Psychiatry Training Research Articles

Are In-Person Trainee Interviews a Relic of the Past?

Are In-Person Trainee Interviews a Relic of the Past?

Combining remote work and training: the experience of participating in the first Virtual EPA Gaining Experience Programme

AbstractEach year the European Psychiatric Association offers early career psychiatrists the opportunity to take part in the Gaining Experience programme, a scholarship that funds short observership placements (between 2 and 8 weeks) overseas in different psychiatric institutions across Europe to ECPs who have completed their psychiatric training. However, since COVID-19 was declared by the WHO as a worldwide emergency on 11th March 2020, it was no longer possible to provide offline overseas observerships. Therefore, the Gaining Experience programme changed its format in 2020-2021 and became virtual. It was in this context, that an Ukranian early career psychiatrist was going to participate in the virtual Gaining Experience programme at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London (United Kingdom) from December 2021. The observership placement had a particular academic focus, the essence of which was investigating psychotherapy training among ECPs in Ukraine, and to examine how it is included in psychiatry training. The sharing of this example of virtual observership shows that it is possible and feasible high-quality and affordable distance learning for ECPs. This training format can be useful not only during quarantine restrictions, but also in conditions of limited travel opportunities.Disclosure of InterestNone Declared

Are we ready to be techno-digitalicus psychiatrists?

AbstractDigital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a potential solution in those problematic circumstances and logistic issues for which the current mental health service infrastructure is not able to adequately accommodate to the needs of most patients. Indeed, most mental health workforce does not always own an enough and appropriate theoretical either practical training in digital psychiatry and in delivering remote consultations safely and effectively. Most European countries do not have curricula-specific training requirements, either at core or higher specialty level, for psychiatry trainees to demonstrate competence in digital skills that may be considered essential to good clinical practice, including abilities and competencies needed to provide and deliver mental health interventions by using digital tools. The talk will provide an overview on the level of the current state-of-the-art of the European techno-digitalicus psychiatrist and psychiatry trainee.Disclosure of InterestNone Declared

Refugees, war trauma and mental health: knowledge and experience from trainees and early career psychiatrists

IntroductionPsychiatry Across Borders working group of the European Federation of Psychiatric Trainees has the mission to improve psychiatric training in transcultural psychiatry and trauma-related topics in Europe. It started conducting a survey in 2016, to assess trainees’ experiences in forcibly displaced people mental health (Frankova et al. Transcult.Psychiatry, in press).ObjectivesTo investigate European psychiatric trainees’ and Early Career Psychiatrists’ (ECPs) training about trauma and refugees’ mental health, focusing on educational and clinical difficulties occurring while assisting war refugees or in Eastern Europe, due to the ongoing conflict.MethodsA new survey for European psychiatric trainees and ECPs was designed. A web questionnaire was shared through various channels, including social media, in September 2022. It included an informed consent form and investigated socio-demographic data, training in trauma and refugees’ mental health, clinical practice in war areas or with war refugees.ResultsAs of 16/10/22, 31 were the responders, mainly adult psychiatrists (93.6%). Although the 87.1% worked with forcibly displaced people, only 29% received a specific training, and 53.6% didn’t feel prepared to face war trauma-related disorders. However, 64.3% could reach out to a teamwork member specialized in the topic, and 72.2% to interpreters. The 67.7% worked with actual war refugees, mainly addressed to psychiatric services due to new onset of psychiatric symptoms, especially insomnia (66.7%), often diagnosed with Acute Stress Reaction (66.7%) and treated with psychiatric drugs (83.3%). Two colleagues working in war areas participated in the survey: both lost patients at follow-up and experienced increased workload or lack of means (i.e., drug supply) or support.ConclusionsThis survey can spot educational needs in transcultural psychiatry, helping to program targeted interventions for psychiatric trainees and ECPs, aimed at implementing clinical practice towards the common goal of social cohesion.Disclosure of InterestNone Declared

Psychiatry residents’ perceptions of competence acquisition, training programe compliance and clinical supervision in the Spanish psychiatry training system

IntroductionThere are differences in the training curricula of medical specialists in different countries. The opinion of the doctors in training on how they acquire competencies and carry them out is of great importance. In our case, we asked ourselves what were the perceived shortcomings in psychiatric training.ObjectivesThe main objective of the study is to describe the opinion of psychiatry residents in Spain on the acquisition of competencies, compliance with the training programme and quality of clinical supervision.MethodsThis is a descriptive, cross-sectional, mixed (quantitative and qualitative) study. Based on previous bibliography and the ministerial order of the official training programme, an online survey was prepared, which was disseminated telematically through the residents’ representatives of the National Commission of the Speciality of Psychiatry of the National Council of Health Sciences Specialities.ResultsA total of 109 responses were obtained, with representation from all the Autonomous Communities of Spain. Graph I shows the opinion of the psychiatry residents as to which competencies they feel are less developed at present, with the competencies related to psychotherapy standing out in first place with great importance. In terms of compliance with the training programme, the parameter most in line with what was established was the average number of shifts, with an average of 4.26 shifts per month. However, 11.7% of residents do not take compensatory rest after on-call duty as required by law. Moreover, the rotation times established by the BOE are not complied with in 38.5% of the hospitals. With regard to the rotations that the residents feel should increase their rotation time, the child and adolescent psychiatry and dual pathology rotations stand out (graph II). Finally, with regard to the supervision process, only 22.90% of first-year residents are always supervised in person during their rotations (graph III).Image:Image 2:Image 3:ConclusionsOur study reflects the belief on the part of the resident physicians that further training in psychotherapy (45.7%), psychogeriatrics (10.6%) and dual pathology (8.5%) would be necessary. The fact that only 11.7% of the participants stated that they did not take compensatory rest after on-call duty seems to us to be an improvement over what was initially expected. There are other less reassuring data, such as the fact that only 22.9% of first-year residents report having continuous supervision. We consider that the results found follow the trends observed in studies carried out in residents from other countries. We stress the need to carry out a greater number of studies with a broad population base in which to find the failures that psychiatry residents themselves perceive in their training.Disclosure of InterestNone Declared

Using a mobile application for psychiatry training in medical students: a quasi-experimental study.

Microlearning and gamification through mobile technology can significantly enhance knowledge acquisition and satisfaction. Roozbehyar application, was designed using microlearning and gamification approaches for psychiatry clerkship training. This quasi-experimental study was conducted in Roozbeh Hospital, in 2021. The intervention group was assigned to the Roozbehyar during a 4-week course. Knowledge and satisfaction were assessed after 4weeks. We recruited 27 (F/M: 19/8) and 35 students (F/M: 22/13) in the intervention and control groups, respectively. Learning through Roozbehyar was associated with higher scores in the final written exam (p value: 0.031). No difference was seen in the final global assessment scores. The satisfaction scores of the students regarding the content and learners' aspect of the application were above average, yet scores in structural and support aspects were below average. We highlighted the effect of a microlearning mobile application in increasing knowledge and satisfaction in psychiatry training in medical students.

Addressing Challenges in Addiction Treatment and Training in Africa

Substance use disorder is a major contributor to disability adjusted life year. Globally and especially in Africa there is high treatment gap for substance use disorders (SUDs) and lack of training in addiction psychiatry. This commentary discusses challenges to SUD treatment and training in Africa and offers suggestions to advance the field. Sociopolitical and health system factors limit the availability of treatment and training of healthcare providers for addiction in Africa. It is essential that governments in Africa prioritise investment in addiction treatment and training to reduce the morbidity and mortality associated with lack of treatment.

Self-injury and suicidal behavior in children and youth population: Learning from the pandemic

IntroductionSuicidal behaviour and self-harm are increasing in children and adolescents. Non-suicidal self-harm are a dysfunctional method of emotional regulation, and it must be distinguished from suicidal behaviours. MethodsNarrative review of the current situation on suicide and self-harm in Spain. Descriptive study of suicidal behaviours in paediatric emergencies. ResultsMental health consultations were analysed (March-2019 to March-2020 and March-2020 to March-2021) in a multicentric study of the SEUP (Spanish Society of Pediatric Emergencies), finding a 122 % increase of the diagnosis of "non-accidental drug intoxication” and 56 % of “suicide/suicide attempt/suicidal ideation”. In another prospective analysis, 281 attempts were recorded, with the patient profile being: female (90.1 %), 14.8 years old, 34.9 % without previous psychiatric diagnosis; 57.7% with previous suicidal behaviour. The presence of psychiatric disorders, especially depression, and previous attempts, are the best-known risk factors for suicidal behaviour, although other factors are involved (family, personal or social). Pediatricians should be trained to deal with questions about suicide and acquire the skills to conduct an interview with a supportive and empathetic attitude. In Spain, suicide prevention plans are heterogeneous among communities, and there is not a unified national suicide prevention plan. ConclusionsPrimary, hospital and mental health care resources for paediatric population should be strengthened to prevent suicidal behaviours. Specific training for school staff, and child and adolescent psychiatry training for paediatricians and nurses are crucial in the prevention of suicide in children and adolescent population.

Diverse Geriatric Workforce Education History, Needs, and Opportunities: Focus on Psychiatric Advanced Practice Nurses

Primary TopicAdvanced Practice Nursing History and Current State of Education Update Secondary TopicExploration of opportunities for filling educational gaps for subspecialty geriatric psychiatry training in Diverse WorkforceThis symposium is sponsored by the AAGP IDEA Committee.Advanced practice nurses are continuing to grow as partners of care for the geriatric psychiatry patient population. With increasing specialty workplace shortages across acute, ambulatory, and long-term care settings and growing numbers of geriatric psychiatrists retiring and less coming into the field, there is need to increase interprofessional collaboration with advanced practice nurses. The variety of advanced practice nurses practicing in the field has led to understandable confusion surrounding educational standards and experience from physician colleagues.Advanced nursing education has evolved over decades adapting to the needs of the ever-changing healthcare system and patient needs. Advanced practice nurses came in existence to assist in providing care to the underserved and often rural populations that struggled to maintain physician employment. The first advanced practice nurse specializing in the field of psychiatry was the certified nurse specialist. This role originally encompassed a larger focus on psychotherapy. Over decades and changes in healthcare, there was a larger call for psychiatric prescribers due to psychiatrist shortage, leading to the development of the psychiatric nurse practitioner role. Psychiatric nurse practitioners are board certified to provide psychiatric healthcare across the lifespan but are considered generalists until provided experience and training in specialty areas. Psychiatric nurse practitioners specializing in geriatric psychiatry do not currently have any additional academic institution driven training, but become specialists through mentorship from geriatric psychiatrists, nurse practitioners, or physician assistants within depth knowledge in geriatric mental healthcare. They also engage with continuing medical education, professional organization involvement, and gain clinical experience at bedside and in advanced practice nursing. Some advanced practice psychiatric nurses come into geriatric psychiatry practice from a calling and passion for this population, while others find their career gravitates towards this population as a response to a call from the community in need of care. There is desire and need for increased standardized educational opportunities for advanced practice nurses who are passionate about caring for the mental health needs of older people, and a hope that geriatric psychiatrists may offer assistance and guidance with the interprofessional united goal to improve access to quality care to our geriatric patients.

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

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

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

A survey of Australian psychiatrists' and psychiatry trainees' knowledge of and attitudes towards psychedelics in the treatment of psychiatric disorders.

To assess Australian psychiatrists' and psychiatry trainees' knowledge of and attitudes towards psychedelics as treatment for psychiatric disorders. Australian members of the Royal Australian and New Zealand College of Psychiatrists were invited to participate in an anonymous survey that ran from October 1 to November 30 2021. Participants were asked about their knowledge of the risks and benefits of, and attitudes towards, psychedelics, including the factors that influence those attitudes. Fifty-one doctors responded to the survey, and 38 completed all items. The majority were male, consultants and based primarily in New South Wales. Respondents reported awareness of the evidence demonstrating the benefits of psychedelics for most disorders; however most respondents, particularly females, perceived psychedelics as risky. Most considered themselves open-minded and believed psychedelics deserved further research. The poor response rate was a major limitation of this study. Our sample of Australian psychiatrists and trainees were enthusiastic about psychedelics as psychiatric treatment and were aware of some of the evidence demonstrating their efficacy. Safety continues to be a concern, despite growing evidence of their safety in therapeutic settings. Education about the evidence of their efficacy and the risks associated with their use is needed.

Prevalence of Violent Victimization and Associated Factors among Psychiatric Outpatients

Background: Victimizations, coupled with the existing political and socioeconomic instability in East Africa, poses unbearable burden on people with mental illness. Methods: Six hundred twenty nine psychiatric patients were interviewed by trained psychiatry clinicians consecutively to study prevalence, and associated factors of victimization by using interviewer administered standard international crime victim survey questions. Analysis was done by using SPSS version 20. Adjusted odds ratio with 95% confidence interval and p-value =<0.05 were used to declare the statistical significance. Results: Lifetime and past year prevalence of victimization were 57.4% and 27.4% respectively. Majority of men were perpetrated by Strangers and acquaintances where as majority of women by near family members. In Binary Logistic Regression analysis: factors such as being female; history of psychiatric admission, suicidal attempt, previously cigarette smoking, khat chewing; criminal history and violent perpetration had significant association with victimization. Conclusion: The study identified high prevalence of victimization on people with mental illness which is potential for the formation of stress strain reaction as well as violation of legal rights of that population. Cooperation between law enforcers and mental health clinicians is needed.

When the illness speaks

SUMMARYThe nature of culpability and agency in patients with a variety of psychiatric diagnoses is complex. In this article, a psychiatry resident (specialty trainee in psychiatry) reflects on a clinical encounter in medical school to demonstrate some of the benefits (including the removal of stigma) and dangers (including the threat to patients’ agency) of using the medical model to conceptualise psychiatric illness.

Evaluating workforce needs for higher specialist training for psychiatry of intellectual disability in Kent, Surrey and Sussex: a workforce scoping service evaluation

PurposeWhilst recruitment and retention of high-quality staff is vital to providing a good service, at the time of the evaluations, Kent, Surrey and Sussex (KSS) was the only area of the UK without a Higher Specialist Training (HST) scheme in intellectual disability (ID). The purpose of this project was to identify barriers to recruitment and support the need for change.Design/methodology/approachThis evaluation included conducting interviews with 16 practitioners in the region with links to ID to consider the gaps in training and find solutions.FindingsFour themes were identified, namely, good experiences are important to recruiting people into the ID field; bad experiences or lack of exposure to people with ID are likely to prevent engagement with this field; there is an ongoing need for specialist psychiatrists in ID services; and there is a developing need for specialists in neurodevelopmental disorders. Finally, the challenge means we need to think differently about developing a workforce. Seven recommendations to support workforce delivery in KSS were developed.Originality/valueThis paper highlights an important rationale for ongoing need for HST in ID work and also reasons to engage people in this field. This has not been undertaken in the ID field in this way previously.

Using social network analysis approach in developing rural psychiatrist workforce

This study examines how rural and remote junior doctors career decisions are influenced by highly connected principles within a discipline. Social network analysis was completed with data collected, by structured interview, with five psychiatry trainees and three early career psychiatrists in a rural location rated MM3 using the Modified Monash Model. UNICET software was used to determine the interactions between individual networks to look for overlap and common influencers. A single central, highly connected, psychiatrist was found at the core of the entire social network. This connector was instrumental in recruitment and retention in rural psychiatry workforce. Improving the understanding of human capital can encourage innovative solutions in developing sustainable strategies for recruiting and retaining rural psychiatry workforces.

Mental illness stigmatization factors: Survey among caregivers in Mahajanga Madagascar

Introduction: Psychiatric patients' stigmatization is a major public health problem. The objective of this survey is to determine the factors reinforcing the stigmatizing behaviors of nursing staff towards psychiatric patients. Methods: This study is descriptive, cross-sectional and prospective analytic conducted in the Emergency Departments of the both Mahajanga University Hospitals and the CSB of the District of Mahajanga I from November to December 2021. Results: Toxic causes of mental illness were the most mentioned by caregivers (91.4%) followed by environmental causes (74.29%), neurobiological and genetic causes (74.29%) and supernatural causes (17.1%). Thirty-four point three percent of staff believed that mental disorders are not curable. In 73.08% of cases, the staff referred the patient directly. In our study, both groups of staff had high social distance scores with averages of 22.58 for physicians and 23.15 for nurses. High scores were found in 87.5% of cases for physicians and in 89.1% of cases for nurses. There was an association between social distancing and the following stereotypes as perceived by staff: craziness (p=0.002), dangerousness (p=0.031). The decision to treat or refer patients depends mostly on the acquisition of additional Training in Psychiatry (p=0.000). The Training improved skills to take care of the patients. Conclusion: Anti-stigma actions must be carried out in Mahajanga, particularly among healthcare staff, to improve the quality of life of patients.

Commentary on alignment of medical student assessment and vocational training in psychiatry and addiction medicine.

To comment upon the potential for alignment of medical student assessment and vocational specialist training through the RANZCP-CanMEDS model of Entrustable Professional Activities (EPAs) and Workplace-Based Assessments (WBAs). We discuss a specific post hoc example of such an alignment in an Australian graduate medical school in Psychiatry and Addiction Medicine. Vocational training models of assessment, such as the RANZCP specialist training program for psychiatrists, can potentially be mapped to medical student education in formative and summative assessment through CanMEDs-based EPAs and WBAs, to assist in transition to specialist training.

Addiction experts: The discrepancy between expectations and reality of generalist psychiatry training.

The generalist psychiatrist is recognised in Australia as a specialist in the management of addiction. However, generalist training does not adequately prepare psychiatrists to take on this expert role. This problem is exacerbated by the lack of consensus around core competencies and training pathways. This article conceptualises the status of addiction training in generalist psychiatry training, outlines current gaps and worrying trends and provides suggestions for how these can be addressed. Limited international leadership in the field provides an opportunity for psychiatry training in Australia and New Zealand to set a gold standard for training general psychiatrists to hold core competencies in addiction psychiatry. Key strategies will include: the identification and monitoring of addiction rotations; providing a formal training module in addiction; specifying a set proportion of addiction exam questions; and obtain consensus on core competencies.

Autolesiones y conducta suicida en niños y adolescentes. Lo que la pandemia nos ha desvelado

IntroductionSuicidal behavior and self-harm are increasing in children and adolescents. Non-suicidal self-harm are a dysfunctional method of emotional regulation, and it must be distinguished from suicidal behaviors. MethodsNarrative review of the current situation on suicide and self-harm in Spain. Descriptive study of suicidal behaviors in pediatric emergencies. ResultsMental health consultations were analyzed (March-2019 to March-2020 and March-2020 to March-2021) in a multicentric study of the Spanish Society of Pediatric Emergencies (SEUP), finding a 122% increase of the diagnosis of «non-accidental drug intoxication» and 56% of «suicide/suicide attempt/suicidal ideation». In another prospective analysis, 281 attempts were recorded, with the patient profile being: female (90.1%), 14.8 years old, 34.9% without previous psychiatric diagnosis; 57.7% with previous suicidal behavior. The presence of psychiatric disorders, especially depression, and previous attempts, are the best-known risk factors for suicidal behavior, although other factors are involved (family, personal or social). Pediatricians should be trained to deal with questions about suicide and acquire the skills to conduct an interview with a supportive and empathetic attitude. In Spain, suicide prevention plans are heterogeneous among communities, and there is not a unified national suicide prevention plan. ConclusionsPrimary, hospital and mental health care resources for pediatric population should be strengthened to prevent suicidal behaviors. Specific training for school staff, and child and adolescent psychiatry training for pediatricians and nurses are crucial in the prevention of suicide in children and adolescent population.