Psychiatry Training Research Articles

Rural workforce challenges: Why not rural psychiatry?

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

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

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

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

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

Interest in Rural Training Experiences in a Canadian Psychiatry Residency Program.

With the large majority of mental health professionals concentrated in urban settings, people living in rural and remote areas face significant barriers to accessing mental health care. Recognizing that early exposure is associated with future practice in rural and remote locations, we sought to obtain baseline data regarding interest in expanded rural residency training opportunities and academic teaching. In March 2021, all psychiatry residents at the University of Alberta (UofA) were invited to complete a 19-question survey that included both closed-ended (age, gender, year of study, rural experience, interest in rural training, etc.) and open-ended questions (challenges, barriers, academic training, and other comments). A reflexive thematic analysis using an inductive and semantic approach was completed on the comments. 36 residents completed the survey (response rate, 75%). Significant associations were identified between previous rural training experience and interest in rural psychiatry training and practice. Female residents and junior residents were significantly more interested in rural training experiences than their counterparts. Thematic analysis noted concerns with the financial costs of accommodation and transportation, high service burden, continuity of care and isolation from their cohort. Many were interested in academic sessions on the realities of rural practice; approaches to collaborative care; and strategies on culturally relevant care; specifically Indigenous health. The University of Alberta has highlighted a focus on improving equity and accountability; and with a large rural catchment region; the residency program is well positioned to make training adjustments to diversify training. Based on our findings we have incorporated rural rotations for incoming residents and have developed further rural academic content to support our responsiveness and accountability to the rural and northern communities we are committed to serving. Future research should review the impact of rural training exposure in medical specialties on recruitment and retention as well as on healthcare outcomes.

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

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

COVID-19-Related Disruptions Are an Opportunity for Reflection on the Role of Research Training in Psychiatric Residency Programs

This commentary describes COVID-19-related disruptions and responsive accommodations to facilitate a research project required to complete postgraduate psychiatry training in a resource-limited small island developing state. After providing context concerning the impact of the pandemic on medical education, we focus on implications for postgraduate training in psychiatry. Lessons learned from this experience have relevance for ongoing discussions concerning the role and implementation of research training in residency programs. Research skills are essential for evidence-based practice as well as academic careers. Longitudinal integration of research training and flexibility of research requirements are needed in postgraduate psychiatry to balance residents’ development of research skills with demands of clinical service.

Challenges Faced by Psychiatry Trainees During Residency in Pakistan

Introduction: Medical students and trainees have higher levels of stress and burnout compared with the general population. Objective: The main objective of this study is to find the challenges faced by psychiatry trainees during residency in Pakistan. Material and methods: This cross sectional study was conducted in Wah medical college / POF hospital Wah Cantt during 2021 to 2022.The data was collected from 100 participants through Snowball technique. Trainees from Pakistan who have completed their residency program or have cleared their exam in last 3 years were included in the study. Results: The data was collected from 100 participants. Among those 100 participants 48 (47.1%) females and 52 (52.9%) males. They rate their trainings in terms of learning as 14.3% participants were considered excellent. Among the 100 trainees who filled the questionnaire, the results showed that majority of the trainees were satisfied with their supervisor in terms of knowledge, competency and willingness to teach. Practical implications: After reading this article we can easily find the problems faced by trainees during the training process. Conclusion: It is concluded that the trainees were satisfied on the whole with the supervisors knowledge, competency and the layout of the training program. Keywords: Satisfaction, Trainees, Programmed, Residency, Psychiatric

Entrustable Professional Activities and Learning: The Postgraduate Trainee Perspective

ObjectiveEntrustable professional activities (EPAs) are used as clinical activities in postgraduate psychiatry training in Australasia. This study aimed to explore psychiatry trainees’ perceptions of the impact of EPAs on their motivation and learning.MethodsA constructivist grounded theory approach was used to conceptualize the impact of EPAs on trainees’ motivation and learning. A purposive sample of trainees was recruited from across New Zealand. Semi-structured individual interviews were used for data collection and continued until theoretical saturation was reached.ResultsThe impact of EPAs on learning was mediated by the trainee’s appraisals of subjective control, value, and the costs of engaging with EPAs. When appraisals were positive, EPAs encouraged a focus on particular learning needs and structured learning with the supervisor. However, when appraisals were negative, EPAs encouraged a superficial approach to learning. Trainee appraisals and their subsequent impact on motivation and learning were most affected by EPA granularity, alignment of EPAs with clinical practice, and the supervisor’s conscientiousness in their approach to EPAs.ConclusionsTo stimulate learning, EPAs must be valued by both trainees and supervisors as constituting a coherent work-based curriculum that encompasses the key fellowship competencies. If EPAs are to be effective as clinical tasks for learning, ongoing faculty development must be the leading priority.

3.109 Therapeutic Groups for LGBTQ+ Adolescents to Advance Community Needs and Psychiatry Trainees’ Learning

LGBTQ+ youth have disproportionate mental health needs and feelings of isolation, as explained by the minority stress model. However, most psychiatry trainees report that they do not have adequate exposure to LGBTQ+ youth mental health topics. The aims of this project are to: 1) address LGBTQ+ youth mental health needs through creating a therapeutic group environment; and 2) train psychiatrists to serve the needs of LGBTQ+ youth through case-based learning modules and supervised real-world experiences while measuring their knowledge, comfort, and competency working with this population.

SUICIDALITY IN BLACK CHILDREN AND ADOLESCENTS: A SECOND LOOK

The purpose of this presentation is to educate child and adolescent psychiatrists, medical students, and psychiatry trainees about the external factors influencing the current Black youth suicide crisis and to discuss interventions and resources to address the issue. Black children experience significantly higher rates of suicide and depression when compared to children of other racial groups. Suicide is the second leading cause of death among Black children under age 12 years, and the suicide death rate among Black youth has been growing faster than any other ethnic group.

23.4 Teaching to Our Time: The Present and Future of What Is Taught to US Psychiatry Trainees about Climate Mental Health

Climate change is considered the greatest public health crisis of the 21st century and significantly impacts mental health (Watts et al, 2020). Whereas others have published on the importance of education about the effects of climate change on health in medical training curricula (Wellbery et al, 2018), the degree to which psychiatry residents and fellows currently learn about this topic during training, if at all, is unknown. Furthermore, there is no consensus as to what type of curriculum would be most appropriate to teach psychiatry trainees about this topic.

Ramifications of a Patient’s Physical Assault on Inpatient Ward Psychiatrists

Ramifications of a Patient’s Physical Assault on Inpatient Ward Psychiatrists

DIAGNOSTIC AND THERAPEUTIC DEVELOPMENTS IN INTELLECTUAL DEVELOPMENTAL DISORDER: WHAT'S NEXT?

The objectives of this presentation are: 1) to understand the latest innovations in precision medicine and genetics with intellectual developmental disorder (IDD); and 2) to explore ways that these latest innovations are informing clinical practice and training in child and adolescent psychiatry to improve care and quality of life for individuals with IDD.

2.122 Triple Board Experiences Across the Nation: Navigating Strengths and Challenges in Combined Training Programs

Triple board program (TBP) trainees complete training in pediatrics, general psychiatry, and child and adolescent psychiatry. TBPs produce versatile physicians, able to provide a wide breadth of patient care and reach underserved populations, particularly within the mental health field. Previous wellness survey scores among residents have indicated higher rates of burnout in TBP residents in comparison to noncombined residency training programs. The primary aim of this survey was to assess factors related to increased burnout, professional fulfillment, and protective factors promoting resiliency and wellness among TBP residents.

HARNESSING CHILD AND ADOLESCENT PSYCHIATRY EXPERTISE THROUGH BEHAVIORAL HEALTH EDUCATION IN COLLABORATIVE CARE PROGRAMS AND PEDIATRICS RESIDENCY TRAINING INTERVENTIONS

Collaborative care is a model of behavioral health integration that promises to improve behavioral health outcomes in primary care settings. Significant gaps in the basic education of primary care providers (PCPs) and child and adolescent psychiatrists limit broad dissemination of the collaborative care model. Innovations are needed to address the training gap among child and adolescent psychiatry trainees, as well as pediatric trainees, particularly around integrated models such as collaborative care.

2.121 A Needs Assessment of Cyberbullying Curricula in Psychiatry Residency Training

Research indicates that most teens have faced some form of cyberbullying (Anderson, 2018; Cook, 2021). Cyberbullying victims are at higher risk of developing depression, self-harm, suicide attempts, substance abuse, and anxiety (Englander et al, 2017; John et al, 2018; Zhu et al, 2021). It is unclear how much instruction child and adolescent psychiatry trainees are provided on this topic. The purpose of this study is to assess trainees’ comfort in evaluating and treating victims of cyberbullying.

1.50 Development and Evaluation of a Diversity, Equity, and Inclusion (DEI) Training for Psychiatry Residents

The Accreditation Council for Graduate Medical Education (ACGME) outlines core competencies that psychiatry residents must obtain during training. These competencies specify a need for residents to effectively evaluate, treat, and communicate with patients from diverse racial, cultural, and socioeconomic backgrounds. This is important for psychiatry trainees due to a discrepancy in access to and quality of mental health care for racial and cultural minorities. To address this, many psychiatry residency programs have created diversity, equity, and inclusion (DEI) curriculums.

82.4 The State of Psychiatry Training in the Care of Patients with Intellectual and Developmental Disabilities

This presentation will aim to understand how trainees in both general and child and adolescent psychiatry residency programs are taught about the care and treatment of patients with intellectual and developmental disability (IDD). It will also explore areas of improvement and methods for increasing the knowledge and confidence of psychiatric trainees in the care of individuals with IDD.

2.125 A Needs Assessment of Child and Adolescent Psychiatry Postgraduate Training in Equity, Diversity, and Inclusion Principles

The current social climate has brought attention to historic and systemic inequities impacting child and youth mental health. Despite this, equity, diversity, and inclusion (EDI) principles have not been a major component of Canadian child and adolescent psychiatry training. This study reports the results of a needs assessment conducted to examine the state of national child and adolescent psychiatry EDI curricula as part of a larger project grounded in Kern’s framework for curriculum development, with the ultimate goal of co-designing an evidence-informed educational intervention focused on EDI themes relevant to child and adolescent psychiatry.

From co-morbidity to transdiagnostic potential and novel immunotherapies for psychosis

One of my first placements in psychiatry training was with the early intervention in psychosis services in Birmingham, in the late 1990′s. It was in this context that I became aware of the frequency and importance of affective co- modbidity and lack of diagnostic certianty in early stages of develping severe mental illness. This challenged the established dichotomy between affective and non-affective severe mental illnesses, and has driven my work and thinking ever since- including that embracing the presence of affective symptoms in schizophrenia may open the door for new treatments. Understanding affective dysfunction as a potential intrisic component of developing psychotic disorders has also shown the potential for transdiagnostic symptoms with shared underlying biological processess, including immune dysfunction, related to remission and functional outcomes. Currently my work focuses on targeting the immune system to improve recovery in clinical trials, and further mechanistic studies that reach beyond traditional diagnostic catagories.