Psychiatry Training Programs Research Articles

M12 - PAVING THE WAY FOR PRECISION MEDICINE IN PSYCHIATRY – DESIGN AND IMPLEMENTATION OF A UNIFIED RARE GENETICS CURRICULUM

Background This is an exciting time in psychiatry. For the last few years, we have been witnessing an accelerated pace of genetic discoveries that are redefining our understanding of mental health disorders spanning from autism to schizophrenia. Insights have come from common and rare genetics alike, fueled by techniques that have a higher resolution and a lower cost. However, most psychiatrists were trained in an era that preceded this cutting-edge work, and psychiatry residency and fellowship programs have not yet integrated this new information into their curricula. Current challenges include determining unified content areas that should be known by psychiatrists, as well as implementing the delivery and teaching of these concepts using principles of adult learning. Here, we describe joint efforts to address this practice gap, using rare genetics as a vehicle. Methods Multiple stakeholders have gotten together to address this issue. The Education Taskforce of the International Society of Psychiatric Genetics (ISPG) was formed to identify and standardize key content areas that should be covered in psychiatry training programs across the globe, while the National Neuroscience Curriculum Initiative (NNCI) has focused on implementing the delivery of this content. As a joint effort, we have developed an interactive case conference tailored towards teaching principles and applications of rare genetics in psychiatry, using autism as an example to provide clinical correlation and applicability of this knowledge. We designed the module using the NNCI standards, and included supporting media and guidance for facilitators to allow for this material to be free-standing and independent from local expertise for its delivery. We administered this exercise to 300 psychiatry residents, fellows, and psychiatry program directors at diverse settings, and obtained pre and post knowledge assessments, as well as qualitative data on impressions and utility of the module. Results Our preliminary results showed an overall low genetic literacy among all surveyed groups in the pre-assessments, followed by a high retention of content after the exercise, with detailed analyses underway. We also obtained positive qualitative feedback, which included an increased appreciation for the clinical relevance of this knowledge and satisfaction with the method of delivery. Discussion Our results were in agreement with our hypothesis of low genetic literacy across psychiatry, which justifies the need for increased efforts to standardize and deliver this knowledge. We showed that the module was well received and feasibly applied with local resources within diverse settings, and led to increased genetics knowledge in participants. This highlights the importance of blending key content with sound pedagogical methods and maintaining the clinical grounding of exercises, and underscores the relevance of modest and attainable learning objectives. The approach used here, for which collaborations between the ISPG Education Taskforce and the NNCI were key, could easily be adapted and broadly generalized for other core competencies in genetics.

Assessing Integrative Psychiatry Curriculum Needs.

BackgroundResearch on incorporating integrative medicine (IM) into medical training is increasing. Programs and organizations around IM have been established, but there has not previously been a needs assessment focused on integrating IM into psychiatry training.ObjectivesThe results of a needs assessment of training directors and faculty, focused on interest and priorities for developing an IM curriculum for psychiatry training programs, are described.MethodsPsychiatry Training Directors and faculty were invited to participate in a detailed electronic survey. Areas of inquiry included (a) IM content areas to include in training; (b) IM approaches to specific medical conditions; (c) existing IM content; (d) importance, interest, and strategies for IM training; and (e) availability of wellness programs for trainees.ResultsThirty-six respondents from psychiatry training programs completed the survey. Of the training programs represented by the respondents, 50% indicated that they currently had IM content in their curriculum; only 11.8% of them rated their programs’ existing IM content as sufficient. Content areas rated most highly for inclusion in a psychiatry IM curriculum included sleep health, motivational interviewing, and self-care. Respondents indicated incorporating IM into the psychiatry training curriculum (47%) or as an elective (44%) as the desired implementation strategy, with experiential onsite activities demonstrating IM topics (67%) and online modules supplemented by local faculty (58%) as the 2 most desirable learning formats. Significant barriers identified were time constraints, lack of faculty expertise in IM, current lack of curricular requirements for IM competencies, and budgetary limitations.ConclusionResponses to the survey suggest that faculty need support and additional education in implementing IM training. A standardized, online curriculum could help meet that need. Our results also indicate that wellness programs for residents are currently inadequate; bolstering them could help address burnout and increase the knowledge psychiatrists have of IM modalities. The types of institutions represented by faculty interested in further developing IM offerings vary considerably, as do their current efforts to integrate IM into training programs.

The Integrative Psychiatry Curriculum: Development of an Innovative Model.

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

Impact of Experience-Based, Longitudinal Psychiatry Training on Family Medicine Residents’ Attitudes Toward Depression and Psychiatry in Singapore: a Prospective Study

The primary aim of this study was to evaluate the impact of an experience-based, longitudinal psychiatry training program in a Family Medicine residency on residents' attitudes toward depression and psychiatry. The secondary aim was to identify background predictor variables of changes in attitudes. Pre- and post-training surveys were prospectively conducted on attitudes toward depression and psychiatry on Family Medicine residents undergoing an experience-based, longitudinal psychiatry training program. The primary outcome measures were pre- and post-training Depression Attitude Questionnaire (DAQ) and Modified Attitudes to Psychiatry Scale (mAPS) scores. Regression analysis was carried out to determine background variables predictive of improvement in DAQ and/or mAPS scores post-training. Sixty-three Family Medicine residents (100% response rate) responded to the pre-training surveys. All 63 subjects completed the post-training surveys (100% retention rate). There was significant improvement in DAQ and mAPS scores post-training, indicating better attitudes toward depression and psychiatry. Significant improvement was observed in 8 out of 13 DAQ items and 3 out of 4 mAPS domains. Regression models showed having a previous 3-month elective psychiatry inpatient posting was a predictor of less improvement in mAPS scores. Our experience-based, longitudinal psychiatry training program significantly improved Family Medicine residents' attitudes toward depression and psychiatry. Experiential and situated learning in communities of practice, as well as educational continuity with longitudinal supervision, coaching, and modeling may have contributed to this improvement.

Physician Suicide: Cases and Commentaries

Back to table of contents Previous article Book ForumFull AccessPhysician Suicide: Cases and CommentariesLaura Bajor, D.O.Laura BajorSearch for more papers by this author, D.O.Published Online:1 Nov 2018https://doi.org/10.1176/appi.ajp.2018.18080983AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Peter Yellowlees, M.B.B.S., M.D. Washington, D.C., American Psychiatric Association Publishing, 2019, 251 pp., $52.00 (paperback).As a human race we’ve long understood the importance of preventive maintenance for our cars, so it’s odd that the importance of maintaining physician well-being is only now beginning to be widely recognized (p. xi).Roughly 400 American physicians take their own lives every year, a staggering figure that constitutes but a fraction of the number of doctors who take their own lives each year worldwide. Having made the treatment of distressed physicians a major emphasis of an accomplished career in public, private, and academic psychiatry, Dr. Yellowlees has a unique vantage point from which to pass on knowledge regarding the factors and circumstances associated with this phenomenon. That experience base, including the loss of two physician patients among many others assisted in stepping back successfully from the precipice, makes him well qualified to educate both practitioner colleagues and the lay public about the factors and circumstances that contribute to physician suicide.Yellowlees’ choice of a case study and discussion format serves to humanize his hypothetical distressed physicians while also facilitating immersion of readers into the narrative stream by making the people and situations under discussion more relatable than had the same material been presented in a more traditional textbook format. His nuanced, multi-faceted portrayals of troubled physicians afford his subjects an appropriate measure of dignity. The author also does not shrink from frank examination of factors and life choices that lead doctors into extremis and to bolstering the all too common stereotype of being among the most difficult patients to assist. These include the use of illicit substances to self-medicate depression and other mental illnesses, failure to accept the realities of age-related physical and cognitive decline, grief over real or perceived serious medical errors, the weight of financial, relationship, and organizational pressures, and the fallout of characterological issues ranging from martyrdom to sociopathy. Readers would be hard-pressed not to recognize some hint of similarity to themselves or their colleagues. Each case study is followed by two to three pages of didactic-style discussion, including pointers to community resources and a brief chapter bibliography.One particularly heartrending case involved a cascade of tragic events culminating in the suicide of “Dr. B,” a 79-year-old cardiologist. A widower for whom not much remained beyond his physician identity, Dr. B concealed the diagnosis of mild cognitive impairment for 2 years beyond the time it was conferred. Although Dr. B’s colleagues suspected that he might be deteriorating, they found ways to rationalize inaction. Eventually, Dr. B became overwhelmed on a day when his clinic was short-staffed, and he made errors that resulted in two patient deaths. Plagued with guilt, he hung himself. Yellowlees’ choice to commence this case study with a suicide note from Dr. B to his children serves masterfully to transport readers into the subjective abyss of guilt and despair as Dr. B experienced it. The author also succeeds in providing an objective counterpoint by critiquing a medical culture that demands near-total devotion of its practitioners but all too often fails to support their inherent humanity, such as in the case of Dr. B’s cognitive decline.Had Dr. B, as a respected medical educator, felt safe in disclosing his condition, or if his colleagues had the wherewithal to confront him about it, he might well have been able to continue practicing in a capacity that emphasized his strengths while preserving patient safety. As such, one of Yellowlees’ stated goals for this work was to set his physician readers up as reasonably competent with regard to the “how and when” of intervening to assist a suffering colleague. He accomplishes this mainly by providing examples of interventions that are thoughtful and effective, as well as a few, such as in Dr. B’s case, that are meant to be obviously less than optimal. He also takes pains to point out that in some cases, no type or amount of intervention can be effective if insight and readiness are critically lacking within the person to whom help is proffered.Dr. Bajor is a staff psychiatrist at the James A. Haley Veterans’ Hospital and on the faculty at the University of South Florida Morsani School of Medicine, Tampa, Fla., and at the Harvard South Shore Psychiatry Training Program, Brockton, Mass.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byNone Volume 175Issue 11 November 01, 2018Pages 1149-1150 Metrics KeywordsOther Psychological IssuesAdministrationSuicidePDF download History Accepted 17 September 2018 Published online 1 November 2018 Published in print 1 November 2018

Addictions Training in General Psychiatry Training Programs: Current Gaps and Barriers.

The primary purpose of this article is to review the findings of a 2017 survey of psychiatry training program directors to identify current gaps and barriers in addictions training in general adult psychiatry programs. The American Association of Directors of Psychiatric Residency Training (AADPRT) Taskforce on Addictions was created in 2017 with the aim of determining what programs need to improve addictions training in psychiatry residency programs and identifying ways to meet these needs. A 23-item confidential, anonymous online survey was developed and disseminated to AADPRT members who were general psychiatry program directors using the AADPRT Listserv (n = 200). Eighty-five programs (42%) responded to the survey. Programs reported that addictions training often takes place in general psychiatry settings rather than specialty settings. Curriculum content and clinical experiences varied substantially between programs. The lack of addictions-trained faculty members was identified as an impediment to providing more comprehensive training. While a lack of advanced training in addictions among faculty may be a limiting factor, developing expertise through faculty development activities and nationally disseminating model curricula can help improve national addictions training. Future goals include development of a strategic plan for improving addictions training, including an outline of a developmental approach across training to the acquisition of milestones-based competencies that apply to addictions assessment and treatment.

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

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

Sexual Health During Postgraduate Training-European Survey Across Medical Specialties.

BackgroundSexual health problems are common. Therefore, training in sexual health is relevant for the clinical practice of trainees and early-career specialists in several specialties who deal with patients with sexual health problems. However, little is known about how sexual health training is provided across countries and specialties.AimTo assess (i) sexual health training during postgraduate training programs in psychiatry, obstetrics and gynecology, urology, and endocrinology across Europe; (ii) the confidence of trainees and early-career specialists in dealing with patients with sexual health problems; and (iii) their need for further training in sexual health during postgraduate training programs.MethodsThe study was based on a collaboration among European societies of trainees in these 4 specialties. An online survey was developed and conducted from January 2015 through June 2016.Main Outcome MeasuresSelf-reported questionnaire.ResultsWe collected 366 completed surveys from 40 countries. Sexual health training was considered an important or very important part of specialty training by 78.7% of participants. Overall, 62.3% of participants had not received any training in sexual health. Especially in obstetrics and gynecology, the large majority did not have training in sexual health (82.8%), followed by psychiatry (59.8%), urology (58.4%), and endocrinology (56.1%). There were statistically significant differences among specialties in the confidence of participants in managing patients with sexual health problems. In general, trainees and early-career specialists who had received sexual health training felt more confident in dealing with patients with gender dysphoria (P = .011), need for sexual therapy (P = .0004), paraphilic disorders (P = .0003), and sexual dysfunction (P = .0017).ConclusionsTrainees and early-career specialists found sexual health training important for their future medical practice; however, less than half received it during their postgraduate training. Participants felt more confident in managing patients with sexual health problems when sexual health training was included in the postgraduate training program.Kristufkova A, Pinto Da Costa M, Mintziori G, et al. Sexual Health During Postgraduate Training—European Survey Across Medical Specialties. Sex Med 2018;6:255–262.

U.S. Seniors Matching to Psychiatry Increases For Sixth Straight Year

U.S. Seniors Matching to Psychiatry Increases For Sixth Straight Year

Assessment and Treatment of Pediatric Sleep Problems: Knowledge, Skills, Attitudes and Practices in a Group of Community Child Psychiatrists.

As part of a university-based quality improvement project, we aimed to evaluate child psychiatrists’ knowledge, skills, attitudes, and practices regarding assessment and treatment of pediatric sleep problems. We developed a nine-question survey of knowledge, skills, attitudes, and practices regarding assessing for and treating sleep complaints in pediatric patients, and administered this survey to child psychiatrists in training and in practice in the state of Missouri. Respondents reported sleep hygiene as the first-line treatment strategy, followed by the use of supplements or over-the-counter remedies. The most common barriers to evidence-based assessment and treatment of sleep problems were the lack of ability to obtain reliable history, and parental preference for medications over behavioral approaches for sleep concerns. These results suggest potential opportunities for enhancing knowledge regarding validated assessment tools and non-pharmacological treatment options for sleep problems. Additional research is needed to further assess the quality and type of sleep education provided in child psychiatry training programs.

A Pilot Study Examining Factors Influencing Readiness to Progress to Indirect Supervision Among First Year Residents in a General Psychiatry Training Program

In the first year of training, psychiatry residents progress from direct supervision to indirect supervision but factors predicting time to transition between these levels of supervision are unknown. This study aimed to examine times for transition to indirect levels of supervision and to identify resident factors associated with slower progression. The authors compiled data from training files from years 2011-2015, including licensing exam scores, age, gender, medical school, month of first inpatient psychiatry rotation, and transition times between levels of supervision. Correlational analysis examined the relationship between these factors. Univariate analysis further examined the relationship between medical school training and transition times between supervision levels. Among the factors studied, only international medical school training was positively correlated with time to transition to indirect supervision and between levels of indirect supervision. International medical graduate (IMG) interns in psychiatry training may benefit from additional training and support to reach competencies required for the transition to indirect supervision.

5.33 Current State of Training in Autism Spectrum Disorder and Developmental Disabilities Across New York State Psychiatry Training Programs

5.33 Current State of Training in Autism Spectrum Disorder and Developmental Disabilities Across New York State Psychiatry Training Programs

“Ultra” early precut fistulotomy for biliary access to prevent post- ercp pancreatitis. A retrospective analysis

The Accreditation Council of Graduate Medical Education (ACGME) mandates that residents in psychiatry training programs learn to provide psychiatric consultation to other medical and surgical services. The ACGME, however, offers little information to instruct academic faculty and institutions to what constitutes a quality educational experience in psychosomatic medicine/consultation-liaison psychiatry for the resident trainee.These recommendations were developed through a collaborative process between educators in C-L psychiatry and members of the Academy of Psychosomatic Medicine’s Residency Education Subcommittee.This manuscript provides a broad framework for what constitutes a well-rounded clinical and academic resident rotation on psychiatric consultation-liaison services. A rotation that is viewed positively by residents is important as it likely provides a foundation for a growing interest in Psychosomatic Medicine and the development of future fellows and subspecialty trained physicians.

IACAPAP Textbook of Child and Adolescent Mental Healthedited by Joseph M. Rey, M.D., Ph.D. Geneva, International Association for Child and Adolescent Psychiatry and Allied Professions, 2015 (downloadable PDFs).

Back to table of contents Previous article Next article Book ForumFull AccessIACAPAP Textbook of Child and Adolescent Mental HealthJuan David Palacio, M.D., M.Sc.Juan David PalacioSearch for more papers by this author, M.D., M.Sc.Published Online:1 Jul 2017https://doi.org/10.1176/appi.ajp.2017.17030361AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by Joseph M. Rey, M.D., Ph.D. Geneva, International Association for Child and Adolescent Psychiatry and Allied Professions, 2015 (downloadable PDFs).The e-textbook from the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP), freely available online, is an easily accessible e-book for any professional working in the field of child and adolescent mental health. In the book, world authorities in child and adolescent psychiatry cover diverse topics from the clinical assessment and development of children and youths to major psychiatric disorders. The book also covers some cultural, social, legal, and administrative aspects of this field.Reviewing the chapter on bipolar disorder, I found basic concepts, clear and updated information, and tables that allow readers to readily appreciate the content. In addition, the authors suggest illustrative and valuable links to videos of authorities in bipolar disorder and to other documentaries, which exquisitely complement and deepen the text. In this way, reading becomes easy, concise, and enjoyable. The chapter on attention deficit hyperactivity disorder (ADHD) accurately covers the main literature on the subject, illustrating the evolution of ADHD throughout life, explaining the different presentations of the disorder, and also covering current controversies about ADHD. Once again, the suggested links to expert videos, guidelines from the National Institute for Health and Care Excellence, and other materials make it a versatile and very novel chapter.In general, the manner in which this book has been developed makes it a good basic text to support the teaching of future psychiatrists. Some sections also contain self-assessment questions to reinforce knowledge, and some offer additional teaching material such as downloadable PowerPoint presentations, “ready to go” material to teach future generations. Some chapters have been translated into French, Portuguese, Japanese, Spanish, Russian, and Hebrew. This strength is in turn a huge challenge for the future: to cover different languages ​​in all chapters.The intention of Joseph M. Rey to develop a high-quality, innovative, didactic textbook of child infant mental health and to reach various countries of the world is well fulfilled through this effort of the IACAPAP.Dr. Palacio is Director of the child psychiatry training program at the University of Antioquia, Medellin, Colombia.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byPrevention of Intellectual Development Disorder18 May 2022 | enadakulturaInternet Addiction as One of the Main Types of Addiction in Modern High-School Students31 March 2022 | Scientific Bulletin of Mukachevo State University Series “Pedagogy and Psychology”, Vol. 8, No. 1Features of affective disorders correction in patients with epilepsy (therapy, rehabilitation, prevention)31 March 2021 | Medicine Today and Tomorrow, Vol. 90, No. 1Psychometric Evaluation of the Malay Version of the Multidimensional Beck Youth Inventories-2 (BYI-2 Malay): Measuring Self-Concept, Anxiety, Depression, Anger, and Disruptive Behaviour among Adolescents in Sheltered Homes26 March 2021 | Pertanika Journal of Social Sciences and Humanities, Vol. 29, No. 1Is the Progress of Children with ASD in a Behavioural Therapy Programme Influenced by Parents’ Hyper-Systemizing?1 September 2020 | Journal of Evidence-Based Psychotherapies, Vol. 20, No. 2 Volume 174Issue 7 July 01, 2017Pages 698-698 Metrics KeywordsOther Psychological IssuesAdministrationTextbookChild PsychiatryAdolescentsTeachingMental HealthPsychiatric DisorderPDF download History Accepted 1 March 2017 Published online 1 July 2017 Published in print 1 July 2017

Learning environment of the Saudi psychiatry board training program.

Objectives:To assess the learning environment of the Saudi psychiatry board program using the Dutch Residency Educational Climate Test (D-RECT) and to explore residents’ perception of different domains of the learning environment.Methods:This was a descriptive cross-sectional study. The D-RECT instrument was distributed to all residents at all training sites of the Saudi psychiatry training program. It is a reliable and valid instrument to measure educational environment at the postgraduate level. Mean scores are presented, t-tests, analysis of variance, and post hoc analysis were used to compare subgroups and pearson’s correlation was used to assess relationships.Results:Seventy-eight out of 96 residents responded (81.25%), one third of them were female. Overall D-RECT score was 2.76±0.55. The supervision subscale scored 2.83±0.83, coaching and assessment scored 2.60±0.73, feedback scored 2.00±0.85, team work scored 2.81±0.86, peer collaboration scored 3.54±0.84, professional relations between consultants scored 2.71±0.95, work is adapted to residents’ competence scored 2.71±0.86, consultants’ attitudes scored 2.71±0.86, formal education scored 2.68±0.72, and patient handover subscales scored 3.25±1.06. Female residents scored significantly higher than their male counterparts and there were no statistical significant difference between years of residency. Cronbach’s alpha was 0.936.Conclusion:Most of the learning climate domains scored poorly, which necessitates a rigorous plan for reevaluation and improvement. Furthermore, D-RECT proved to be a reliable instrument and could help in evaluation and improvement of postgraduate training programs.

Attitude of Medical Students towards Psychiatry: The case of Jimma University, Southwest Ethiopia.

The inability to attract medical graduates to specialize in psychiatry has always been a serious challenge to psychiatry training programs. Therefore, the aim of this study was to assess the attitude of medical students towards psychiatry. A comparative cross-sectional survey was conducted among 122 fourth year medical students of Jimma University. The attitude of medical students towards psychiatry was measured by Attitude toward Psychiatry - 30 (ATP-30). The collected Data were analyzed by SPSS version-20 using independent samples t-test plus bivariate and multivariate logistic regression. The level of significance was determined at 95% confidence interval. Medical students who did not take psychiatry clinical rotation had a higher ATP-30 mean score 55.52(±15.2) indicating positive attitude towards psychiatry than those who completed psychiatry clinical rotation (mean= 49.75 ±10.67). Female medical students had significantly more positive attitude towards psychiatry than males (OR=9.23, 95% CI: 2.32; 36.76). Medical students who did not take psychiatry clinical rotation had more positive attitude towards psychiatry than students who completed the psychiatry clinical rotation (OR=7.58, 95% CI: 2.02; 28.37). Subjective experience of mental illness and reported family history of mental illness significantly predicted positive attitude toward psychiatry. The findings suggest that doing psychiatry rotation might have affected the attitude of medical students towards psychiatry. Future research should assess the experiential factors during psychiatry training of medical students that affect their attitudes. Also, future research needs to evaluate the attitudes of fourth year medical students before and after their psychiatry clinical rotation.

Teaching Psychiatric Trainees to “Think Dirty”: Uncovering Hidden Motivations and Deception

Despite the prevalence with which trainees encounter patients who attempt to manipulate, deceive, or withhold information from them, trainees receive little formal training in "thinking dirty"-that is, incorporating elements of hidden patient motives into their interview, formulation, and plan. Lack of acknowledgment of these aspects of patient care can lead to resident dissatisfaction, negative countertransference reactions, and decreased empathy for patients. In this article, the authors outline a multimodal approach used in a large psychiatry training program for teaching trainees to recognize hidden motivations and deception, which involves formal didactic teaching, process rounds, and clinical experience. This approach improves trainee understanding of patients' motivations, and it allows trainees to better regulate their emotional responses to patients withholding information or deceiving them. Formally addressing this topic in the curriculum can lead to improved patient outcomes and decreased resident burnout, particularly on high-intensity rotations.

Group Aims to Improve MH Care for People of African Ancestry

Back to table of contents Previous article Next article International NewsFull AccessGroup Aims to Improve MH Care for People of African AncestryAaron LevinAaron LevinSearch for more papers by this authorPublished Online:5 Apr 2017https://doi.org/10.1176/appi.pn.2017.3a27AbstractA common geographic ancestry and a similar social history of slavery and racism elicit new efforts for mental health care in populations of African ancestry.An international group of 54 psychiatrists and other clinicians have restarted an effort to address the mental health issues of people of African ancestry on both sides of the Atlantic by creating the Africa Global Mental Health Institute (AGMHI) at a meeting last November in Capetown, South Africa.The institute’s deeper roots date back to 2002, when the late Harvard psychiatrist Chester Pierce, M.D., brought together psychiatrists from Africa, the Caribbean, and the United States to discuss “the myriad mental health issues and challenges facing people of African descent.”That idea lay fallow until the recent Capetown meeting, organized by clinicians from the Americas, Asia, and Africa.Founders of the Africa Global Mental Health Institute hope to educate clinicians and ultimately affect policy to improve the mental health of people of African descent on both sides of the Atlantic, says Michelle Durham, M.D., M.P.H.Boston Medical Center“We’re in a better position now,” explained child and adolescent psychiatrist Michelle Durham, M.D., M.P.H., an assistant professor of psychiatry at Boston University School of Medicine and associate director of its Global and Local Center on Health Disparities.“More people were involved this time, and we have more partners on the continent,” said Durham, the AGMHI’s director of education, in an interview. “Our next challenge is building an institution, and we have a timeline to do that with goals for the next one, two, and three years.”Durham sees two primary issues that need to be addressed. One is the dearth of psychiatrists and other mental health professionals in Africa. The other is the inadequate research on people of African descent, wherever they live.“People rely on studies and books that have nothing to do with the people of non-European descent they’re serving,” said David Henderson, M.D., chair of psychiatry at the Boston University School of Medicine and chief of psychiatry at Boston Medical Center.In response, the AGMHI founders want to set up an international network of researchers that will develop clinical, epidemiological, outcomes, and other studies both in Africa and in the diaspora. That network then would inform judgments on both sides of the Atlantic.To develop the mental health workforce in Africa, organizers hope to connect academic medical centers in high-income countries with those in low-income countries. The goal would be to strengthen training programs in psychiatry, psychology, social work, and public health (Psychiatric News, August 7, 2015).AGMHI also plans to work with government health ministries and local and international organizations to develop support for mental health policies and research.Information must be a two-way street—or perhaps a roundtrip plane ride, said Durham.“Bidirectional learning is also important,” said Durham. “We have a lot to learn from each other.”She cited one example from the large Ethiopian population seen at Boston Medical Center.Epidemiological studies in Ethiopia found a 5:1 male-to-female ratio in the prevalence of schizophrenia, rather than the usual 1:1 found globally. Further research revealed that families were hiding women with mental illness in an effort to protect them, delaying treatment by 10 to 20 years. Research methods expert and conference participant Christina Borba, Ph.D., M.P.H., an assistant professor at the Boston University School of Medicine and director of research in the Department of Psychiatry at Boston Medical Center, intends to study Ethiopians living in Boston to see if similar practices exist there. If they do, the medical center plans to develop a program to work with the community to clinically detect those women and bring them in for care.“People who come here bring their countries with them,” observed Henderson. “But each country needs people with research skills to understand local conditions. They have to develop their own data to take care of their own patients.”“We see challenges locally that we hope to address globally,” said Durham. “We hope to do that by using clinical, research, policy, and teaching perspectives to build up resources overall.” ■The website for the Africa Global Mental Health Institute can be accessed here. ISSUES NewArchived

Incorporating Lifelong Learning From Residency to Practice: A Qualitative Study Exploring Psychiatry Learners' Needs and Motivations.

There has been an increased focus on lifelong learning (LLL) as a core competency to develop master learners in medical education across the learner continuum. The purpose of this study was to explore the perceptions of psychiatry residents and faculty about LLL implementation, motivation, and training needs. This qualitative study was conducted in a large, urban, multisite psychiatry training program as part of a larger mixed methods study of LLL in psychiatry education. Using a purposive sampling approach, psychiatry residents were recruited to participate in focus groups; early career psychiatrists and psychiatry educators were recruited to participate in semistructured interviews. Content analysis of interviews and focus groups was done using the iterative, inductive method of constant comparative analysis. Of the 34 individuals participating in the study, 23 were residents, six were psychiatry educators, and five were early career psychiatrists. Three predominant themes were identified in participants' transcripts related to (1) the need for LLL training in residency training; (2) the implementation of LLL in residency training and practice; and (3) the spectrum of motivation for LLL from residency training into practice. This study identified the lack of preparation for LLL in residency training and the impact of this gap for psychiatrists transitioning into practice. All participants described the importance of integrating LLL training within clinical rotations and the importance of grounding LLL within the clinical workplace early in residency training to support the delivery of effective, high-quality patient care.

Psychiatric trainees’ experience of their training in perinatal mental health

IntroductionApproaching and offering treatment to a patient in perinatal period might be complicated. Often, it is regarded as one of the most difficult aspects in psychiatry. Given the increasing trends in the number of female patients of childbearing age consulting to psychiatric services, it has become an issue that specialists of today and tomorrow need to be well aware of.ObjectivesTo better understand the impact of perinatal mental health training on psychiatric trainees from different countries in Europe who receive such training.MethodsThe European Federation of Psychiatric Trainees conducts annual surveys, directing questions to national trainee representatives, to assess the situation of psychiatric training. EFPT representatives of the countries where perinatal mental health training was reported to be included in psychiatry and/or child and adolescent psychiatry training programmes, namely Germany, France, Malta, Finland and Ireland, were contacted. Qualitative interviews focusing on the confidence (or in confidence) trainees feel when a patient who is planning pregnancy, pregnant or breastfeeding consults to them and the impact of training in perinatal mental health on their attitudes as clinicians were explored.ResultsAlthough theoretical training in perinatal mental health is considered as an important aspect of psychiatry training in general, practical training or rotations are not found as essential. However, being able to benefit to more than one generation was perceived as a source of motivation.ConclusionsPerinatal mental health is appreciated as a critical part of theoretical education by trainees and in countries where a clinical rotation is available, it enhances making more use of resources and consultation possibilities.Disclosure of interestThe authors have not supplied their declaration of competing interest.