Psychiatry Residents Research Articles

Trainees Form New Reproductive Psychiatry Group to Learn, Network, Collaborate

Trainees Form New Reproductive Psychiatry Group to Learn, Network, Collaborate

The pedagogical challenges of teaching psychiatry residents during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has challenged and almost completely disrupted the previous teaching system, based mainly on teachers’ and learners’ physical presence. This impact has forced educators to identify alternative learning models and begin utilizing new approaches, often without detailed analysis or thorough, systematic planning. The current literature review aims to reveal some of the greatest pedagogical challenges in remotely teaching psychiatry residents during the pandemic. This mini-review’s results may help in developing additional pedagogical techniques and key applications for educational activities to teach psychiatry residents, as well as to suggest directions for future psychiatry resident education.

Asian American Mental Health: Looking Beyond the COVID-19 Pandemic

Asian American Mental Health: Looking Beyond the COVID-19 Pandemic

Comment on "A National Survey of Motor Vehicle Crashes Among General Surgical Residents".

Comment on "A National Survey of Motor Vehicle Crashes Among General Surgical Residents".

Impact of Culture, Race, Social Determinants Reflected Throughout New DSM-5-TR

Impact of Culture, Race, Social Determinants Reflected Throughout New <i>DSM-5-TR</i>

The Current State of Journal Clubs in Psychiatry Residency Programs: Results from a National Survey of Program Directors.

ObjectiveThis study aimed to investigate journal club prevalence, implementation, and perceived effectiveness among psychiatry residency program directors in order to highlight best practices.MethodsThe authors distributed a 44-item thoughtfully designed and peer-reviewed questionnaire electronically via Qualtrics to 235 accredited U.S. psychiatry residency program directors identified using the American Medical Association database.ResultsEighty-nine programs (38%) responded. Of these, 83 (93%) had a journal club. Journal clubs were mandatory in 80 programs (96%), met biweekly or monthly in 62 programs (75%), and lasted 46–60 min in 66 programs (80%). Twenty-three programs (28%) offered a list of articles to choose from, and 22 programs (27%) provided a critical appraisal tool. Only 7 programs (8%) measured learner outcomes from journal clubs. Respondents believed that promoting lifelong learning and practicing evidence-based psychiatry were the most relevant educational goals of journal club (2.57 and 2.51 on a Likert scale of 0 to 3). Journal club’s effectiveness in achieving those goals was believed to be lower (2.16 and 2.09).ConclusionsJournal clubs are common in U.S. psychiatry residency programs and tend to follow a traditional format. In order to boost journal club’s effectiveness in achieving the desired educational goals, more programs might elect to infuse elements known to augment learning.

The Drug Abuse Research Training (DART) Program for Psychiatry Residents and Summer Fellows: 15-Year Outcomes.

To increase the number of physician-scientists in research, the Drug Abuse Research Training (DART) program at the Medical University of South Carolina offers a 2-year research track for psychiatry residents and a 10-week summer fellowship for students. The goal of this study was to examine program outcomes and alumni diversity levels over DART's 15-year history. To date, 215 trainees (44 residents, 171 summer fellows) have completed the program. An anonymous online survey was sent to the 143 program alumni with valid contact information. Survey data included demographic characteristics, post-program research involvement, and self-reported barriers to continued research engagement. Overall survey completion response was 83.5% (N = 122). The alumni included 59.0% women, and 36.1% of respondents identified as a member of a minority racial/ethnic group. Following program completion, 77.0% of the alumni reported continued research involvement. More than half of the alumni reported scientific publications (57.4%) and conference presentations (63.1%) since completing DART. Among respondents who did not subsequently engage in research, the most common modifiable barriers included difficulty finding a mentor, self-perceived deficits in statistical skills and research methodology, and overall lack of confidence in research ability. Over the past 15 years, the DART program has established a diverse research training program that now spans the educational spectrum from undergraduate to residency training. Future program goals include additional training to address self-reported modifiable research barriers. This program provides a model for other training programs designed to cultivate research interests and promote the diversity of clinical researchers.

Inter-Professional Education: Inter-Professional Learning Experience of Clinical Psychology and Psychiatry Residency Students

Objective: To explore the inter-professional learning experience of clinical psychology and psychiatry residency students. Design: Qualitative study Setting: This research was carried out at Addis Ababa University’s School of Medicine, College of Health Science, Department of Psychiatry, which offers clinical psychology and psychiatry residency programs. The research was carried out between September and April of 2020. Participants: The inter-professional learning experiences of 5 clinical psychology and 4 psychiatry residents were investigated. Methods: A theme analysis was used in a descriptive qualitative investigation. Semi-structured interviews were used to gather information, which was then evaluated thematically. Data was collected and analyzed at the same time. Results: The results revealed three main themes and five sub-themes reflecting clinical psychology and psychiatry students’ experiences. (a) IPE experience, (b) Factors affecting active involvement, and (c) Professional identity and IPE experience were the themes. Conclusion: The findings of this study revealed that IPE experiences vary and are the result of a complex combination of factors. Inter-professional education between participants with different professional status has a significant impact on their IPE experience. To meet the IPE objectives, the learning experience must include a balanced two-way interactive experience among participants.

What Do Residents Want from Wellness? A Needs Assessment of Psychiatry Residents to Inform a Residency Wellness Strategy.

What Do Residents Want from Wellness? A Needs Assessment of Psychiatry Residents to Inform a Residency Wellness Strategy.

Assessing Interpersonal Relationships in Medical Education: the Connection Index.

The relationship between a resident physician and his/her supervising attending is foundational to graduate medical education and may impact the clinical learning environment and resident well-being. This paper focuses on how to measure connection between a resident and their clinical supervisor. Connection includes the subdomains of psychological safety, empathy, educational alliance, and feedback. After reviewing the literature, the authors designed the 12-item, 7-point Connection Index (CI12) to quantitatively measure connections between a resident and his/her supervisor during a 6-month period (supervision dyad), and based on educational alliance, empathy, psychological safety, and effective feedback. A 9-criteria evaluation framework was applied to assess its reliability and validity on a sample of psychiatry residents at a residency program, July 2016 through June 2018. Out of a total possible number of 50 residents, 100% participated to rate 41 supervisors over 201 supervision dyads; the CI12 satisfied all eight of the eight testable criteria, including high scalability (H = 0.78), consistency (alpha = 0.98), test-retest validity (ICC = 0.95), and construct validity where CI12 was found to have statistically significant correlations with outcomes measures (greater connection was associated with less negative emotional experiences, less mistreatment or bias, less burnout, and higher attendance to supervision sessions). The authors showed the CI12 can be a valid and reliable instrument to quantify whether a resident and his/her supervisor connects during a 6-month supervision with respect to empathy, psychological safety, educational alliance, and feedback. We recommend assessing connections as part of the overall evaluation of a resident's experience with the clinical learning environment.

Measuring patient satisfaction in an outpatient psychiatric clinic. What factors play a role?

IntroductionPatient satisfaction is defined as the perception that one’s general health care needs are being met. Prior research suggests that positive patient satisfaction with health care facilitates the physician–patient relationship and enhances quality of life.ObjectiveThe primary purpose of this study was to assess patient satisfaction (as measured by the Patient Satisfaction Questionnaire (PSQ-18)) of patients observed by general psychiatry residents and to examine the effects of depression and anxiety on patient satisfaction. A secondary purpose was to explore the effects of three 1-h mentalization-based skills training sessions on the PSQ-18 scores of psychiatric residents. We hypothesized that depressive and anxiety symptoms would negatively impact patient satisfaction. We hypothesized that patients’ satisfaction scores would improve after mentalization training.MethodsThis was a prospective case–controlled study, enrolling adult patients (n = 157) referred for psychiatric assessment in a psychiatric resident outpatient clinic. The primary outcome was patient satisfaction as measured by the PSQ-18. This outcome was compared to anxiety and depression symptoms as measured by the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-Item scale (GAD-7) questionnaires. Outcome data from the PSQ-18 were compared among residents before and after they completed mentalization training. The data were analyzed with univariate analyses and multiple linear regression.ResultsOverall the patients were satisfied with clinician communication and interpersonal manner (4.21 ± 0.66 and 4.15 ± 0.69, respectively). The patients score on PHQ-9 was inversely related to their scores on time spent (TS) (p = 0.01) and accessibility/convenience (AC) (p = 0.0009) subscales of the PSQ-18. GAD-7 score was inversely related to patients scores on AC subscale (p = 0.01). Brief mentalization training for the providers did not impact patient satisfaction scores.ConclusionsOur study reveals that depression and anxiety can negatively impact PSQ-18 patient scoring in psychiatric outpatients observed for the first time in a resident clinic. However, this study failed to show that a brief mentalization-based training could improve patient satisfaction scores that were already quite high at baseline.

United States of America Child and Adolescent Psychiatrists' Career Satisfaction by Career Stage.

This study sought to examine career satisfaction among United States of America child and adolescent psychiatrists (CAPs) across career stages, identifying predictive factors for their career satisfaction. A total of 526 CAPs responded to a national career satisfaction survey. Satisfaction was assessed via responses to statements about their career on a Likert scale. Career satisfaction was defined as the sum of the scores for satisfaction with their choice of career, career advancement, and career recognition. Responses were disaggregated by the number of years post child and adolescent psychiatry residency training (early career: 0-10years; midcareer: 11-20years; and late career: 21 + years post-training). Stepwise linear regression analyses identified predictive factors of career satisfaction. CAPs' career satisfaction was high (3.95) and increased with career stage. It was most positively correlated with advancement opportunities, job enjoyment, and control of assigned tasks, and most negatively correlated with workload. Job enjoyment was the leading predictive factor of career satisfaction for early career and late career CAPs, with midcareer CAPs identifying task assignment control as the leading contributor to their career satisfaction (all p = .000). Career satisfaction in Child and Adolescent Psychiatry is high, increases with career stage, and is most predicted by advancement opportunities. Further study of the predictive factors of CAPs' career satisfaction is warranted as we focus on increasing the workforce in child and adolescent psychiatry.

Knowledge and Attitudes for the Management of Behavioral Variant of Frontotemporal Dementia.

Background: The diagnosis of the behavioral variant of frontotemporal dementia (bvFTD) can be especially challenging and is relatively underdiagnosed. There is scarce information on training and attitudes from care providers facing bvFTD in settings with limited resources. We aim to describe clinical knowledge and attitudes facing bvFTD from neurologists, psychiatrists, and residents in Peru.Methods: Potential participants received invitations by email to complete an online questionnaire. In addition, we reviewed 21 curricula from undergraduate medical schools' programs offered by the main schools of medicine in Peru during 2020 and 2021.Results: A total of 145 participants completed the survey. The responders were neurologists (51%), psychiatrists (25%), and residents in neurology or psychiatry (24%). Only 26% of the respondents acknowledged receiving at least one class on bvFTD in undergraduate medical training, but 66.6% received at least some training during postgraduate study. Participants identified isolated supportive symptoms for bvFTD; however, only 25% identified the possible criteria and 18% the probable bvFTD criteria. They identified MoCA in 44% and Frontal Assessment Battery (39%) as the most frequently used screening test to assess bvFTD patients. Memantine and Acetylcholinesterase inhibitors were incorrectly indicated by 40.8% of participants. Seventy six percentage of participants indicated that they did not provide education and support to the caregiver. The dementia topic was available on 95.2%, but FTD in only 19%.Conclusion: Neuropsychiatry medical specialists in Peru receive limited training in FTD. Their clinical attitudes for treating bvFTD require appropriate training focused on diagnostic criteria, assessment tools, and pharmacological and non-pharmacological management.

Evaluating the Effectiveness of an Educational Module for the Bush-Francis Catatonia Rating Scale.

Catatonia is widely underdiagnosed, in large part due to inaccurate recognition of its specific features. This study aimed to evaluate the effectiveness of an online educational module to improve theoretical and practical knowledge of the Bush-Francis Catatonia Rating Scale (BFCRS) across a broad range of clinicians and medical students. A 1-h online module, including a training manual and videos, was disseminated to medical students, psychiatry residents and fellows, and psychiatrists through national Listservs and through the Academy of Consultation-Liaison Psychiatry. Participants completed pre- and post-module testing consisting of a 50-question multiple-choice test and a 3-min standardized patient video scored using the 23-item BFCRS. Participants accessed the module from October 1, 2020, to April 4, 2021. Immediate improvement and 3-month knowledge retention were assessed using quantitative and qualitative analyses. Study enrollment was high with moderate dropout (pre-testing: n = 482; post-testing: n = 236; 3-month testing: n = 105). Adjusting for demographics, large pre-post improvements were found in performance (multiple-choice: 11.3 points; standardized patient scoring: 4.2 points; both p < 0.001) and for nearly all individual BFCRS items. Knowledge attrition was modest, and improvements persisted at 3months. This educational resource provides descriptive and demonstrative reference standards of the items on the BFCRS. This curriculum improved identification of catatonia's features on both multiple choice and standardized patient scoring across all ages and training levels with good overall knowledge retention.

Training Psychiatrists in New Mexico: Reflections from Psychiatry Residents Who Participated in a Rural Track Versus a Traditional Program Alone over the Past Decade.

ObjectiveWith over 60% of rural Americans living in mental health professional shortage areas, there is a need for providing psychiatry residents training experiences in rural communities with the goal of increasing the likelihood that they will end up practicing in those same communities following graduation. The purpose of this study was to survey previous and current psychiatry residents, with the goal of describing the impact of the program on rural track residents compared to those in the traditional residency track.MethodsPsychiatry residents 2010–2020 completed an online survey. For those who participated in the rural residency track, the survey asked additional questions regarding barriers experienced practicing in rural areas (e.g., professional isolation) and whether the goals of the rural track were met.ResultsSeventy-four residents completed surveys, with 26% in the “Rural Track Group” (RTG) and 74% in the “Non-rural Track Group” (NTG). More RTG reported they were more likely to practice in rural, frontier, or underserved areas after residency compared to NTG (74% versus 60%). Most RTG (72%) strongly agreed the rural program helped meet goals. Distance from family was a top barrier for current RTG (63%), followed by concerns about local schools, social isolation, and reduced career opportunities for partners (45%).ConclusionsResidents of the RTG were more likely to consider a career in a rural area than those of the traditional program alone. Psychiatry residency requirements should be reviewed to address top rural training barriers to promote retention in rural areas.

Psychiatry Resident Education in Neurocognitive Disorders: a National Survey of Program Directors in Psychiatry.

ObjectiveAs major neurocognitive disorders increase, little research has examined how psychiatry residents are prepared to provide neurocognitive care to patients.MethodsA national survey was sent to program directors of general psychiatry in the USA and Canada, including questions about satisfaction, attitudes, and graduation expectations for training in major neurocognitive disorders. The authors examined descriptive statistics and a series of chi-squared analyses by training setting, residency type, and presence of subspecialty fellowships. The authors also collected free text responses about perceived needs for enhancing training.ResultsProgram directors agreed that the scope of general psychiatry includes the evaluation of cognitive disorders (78.8%) and the treatment of cognitive symptoms (77.5%) and behavioral/psychological symptoms (78.8%). Required clinical rotations were the preferred method of teaching (63.7%), but didactics were most used (93.8%). The most frequently used clinical teaching setting was geriatric psychiatry (61.3%) and didactics were most frequently taught by geriatric psychiatrists (75.0%). Fifty-six percent were satisfied or very satisfied with their clinical training and 66.3% with their didactics. There were no significant differences in satisfaction or attitudes when compared by training setting, residency type, or presence of subspecialty fellowships. Additional trained faculty were most frequently listed as a need for improving clinical and didactic training.ConclusionsPsychiatry program directors view major neurocognitive disorders as part of the scope of psychiatric practice. The majority of training is provided within psychiatry rotations, especially geriatric psychiatry. Program directors reported several unmet needs for optimal training, particularly related to clinical training services.

The conceptualisation of educational supervision in a National Psychiatry Residency Training Program

Introduction: Development of expertise and counselling skills in psychiatry can be mastered only with effective supervision and mentoring. The conceptualisations of educational supervision amongst supervisors and residents were explored in this study to understand how supervisory roles may have been affected by the adoption of competency-based psychiatry residency training. Methods: A qualitative research approach with thematic analysis was adopted. Individual in-depth interviews using a semi-structured interview guide with a purposive sample of six supervisors and six newly graduated residents were conducted. Transcripts of the interview were analysed and coded using the Atlas Ti software. Results: Four major themes emerged from analysis of the transcripts: (1) Meaning and definition of supervision; (2) Expectations and responsibilities of the educational supervisor; (3) Elusiveness of mentoring elements in educational supervision and (4) Personal and professional development of residents in supervision. Supervisors and residents perceived educational supervision narrowly to be transactional with acquisition of knowledge and skills, but residents yearned for more relational interactions. Conclusion: This study showed that the roles and functions of supervisors in educational supervision were unclear. It also highlighted the lack of a mentoring orientation in supervision in the psychiatry residency training program. An emphasis on assessment of competencies might have contributed to tension in the supervisory relationship and lack of a mentoring role, with concerns on residents’ personal and professional identity development in their psychiatry training.

The sociology of emotions in the psychiatric practice: how residents in psychiatry learn to dislike patients with borderline personality disorder

According to the literature, the most disliked patient subgroup is the one diagnosed with borderline personality disorder (BPD). The current study aimed to explore how psychiatry residents’ emotions toward patients with BPD are learned during biomedical training and how their emotional socialization within an inpatient psychiatric ward contributes to the formation of a professional, authoritative identity, while also strengthening ingroup members’ bonds and reinforcing the asymmetric relationship in terms of power between psychiatrists and hospitalized patients. This article reports on the findings coming from a combination of ethnographic field research in a psychiatric ward of a general hospital and in-depth interviews with eight residents in psychiatry, regarding their emotions toward patients with BPD. The transcriptions of the interviews and the descriptions from field notes were analyzed by thematic analysis. One of the main themes revealed during the analysis of the data is called ‘socialized emotions’ and consisted of three subthemes: a) representational emotions, b) experienced emotions, and c) performed emotions. The three subthemes could correspond to three phases of the process of emotional socialization of the residents in psychiatry regarding patients with BPD: a) formation of emotionalized schemes, b) lived experiences, and c) clinical practices. The sociological understanding of how emotional aspects of the professional identity of the doctor are taught during the residencies is of particular interest. Both clinical and research implications are discussed.

The sociology of emotions in the psychiatric practice: how residents in psychiatry learn to dislike patients with borderline personality disorder

According to the literature, the most disliked patient subgroup is the one diagnosed with borderline personality disorder (BPD). The current study aimed to explore how psychiatry residents’ emotions toward patients with BPD are learned during biomedical training and how their emotional socialization within an inpatient psychiatric ward contributes to the formation of a professional, authoritative identity, while also strengthening ingroup members’ bonds and reinforcing the asymmetric relationship in terms of power between psychiatrists and hospitalized patients. This article reports on the findings coming from a combination of ethnographic field research in a psychiatric ward of a general hospital and in-depth interviews with eight residents in psychiatry, regarding their emotions toward patients with BPD. The transcriptions of the interviews and the descriptions from field notes were analyzed by thematic analysis. One of the main themes revealed during the analysis of the data is called ‘socialized emotions’ and consisted of three subthemes: a) representational emotions, b) experienced emotions, and c) performed emotions. The three subthemes could correspond to three phases of the process of emotional socialization of the residents in psychiatry regarding patients with BPD: a) formation of emotionalized schemes, b) lived experiences, and c) clinical practices. The sociological understanding of how emotional aspects of the professional identity of the doctor are taught during the residencies is of particular interest. Both clinical and research implications are discussed.

A Missing Step: The Value of Psychological Mindedness Training during Psychiatry Residency

Psychiatry residents, who lack psychological mindedness, struggle to understand the multiple determinants of behavior, or the numerous meanings of a single symptom. This is unfortunate because most psychiatry resident interns feel that they are finally among the group where they belong… like-minded physicians who share a fascination with human nature and a desire to grasp all the nuances and complexities of human behavior. This paper provides a framework for psychiatry departments to train residents along a continuum of psychological mindedness. The authors explain the concept of psychological mindedness, explore the pros and cons of acquiring psychological mindedness, and a scientific basis for its use in general psychiatry. A new model is included to capture any resident’s ability to become psychologically minded, with direction for Program Director’s to possibly develop growth in a resident’s psychological mindedness over four years of training.