Residency Training Directors Research Articles

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

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

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Review of “Conflicted Care: Doctors Navigating Patient Welfare, Finances, and Legal Risk”

There is a quote in Hyeyoung Oh Nelson’s Conflicted Care: Doctors Navigating Patient Welfare, Finances, and Legal Risk, which captures the book’s substance beautifully. In an interview excerpt with the director of residency training at the hospital Nelson studied, the doctor explains the “single biggest dilemma” physicians face in an academic medical institution. He addresses an imaginary trainee to illustrate the problem: “Look, this is the time when you are learning to be a doctor: we want you to be cost-effective but we also want you to be thorough and humanistic and use physical diagnostic skills that you have learned appropriately, and not overorder tests. And you have to do all that within two and a half days…” (p. 37). Abundant research by medical and organizational sociologists has underscored the inescapable tension of the healthcare system in the United States: caught between the “do no harm” oath, which directs physicians to put patients’ wellbeing above everything else, and the financial and bureaucratic structuring of healthcare provision, which has introduced the principle of efficiency in every healthcare institution. In an ideal world, these mandates would align: providing the best care would also be cost-efficient (and such is the promise of managed care policies). In the real world, unsurprisingly, health logics and financial logics tend to clash.

CMS Extends Virtual Supervision of Residents to End of Year

CMS Extends Virtual Supervision of Residents to End of Year

Brooklyn Resident Competition Develops Young Researchers

Back to table of contents Previous article Next article APA & MeetingsFull AccessBrooklyn Resident Competition Develops Young ResearchersMark MoranMark MoranSearch for more papers by this authorPublished Online:4 May 2023https://doi.org/10.1176/appi.pn.2023.06.6.24AbstractThe competition, founded and coordinated for 31 years by APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc., promotes resident involvement with APA and the Brooklyn district branch, while helping resident scholars advance their careers as psychiatric researchers.In March 1992, Ramaswamy Viswanathan, M.D., Dr.Med.Sc., then president of the Brooklyn Psychiatric Society (BPS), organized and moderated the first annual Brooklyn Psychiatric Society (BPS) Resident Scholarly Presentations Competition.APA Deputy Medical Director and Chief of Research Nitin Gogtay, M.D. (left), served as a judge in the resident scholarly presentations competition. With him are Kusum Viswanathan, M.D., chief medical officer at Brookdale University Medical Center, and APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc.Mark MoranThis year’s competition 31 years later, which took place in April at Interfaith Medical Center in central Brooklyn, marked his last year coordinating the event. Viswanathan, who is president-elect of APA and professor and interim chair of psychiatry at SUNY Downstate Health Sciences University, is turning over coordination of the event to Maria Bodic, M.D., a psychiatrist at Maimonides Medical Center.The competition brings together resident scholars from psychiatric training programs at four Brooklyn hospitals—Brookdale University Hospital Medical Center, Maimonides Medical Center, SUNY Downstate Health Sciences University, and Interfaith Medical Center. The residents present poster and oral presentations on a variety of research projects, with winners selected by a panel of research experts (Brooklyn District Branch Honors Residents for Outstanding Research).Kelvin Oke, M.D., a resident at Interfaith Medical Center, received first prize in the poster competition for his research project titled “Adolescent Crimes: Association of Multiple Substance Use With Arrests Among Adolescents.”Mark MoranWhen he originated the competition, Viswanathan and his wife, Kusum Viswanathan, M.D., a pediatric hematologist-oncologist who is now the chief medical officer at Brookdale, donated what he called “a modest amount of money” to pay for some of the expenses related to the competition over the years.“At the time we originated it, it was an innovative program and the first such program to be organized by a district branch of APA,” he told Psychiatric News. “It has helped strengthen our residents’ involvement with APA and promoted their professional development.”Kunal Gandhi, M.D. (left), received first prize for his oral presentation titled “Is Cannabis a Gateway Drug? A Retrospective Analysis of American Adolescents.” With him are Tolu Olupona, M.D., president of the Brooklyn Psychiatric Society, and APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc.Mark MoranThe judges were Nitin Gogtay, M.D., APA deputy medical director and chief of research; Aparna Dole, M.D., a clinical instructor in psychiatry at New York University Grossman School of Medicine; and Jose Vito, M.D., a clinical professor of psychiatry at NYU Langone Health. Vito is also past president of the New York County Psychiatric Society.“The BPS Resident Scholarly Presentations Competition is an outstanding way for young psychiatrist researchers to hone their skills at gathering and analyzing data on topics relevant to psychiatric practice and patient care and presenting their findings in a professional setting,” Gogtay said. “I urge these young researchers and all residents interested in research to join APA and avail themselves of the mentorship and resources offered by APA’s Division of Research.”Following opening remarks by LaRay Brown, CEO of One Brooklyn Health, Gogtay spoke about APA and the work of the Division of Research, especially around DSM, PsychPRO (APA’s mental health registry), and the APA Research Consortium.Brooklyn Psychiatric Society President Tolu Olupona, M.D., director of residency training at Interfaith Medical Center, credited Viswanathan and Linda Majowka, BPS executive director, for shepherding the program over many years.The competition “is a great opportunity for psychiatry residents in Brooklyn to showcase their scholarly activity to their peers and other faculty from psychiatry residency programs in Brooklyn,” she told Psychiatric News. “Residents and faculty also network with colleagues from other programs during the event, and the activity helps residents in training to build their CV as they grow in their academic careers.” ■ ISSUES NewArchived

Cleveland’s Safety Net Hospital Builds 112-Bed Psychiatric Facility

Back to table of contents Previous article Next article ProfessionalFull AccessCleveland’s Safety Net Hospital Builds 112-Bed Psychiatric FacilityMark MoranMark MoranSearch for more papers by this authorPublished Online:9 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.35AbstractThe new hospital and an enlarged training program mark the largest expansion of behavioral health services in northeast Ohio in 30 years.MetroHealth Hospital in Ohio, founded in 1837, is the safety net hospital for Cleveland and Cuyahoga County, serving more than 300,000 patients, two-thirds of whom are uninsured or covered by Medicare or Medicaid. Last October, the hospital opened the MetroHealth Behavioral Health Hospital to replace the 20-bed psychiatric unit in the old hospital. The Cleveland MetroHealth Behavioral Health Hospital opened last October and will eventually have 112 inpatient beds, cutting the region’s inpatient deficit by more than 50%.Cleveland MetroHealth HospitalThe psychiatry residency training program at MetroHealth received approval from the Accreditation Council for Graduate Medical a (ACGME) to add three new training slots per year, which will increase the total number of residents from 20 to 32. Like the state-funded expansion of the training program at the University of Iowa (see “Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations”), the developments at MetroHealth are evidence that states and municipalities are responding to the shortage of mental health professionals and the need to invest in expanding the psychiatric workforce. Last November, the Cuyahoga County Council approved the use of $5 million from its Opioid Mitigation Fund to construct the $42 million hospital. The council’s $124 million fund is derived from settlements with opioid manufacturers. According to the U.S. District Attorney’s Office for Northeastern Ohio, the county saw a 1,000% increase in opioid deaths between 2007 and 2016. There were 653 overdose deaths in the county in 2022, according to the County Medical Examiner’s Office. Cheryl Wills, M.D., director of child and adolescent psychiatry at MetroHealth, said the new hospital and the expansion of the training program are the result, in part, of a 2018 needs assessment conducted by the hospital’s strategic team. Taking into account existing resources in the region, the assessment showed that Cuyahoga County was short 200 inpatient psychiatric beds. The new hospital is expanding incrementally—40 adult beds became available when the hospital opened in October. Separate 20-bed units for adolescents, patients with substance use disorders, and geriatric patients are expected to open this year.Cleveland MetroHealth Hospital“MetroHealth has a rich history of serving all people, regardless of ability to pay,” said Wills, who is also APA’s Area 4 trustee. “But we were consistently referring people out for mental health treatment because we had only 20 beds. By expanding with the new hospital to 112 beds, we are addressing 50% of the deficit, a huge step.” Raman Marwaha, M.D., the residency training director at MetroHealth, said the developments there mark the largest expansion of behavioral health services in northeast Ohio in 30 years. “When I joined MetroHealth eight years ago, I had a waiting list of 18 months,” said Marwaha, who is president of the APA Caucus of International Medical Graduates. He said the new hospital is moving incrementally toward reaching the total of 112 beds—40 adult beds became available when the hospital opened last October, and at press time a psychiatric-medical unit and a four-bed psychiatric intensive care unit were expected to open. “The plan is in the next six months to open more beds—a 20-bed adolescent unit, a 20-bed addiction unit, and a 20-bed geriatric unit.” Marwaha said that residents in the expanded program, which will be located at the new hospital, will have training rotations in schools, integrated group practices, and the county correctional facility. Attracting residents and, importantly, faculty to help supervise residents is critical. Wills did some detective work and discovered an Ohio state loan repayment program for which physicians who work at MetroHealth would qualify—a lesson, Wills said, for other institutions and localities. “It’s important to think creatively and strategically and to learn about existing available resources,” she said. “When I started at MetroHealth in March last year, one of my concerns was recruitment of the best faculty possible. I felt we had to have something to offer people, to make it attractive to work here. We are hoping to attract psychiatrists invested in working with underserved and safety net populations who will be involved for the long haul.” ■Ohio Physician Loan Repayment ProgramThe Cuyahoga County Medical Examiner’s Report on opioid deathsCuyahoga County Opioid Mitigation FundHeroin Epidemic, U.S. Attorney’s Heroin and Opioid Task Force ISSUES NewArchived

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

AADPRT Recommends Virtual Interviewing For 2022-2023 Recruitment Year

AADPRT Recommends Virtual Interviewing For 2022-2023 Recruitment Year

The Burden of Leadership: a Survey of Burnout Experiences Among Psychiatry Program Directors.

The objectives of this study were to examine the prevalence of burnout, specify contributors to and protective factors against burnout, and gather suggestions to improve well-being in psychiatry Program Directors. A survey regarding burnout and wellness was distributed to psychiatric Program Directors through the email listserv of the American Association of Directors of Psychiatric Residency Training (AADPRT). The survey response rate was 273 responses out of 880 members surveyed (31%). The majority of respondents were current residency or fellowship Program Directors or Associate Program Directors or had another current educational role (93%, 227/245). Almost half of current Program Directors or Associate Program Directors reported feeling burned out almost daily or once a week (44%, 93/210). These Program Directors reported a desire to resign (77%), experienced discrimination within the past 5 years (66%), and struggled with finding meaning in their job (44%). The most frequently endorsed contributors to burnout were increasing administrative burden and insufficient support. The survey findings confirm that burnout characteristics are common among respondents, associated with a desire to resign and a struggle to find meaning in the highly demanding position of Program Director or Associate Program Director. Advocacy for resources, decreased administrative overload, and increased protected time would enhance well-being in Program Directors. Most striking was the frequency of discrimination reported and its relationship to burnout. Departments may benefit from a careful review of policies, procedures, and training to decrease hostile workplaces for women, international medical graduate, and under-represented in medicine Program Directors.

Psychiatry Residency Directors' Attitudes Toward and Uses of the Medical Student Performance Evaluation and Other Potential Tools for Residency Selection.

A survey was conducted to determine US psychiatry residency directors' attitudes regarding current measures of medical student performance and their preferences for the future. A team of psychiatry medical student educators and residency program directors developed a 23-question survey. In July 2021, links to the survey were sent out to all program directors registered with the American Association of Directors of Psychiatric Residency Training. Seventy program directors out of 223 initiated the survey, resulting in a response rate of 31.4%. Forty percent of respondents reported that the most important use of the Medical Student Performance Evaluation (MSPE) is in screening out applicants for interviews, and only 26.1% reported that the MSPE in its current form could be trusted to provide a valid and reliable assessment of a student's medical school performance. Most respondents agreed that in the absence of United States Medical Licensing Examination (USMLE) step 1 numerical scores, the existing MSPE format/content requirements should be modified, use a set of ranking categories that are uniform across all medical schools, and be supplemented with additional measures of the student's character and ability specific to psychiatry. US psychiatry program directors are eager for change when it comes to the MSPE and how it reports rankings, grades, and professionalism. The transition of the USMLE step 1 score reporting to pass/fail presents an opportunity to pursue this change and for stakeholders from all medical specialties to work together toward a shared goal of an improved residency selection process.

Challenges of Assessing Resident Competency in Well-Being: Development of the Psychiatry Milestones 2.0 Well-Being Subcompetency.

Burnout and depression are major problems facing physicians, with 300-400 physicians dying by suicide each year. In an effort to address this issue, the Accreditation Council for Graduate Medical Education (ACGME) revised the Common Program Requirements for residency and fellowship programs to include a strong emphasis on well-being, and this revision has been extended to including a subcompetency on well-being in the Milestones 2.0. The Psychiatry Milestones 2.0 Work Group was convened to draft updated psychiatry milestones. As part of the open feedback period, the American Association of Directors of Psychiatric Residency Training submitted an organizational letter outlining several points to consider regarding the original draft of the well-being subcompetency. The ACGME was receptive to this feedback and allowed the Psychiatry Milestones 2.0 Work Group to revise the subcompetency. Current research indicates that burnout is largely driven by systemic factors, but well-being literature and initiatives often focus on individual factors and responsibility for burnout rather than systemic change. Program directors tasked with assessing resident well-being can additionally encounter several professionalism concerns, including how to (1) define a subcompetency within a competency that itself has not been well defined; (2) decide the appropriate balance between individual and systemic responsibility for well-being; (3) consider mental health as a parameter of well-being; (4) balance roles as physicians, psychiatrists, and training directors in thinking about the mental health of residents without overstepping boundaries and while maintaining privacy, confidentiality, and resident safety; and (5) measure well-being in a sociocultural context. This article describes how these considerations were incorporated into the revision of the Psychiatry Milestones 2.0 version of the well-being subcompetency, which has subsequently been made available to other specialty work groups for potential use as they develop their specialty-specific Milestones 2.0.

Child and Adolescent Psychiatry Fellowship Program Participation in the National Resident Matching Program Match: Trends and Implications for Recruitment.

Recruitment is one of the most important missions for the Child and Adolescent Psychiatry (CAP) Caucus of the American Association of Directors of Psychiatric Residency Training, the American Academy of Child and Adolescent Psychiatry, and the American Association of Directors of Child and Adolescent Psychiatry. A review of the National Resident Matching Program (NRMP) Match data is needed to inform current and future practices. The NRMP, Accreditation Council for Graduate Medical Education, and Association of American Medical College databases were queried from 1996 to 2021. The NRMP data show that the number of programs participating in the Match has increased from 87 in 1996 to 106 in 2021 and that the percentage of programs that fill their positions in the Match is increasing and has increased from 41% in 1996 to 67% in 2021. However, each year, a percentage of programs do not fill their positions offered in the Match. The numbers indicate a surplus of positions for the number of applicants that appears to be increasing, and there are currently 49 more positions than applicants. Trends in the CAP Match are encouraging, and importantly, more programs and applicants are using the Match. One concerning trend is the surplus of positions while there is a great need for child psychiatrists. More research is needed on the incentives for programs and applicants to participate in the Match and how to increase interest in child and adolescent psychiatry.

Michael Thompson, MD

Michael Thompson, MD

Growing the Psychiatry Workforce Through Expansion or Creation of Residencies and Fellowships: the Results of a Survey by the AADPRT Workforce Task Force.

ObjectiveThe USA needs to produce more psychiatrists to meet projected workforce deficits. The American Association of Directors of Psychiatric Residency Training Directors (AADPRT) sought to examine opportunities for and obstacles to expanding or creating residencies and fellowships.MethodsIn November 2019, the authors conducted a survey of residency and fellowship directors. The survey gathered information about new positions, new programs, participation in interprofessional education, and loss of residency or fellowship positions.ResultsThe survey was distributed to psychiatry residency (N=231) and fellowship (N=194) directors, with a response rate of 33.4%. One quarter of responding residencies and fellowships reported creating new programs; 24.7% of residency and 17.5% of fellowships reported expansion. The most common reason to develop or expand programs was the shortage of psychiatrists, with the local institution as the most common funding source. Fifty-seven percent reported that they had wanted to expand, but faced barriers, primarily lack of funding. Recruitment and retention of faculty are major challenges. Psychiatry departments frequently (87.5%) participate in interprofessional education, generally perceived as positive. Unfortunately, 15.7% of respondents reported loss of positions or closure of programs.ConclusionsCreating and expanding residencies and fellowships are common strategies for addressing the shortage of psychiatrists. Barriers include lack of funding and challenges recruiting/retaining faculty. The loss of residency/fellowship positions or closure of programs is a worrisome trend.

Not Even Pandemic Can Stop APA’s Popular MindGames!

Back to table of contents Previous article Next article APA & MeetingsFull AccessNot Even Pandemic Can Stop APA’s Popular MindGames!Search for more papers by this authorPublished Online:24 Jun 2021https://doi.org/10.1176/appi.pn.2021.7.48AbstractResidents from the University of Texas Health San Antonio won this year’s MindGames, the popular Jeopardy-like APA competition pitting residents from psychiatry programs across the country against each other to test their knowledge of patient care, medicine, and psychiatric history. The winning team members were (from left) Eric Parmon, M.D., Morgan Hardy, M.D., and Anna Zampese, M.D.The other teams were from Cooper Medical School of Rowan University and SUNY Upstate Medical University. Playing for Cooper Medical School were Garrett Rossi, M.D., Roshi DeSilva, D.O., and Michelle Mergenthal, M.D. Playing for SUNY Upstate were Mark Wiener, M.D., James Gilfert, M.D., and Sutanaya Pal, M.D.MindGames is traditionally held at APA’s Annual Meeting but this year had to be held virtually over Zoom.Art Walaszek, M.D., director of residency training at the University of Wisconsin, hosted this year’s event. Special judges were past APA President Michelle Riba, M.D., M.S., a clinical professor of psychiatry at the University of Michigan, and Philip Muskin, M.D., a professor of psychiatry at Columbia University Medical Center. ■ ISSUES NewArchived

Psychiatry Residency Match Numbers Climb Again After Unprecedented Year in Medical Education

Psychiatry Residency Match Numbers Climb Again After Unprecedented Year in Medical Education

Resource Document Calls for Improved Residency Training on SUDs

Resource Document Calls for Improved Residency Training on SUDs

Who We Are Today: a National Survey of Diversity Among Psychiatry Program Directors.

In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee's goals was to understand the AADPRT membership's composition and their perceptions of D&I. This study's objective was to identify the demographic characteristics of the AADPRT membership. Program directors were invited by email to participate in an anonymous survey. The survey collected participants' demographic information including gender, race/ethnicity, training background, age, disability/differently abled status, job role, geographic region where their program is located, type of program, and their program's community setting. Two hundred fifty six of 657 AADPRT members (39%) completed the survey. Respondents were mostly White (64.5%) followed by Asian/Southeast Asian (17.6%), Hispanic/Latinx (4.3%), and Black (1.6%). Only 13.3% of the participants were international medical graduates. Women were more prevalent (61.7%) than men (37.5%), and 9.4% self-identified as members of the LGBTQ+ Community. This study represents the first systematic investigation into the diversity among psychiatry program directors throughout the USA and Canada. Future qualitative studies are needed to better understand the reasons behind this initial study's findings. Potential concerns requiring exploration include the possibility of the program director role serving as a "glass ceiling" for some women and a "leaky pipeline" in academia for groups underrepresented in medicine.

Utilizing Psychodynamic Principles to Teach Professionalism to Medical Students Through an Innovative Curriculum.

Professionalism is a fundamental expectation of practicing medicine and a core competency in medical education, yet the methods of how to teach and evaluate it are still experimental. Professionalism involves self-reflection, a psychodynamic understanding of the patient's and the doctor's predicament, and conflict resolution, so psychiatrists are uniquely qualified to teach it. This article describes an innovative course that utilizes psychodynamic principles to teach professionalism to medical students. The authors present a novel 2-year curriculum for teaching professionalism to first- and second-year medical students utilizing psychodynamic principles to help develop awareness of others' feelings and motivations, self-reflection, compassion, empathy, and skills in ethical conflict resolution by means of written and oral narrative exercises. Outcomes are evaluated by the student ratings about the course and the faculty, and by using the test for emotional intelligence (EI), administered as a baseline and then at the end of each year. Each subsequent year the students demonstrated a statistically significant increase in EI scores, student evaluations of the course ranked among the highest in the medical school, clerkship supervisors and residency training directors noted the high degree of professionalism of the students, and the number of student applicants to psychiatry residency were consistently higher than the national average. In addition, this course was awarded the 2018 Alpha Omega Alpha Honor Medical Society's Edward B. Harris Medical Professionalism Award for the best professionalism course of U.S. medical schools. Psychodynamic principles are fundamental for teaching medical professionalism at a medical-student level. Professionalism also serves as a way to introduce students to psychiatry early in the curriculum, and psychiatrists and other mental health professionals are uniquely qualified to teach medical professionalism.

The Radicalization of a White Psychiatrist.

The Radicalization of a White Psychiatrist.