Psychiatric Residency Training Research Articles

Forensic Psychiatry Education in Child and Adolescent Psychiatry (CAP) Fellowship: Results from a Multi-site Survey.

This study examined the current state of forensic education among child and adolescent psychiatry (CAP) fellowship programs, regarding specific forensic topics, teaching resources, methods, and experiences. The authors aimed to gather and analyze this data to assess the need for additional standardization of forensic psychiatry education in CAP fellowship, such as broader access to resources, and/or inform the development of a standardized curriculum, including milestones, in child and adolescent forensic psychiatry. The authors collaboratively developed a survey instrument on child and adolescent forensic psychiatry education, which was then sent to 135 accredited CAP fellowship programs. The items included in the survey instrument were designed based on literature review, expert consensus, and a 1992 American Association of Directors of Psychiatric Residency Training survey on teaching ethics and forensic psychiatry. Completed response data was returned by 25 of the 135 programs surveyed. Complete responses came primarily from academic institutions (52% public, 36% private) with small- or medium-sized programs (1-12 total fellows, 88%; 11-29 faculty members, 56%). Programs reported on CAP forensic rotation sites, faculty members' level of expertise and involvement in forensic CAP, common forensic topics and experiences offered, and programs' attitudes towards specific topics and experiences. Child and adolescent psychiatrists must gain a clear understanding of the essential components of CAP forensic psychiatry during CAP fellowship, to mitigate discomfort when interacting with the legal system and meet the rising need for forensic CAP expertise across systems and structures impacting youth populations.

Reclaiming the 'person' and advocacy for good clinical care in psychiatric residency training through medical humanities.

Reclaiming the 'person' and advocacy for good clinical care in psychiatric residency training through medical humanities.

Depression among psychiatrists and psychiatry trainees and its associated factors regarding work, social support, and loneliness

BackgroundThis study aimed to survey the prevalence of depression and its associated factors among psychiatrists and psychiatry trainees (physicians in psychiatric residency training).MethodsThis cross-sectional study surveyed Thai psychiatrists and psychiatry trainees from January to February 2023 using an online questionnaire. The questionnaires consisted of (1) the demographic and work-related information; (2) perceptions towards social support and work; (3) the Patient Health Questionnaire-9 (PHQ-9) Thai version; and (4) the 6-item Revised UCLA Loneliness Scale Thai version. All data were analyzed using descriptive statistics, and the associated factors concerning depression were analyzed via multiple linear regression analyses.ResultsOf the 225 total participants, 52(23.1%) and 173 (76.9%) were psychiatry trainees and psychiatrists, respectively. Most of them were female (64.9%) with overall median age (interquatile) was 34 (30, 42) years. Regarding the PHQ-9 findings, the prevalence of depression among all participants was 12.4% (psychiatrists 13.9% and psychiatry trainees 7.7%). From regression analyses, depression was associated with loneliness and perceived levels of work satisfaction and work stress in psychiatrists, while in psychiatry trainees, depression was associated with loneliness and perceived level of ability to control work schedule.ConclusionsOne-tenth of psychiatrists and psychiatry trainees had depression. Although the prevalence of depression in this study was not extremely high, key contributing factors related to depression, such as loneliness, work satisfaction, work stress, and ability to control the work schedule should be required to action to reduce the depression rate among mental health personnel.

Clinical Care of Patients with Neurocognitive Disorders: A Qualitative Study of the Psychiatric Residency Training Experience.

Few data describe how general psychiatry residencies prepare trainees to care for individuals with neurocognitive disorders (NCDs), despite increasing recognition of the need for psychiatrists to provide care for the growing numbers of patients with NCD. This study aims to identify training needs and approaches, as the resident experience is one important perspective that can be added to others, such as milestones developed by expert educators. The authors conducted three focus groups of third- and fourth-year general adult psychiatry residency trainees from three different training programs in May and June of 2021. Focus groups consisted of three to eight unique participants per group. Qualitative data analysis techniques derived in grounded theory were utilized to identify themes. Four main themes emerged from the focus groups: unique challenges of NCD care, intrinsic rewards of working with families, perceived gaps in educational experiences, and limited comfort in future practice. Participants expressed that aspects of NCD care were fundamentally different than care for other mental health conditions encountered in psychiatry residency. They found the progressive nature of the disease to be particularly challenging, and they also expressed challenges with clinical interviews and establishing rapport with individuals with NCDs. However, working with families was especially rewarding. Regardless of training program, participants expressed a need for additional longitudinal and diversified training opportunities to prepare them for future practice in this area.

Incorporating LGBT+ mental health into psychiatric residency and training: perspectives from the Philippines.

The Philippine Mental Health Act upholds the rights and inclusivity of all people, regardless of gender and sexual orientation, within mental health services and programmes. Nevertheless, a noteworthy challenge lies in the inadequate attention given to the needs of LGBT+ individuals within the medical and health professions education in the country. Therefore, it is imperative to integrate LGBT+ mental health into psychiatric residency training. To address this gap, this paper proposes the inclusion of concepts relevant to LGBT+ mental health, including minority stress, intersectionality, identity concealment and LGBT+-affirming practices, to enhance the understanding and response to the needs of LGBT+ Filipinos.

Evidence-Based Practices: An Opportunity to Enhance Psychiatric Residency Training

Staring back at me through the Zoom interface was a small, thin-faced boy, too nervous and overwhelmed to tell me anything more than his own name and the name of his dog: Cooper. This was the first child therapy case I was assigned as a resident trainee. He was a young adolescent with acute lymphoblastic leukemia. Two years ago, he was outgoing, playful, and sociable. Now he apprehensively stared at me, underweight and highly anxious. He was experiencing medical trauma through countless hospital admissions for chemotherapy and opportunistic infections during the ongoing global pandemic. At the time he was transferred to my care, he carried multiple psychiatric diagnoses, including generalized anxiety disorder, major depressive disorder, and posttraumatic stress disorder. I had no idea where to begin. Though I was in my third year of Triple Board training, which includes adult psychiatry, pediatrics, and child psychiatry fellowship, I felt unprepared. My education and exposure to psychotherapy had been somewhat limited; but even still, I knew that learning effective, evidence-based therapeutic skills would not be straightforward.

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

Psychotherapeutic medicine in psychiatric residency training in Austria

ZusammenfassungDie vorliegende Arbeit beschreibt die Entwicklung der psychotherapeutischen Medizin innerhalb der ärztlich-psychiatrischen Fachärzt:innen-Ausbildung. Die Grundlage für die Kompetenzdarstellung bilden die einzelnen Rasterzeugnisse der Ausbildungsordnungen 1994, 2006, 2011 sowie 2015. Die Entwicklung der psychotherapeutischen Kompetenzen innerhalb der ärztlich-psychiatrischen Identität wird anhand des Qualifikations- und Kompetenzprofils sowie der Lernziele dargestellt.

CMS Extends Virtual Supervision of Residents to End of Year

CMS Extends Virtual Supervision of Residents to End of Year

Teaching Psychotherapy to Psychiatric/Mental Health Nurse Practitioner Students in the Virtual Classroom

The aim of this quality improvement project was to evaluate student satisfaction and achievement of select core competencies in psychotherapy by Psychiatric Mental Health Nurse Practitioner (PMHNP) students enrolled in a newly developed, and virtually delivered psychotherapy course. Both qualitative and quantitative data were collected to assess students’ competencies in five domains (i.e. professionalism, cultural diversity, ethical/legal standards of care, reflective practices, and application of knowledge and skills) and satisfaction with content and delivery using simulation and virtual sessions. Using pre- and post-training surveys, we found that competencies in the five domains increased from an average score of 3.1 to 4.5. Integrating a virtual psychotherapy course in advanced nursing education, bringing PMHNP students together to learn about interviewing clients, applying various psychotherapeutic modalities and techniques across diverse cultures, and maintaining ethical and legal standards of care is a challenging but achievable endeavor. We found that using a version of an APA self-assessment tool that was used in psychiatric residency training programs was an effective way to assess PMHNP students’ knowledge, skills, and attitudes on these core competencies. Although this training course proved to be effective in imparting appropriate skills, there is a need to develop sophisticated methods to evaluate how students use complex psychotherapy skills in the clinical setting.

APA Foundation welcomes its largest class of fellows

The American Psychiatric Association Foundation (APA Foundation) proudly welcomed 116 future psychiatric leaders into the 2023 class of fellows, marking the largest class in its program history, according to an APA news release. The APA Foundation Resident Fellowship Program complements psychiatric residency training by providing experiential learning, mentorships, and professional development opportunities. Twenty‐seven U.S. states and 80 medical institutions are represented in this class. The 2023 class is also the most diverse in the fellowship's history, with over 77% of participants self‐identifying as people of color, 61% as women, and 24% as LGBTQ+. “We couldn't be more excited to add this impressive class into our community of fellows and fellowship alumni at this critical time in mental health care,” said APA Foundation Executive Director Rawle Andrews, Jr., Esq. “This cohort has already proven themselves to be a valuable source of talent and innovation. The future of psychiatry is in good hands.” Each fellow is assigned to one of nine different fellowships, encompassing topics from child and adolescent psychiatry to psychiatric research and public psychiatry. They will join 61 second‐year fellows for a total of 176. “We are looking forward to working with and training these future leaders of our field,” said Vedrana Hodzic, APA Foundation's director of fellowships, mentorship, and medical education, who oversaw the recruitment of this year's class.

Spirituality and Religion in Canadian Psychiatric Residency Training: Follow-up Survey of Canadian Psychiatry Residency Programs.

This study assesses the availability and nature of psychiatry resident training in religion and spirituality across Canada. Evidence shows that religious and spiritual topics are important to psychiatric patients and that psychiatrist competence in approaching these topics is correlated to whether they have had previous training in them. Prior studies have shown a lack of training in religion and spirituality in Canadian psychiatry programs and recommended incorporation into psychiatry residency curricula. A survey was conducted, asking questions about the amount and type of training in religion and spirituality that was accessible to psychiatry residents in the 17 psychiatry residency programs in Canada. One response was sought from each institution by reaching out to the institutions' program directors and requesting that a knowledgeable faculty member complete the survey. Out of 14 responding psychiatric residency programs, 2 reported no training opportunities in religion or spirituality, 4 reported only voluntary training opportunities that were largely resident directed, and 8 reported mandatory training. The number of Canadian psychiatry residency programs providing mandatory training in religion and spirituality has increased since the prior published survey in 2003 and there are fewer programs reporting no training at all. However, overall, Canadian psychiatry institutions still place less emphasis on religious/spiritual education than recommended by the international psychiatric community. Several Canadian institutions report well-received implementation of curricula on religion and spirituality that could inform other Canadian institutions.

Differences In Antipsychotic Prescriptions In Relationship To Physician Demographics And In-patient Setting At An Inner-city hospital – A Prospective Cohort Study

IntroductionAntipsychotics are medications with an array of FDA approved indications in the field of psychiatry including Schizophrenia, Bipolar Mania, Bipolar Depression, Maintenance treatment for Bipolar Disorder, Schizoaffective Disorder, as well as an Adjunct treatment in Unipolar Depression and Tic disorders, among other indications for non-adult patients. Antipsychotics are widely used in psychiatric inpatient units throughout the United States, and globally. We observed trends of antipsychotic use in 3 different adult inpatient units with the same patient demographics located within one inner city hospital in the Bronx over a period of 4 months. We correlated the choice of antipsychotic to the prescribing physician’s period of training/date of graduation from psychiatry residency and reported the results.ObjectivesIdentify the choice of antipsychotics used by different psychiatrists.Correlate the dates of each psychiatrists residency training to the antipsychotics they chose.Identify whether the psychiatry residency training accuried in different decades has influenced psychiatrics to pick certain antipsychotics.MethodsWe obtained the dates of psychiatric residency training for each of 3 psychiatrists (Physicians 1, 2 and 3) assigned to one of 3 different inpatient psychiatric units which share the same patient demographics in an inner-city hospital in the Bronx. We obtained a record of total psychiatric inpatient hospitalizations from February 10th 2022 to June 10th 2022 in all 3 psychiatric inpatient units. The principal diagnoses for the total hospitalizations (300 patients) were reviewed and patients with diagnoses that do not have FDA approval for antipsychotic use were excluded. Among the remaining patients (267) we compared antipsychotic prescription trends and grouped patients according to antipsychotic of choice. We then correlated the antipsychotic of choice groups to one of three units/prescribing physician and the years of psychiatry residency training. The trends for antipsychotic of choice were compared to training dates and presented in a table.ResultsPhysician 1 who trained from 1980 to 1984 prescribed: 87% HALDOL and 13 % Chlorpromazine. Physician 2 who trained from 1992 to 1996 prescribed: 91 % PALIPERIDONE and 9% Risperidone. Physician 3 who trained from 2003 to 2007 prescribed: 60 % ABILIFY and 40% Olanzapine.ConclusionsThe physician with the earliest graduation date used mainly HALDOL, a first-generation antipsychotic, to treat disorders with FDA approval for antipsychotic use. The physician with the most recent graduation date, used mainly ARIPIPRAZOLE, a third-generation antipsychotic, to treat disorder with FDA approval for their use. The physician with a graduation date between them, used mainly (PALIPERIDONE), a second-generation antipsychotic to treat the disorders.Disclosure of InterestNone Declared

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

(185) Small Group Supervision in Psychiatric Residency Training: A National Survey to Determine Prevalence, Barriers and Feasibility

(185) Small Group Supervision in Psychiatric Residency Training: A National Survey to Determine Prevalence, Barriers and Feasibility

AADPRT Recommends Virtual Interviewing For 2022-2023 Recruitment Year

AADPRT Recommends Virtual Interviewing For 2022-2023 Recruitment Year

Translation, validity and reliability of decision style scale in forensic psychiatric setting in Indonesia

ObjectiveClinical reasoning as an essential skill for psychiatrists, especially in forensic psychiatry, relies on their thinking and decision-making skills. However, not all psychiatrists are aware of their decision-making styles. This study examines the validity and reliability of the Indonesian translation of the Decision Style Scale (DSS) instrument among general psychiatrists in the Indonesian forensic psychiatry setting. MethodThis is a cross-sectional study involving 32 general psychiatrists from all nine psychiatric residency training centers in Indonesia. The study was conducted between August 2020 and February 2021. The translation process involved certified independent translators. The validity was tested using Item-Level Content Validity Index (I-CVI), Scale-Level Level Content Validity Index (S-CVI), and item-total correlation. Internal consistency reliability was measured using Cronbach's alpha. ResultsAfter translation, the instrument was sent back and received feedback from the original authors of DSS. The final version of DSS was valid with an I-CVI score of 0.84–1 and an S-CVI score of 0.99. All but one item had a corrected item-total correlation of more than 0.30. The reliability test of DSS also showed acceptable results with Cronbach's alpha values of 0.43–0.83, and an overall internal consistency score of 0.83 and 0.62 for intuitive and rational scales, respectively. ConclusionDSS serves as a valid, reliable, and readily-available tool to measure psychiatrists' decision-making styles in forensic psychiatry settings. Enhancing psychiatrists’ awareness of their decision-making styles may help in mitigating the risk of bias in forensic psychiatry evaluations.

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.