 Recruitment Year

Training and education in Digital Psychiatry: a perspective from Asia-Pacific Region

Introduction Digital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a cost-effective solution in those circumstances in which the current mental health services and infrastructure are not able to properly accommodate the patients’ needs. However, mental health workforce is often poorly theoretical/practical trained in digital psychiatry and in delivering remote consultations safely and effectively, not being common to own curricula-specific training requirements in digital psychiatry and skills.ObjectivesOur aim is evaluating the level of training, knowledge, experience and perception regarding the topic of digital psychiatry in a sample constituted by medical students, psychiatry trainees and early career psychiatrists from WHO South-East Asia and Western Pacific Regions (APAC).Methods A web-based international cross-sectional survey was carried out to specifically investigating digita psychiatry in APAC regions.Results An overall lack of theoretical and/or practical training on new digital tools and digital health interventions in psychiatry has been observed. The level of training influences knowledge background, which, in turn, influences young professionals’ perceptions and opinions regarding digital psychiatry and interventions in mental health.ConclusionsImplementing psychiatry training programs may significantly improve the level of knowledge and use of digital tools in mental healthcare. Moreover, mental health services and infrastructures should be properly adapted to the digital era, considering the overall weak and heterogeneous technical support and equipment, issues of internet connectivity and other administrative related challenges observed in APAC.DisclosureNo significant relationships.