Acad Psychiatry current issue

[EDITORIALS] Improving the "Impact" of Academic Psychiatry

Coverdale, J. H., Weiss Roberts, L., Balon, R., Louie, A. K., Beresin, E. V. — 2008-05-08

[COMMENTARIES] End of Third-Year Objective Structured Clinical Examination: Boon or Bane?

Ramchandani, D. — 2008-05-08

[COMMENTARIES] Psychiatry Clerkship Objective Structured Clinical Examination is Here to Stay

Vaidya, N. A. — 2008-05-08

[COMMENTARIES] Assessing the Quality of Residency Applicants in Psychiatry

Lehrmann, J. A., Walaszek, A. — 2008-05-08

[RESEARCH ARTICLES] Practical Strategies for Becoming a Successful Medical Book Author

2008-05-08

OBJECTIVE: The authors, all senior editors in the Books Division of American Psychiatric Publishing, Inc., provide practical advice to authors who may be considering writing or editing a medical book. METHODS: The authors summarize strategies for developing a book proposal and outline an approach to developing a focus for a book. They also list a number of common errors that authors frequently make when they develop a book proposal. The authors provide guidance on publishing research and discuss how authors can collaborate with a publisher’s marketing department to publicize their book. RESULTS: By employing a systematic and well-considered approach to preparing a book proposal and writing or editing a book, authors may achieve professional success and personal satisfaction. CONCLUSION: Writing or editing a medical book requires a different series of steps than authoring a journal article.

[RESEARCH ARTICLES] Effects of LifeSkills Training on Medical Students' Performance in Dealing with Complex Clinical Cases

2008-05-08

OBJECTIVE: Sound clinical judgment is the cornerstone of medical practice and begins early during medical education. The authors consider the effect of personality characteristics (hostility, anger, cynicism) on clinical judgment and whether a brief intervention can affect this process. METHODS: Two sophomore medical classes (experimental, comparison) were assessed on several personality dimensions and responded to a series of clinical vignettes. The experimental group received cognitive behavior training to improve stress, coping, and interpersonal skills. Participants were reassessed within 1 week of the initial assessment. RESULTS: Significant associations between hostility and cynicism and maladaptive responses to the clinical vignettes were noted. Following the intervention, hostility, cynicism, anger, and aggression were significantly reduced, with concomitant reductions in maladaptive decision-making. CONCLUSION: The relationship between the quality of clinical decision-making and personality characteristics was confirmed. The potential to modify this relationship using a brief cognitive behavior intervention suggests that such interventions should be an essential component of medical education.

[RESEARCH ARTICLES] What Troubles Clerks in Psychiatry? A Strategy to Explore the Question

Pessar, L. F., Pristach, C. A., Leonard, K. E. — 2008-05-08

OBJECTIVE: The psychiatric clerkship is a stressful experience that influences attitudes toward patients with psychiatric illnesses and influences recruitment into the field. This study focused on medical students’ encounters with patients they found troubling or difficult, and whether specific themes regarding their emotional responses could be identified. METHODS: Third-year medical students rotating through the psychiatry clerkship participated in a problem patient conference for which they were required to submit a form detailing a troubling encounter that occurred with a patient in the prior week. During the conferences, students discussed these encounters and their responses to them. The encounters were later reviewed and grouped into a set of four themes. Comparisons were made between male and female students, and response to patients at the start and finish of the clerkship. RESULTS: For both male and female students the most common reaction of a problematic encounter was frustration/helplessness, followed by having a strong negative reaction, then identification with patients evoking a disturbing response, and finally feelings of intimidation and fear. There were no gender differences for any of the four categories. The proportion of encounters classified as intimidating/frightening significantly declined from the first half to the second half of the rotation. CONCLUSION: The problem patient conference is an effective tool to elicit candid concerns regarding the care of psychiatric patients and is an opportunity to empathically address struggles specific to the psychiatric clerkship.

[RESEARCH ARTICLES] Do Clinical Evaluations in a Psychiatry Clerkship Favor Students With Positive Personality Characteristics?

Chibnall, J. T., Blaskiewicz, R. J. — 2008-05-08

OBJECTIVE: The authors examine associations of personality characteristics, National Board of Medical Examiners subject examination performance, and Objective Structured Clinical Examination performance with clinical evaluations of third-year medical students in a psychiatry clerkship. METHODS: Students completed the Revised NEO Personality Inventory, which measures personality domains of neuroticism, extraversion, openness, agreeableness, and conscientiousness and associated personality traits. At clerkship completion, students completed the National Board of Medical Examiners subject examination and a psychiatry Objective Structured Clinical Examination, and were evaluated by attending physicians (using a standardized evaluation form) regarding their clinical "knowledge and skill" and "interpersonal behavior." Data were analyzed using Pearson correlation and canonical correlation. RESULTS: National Board of Medical Examiners subject examination and Objective Structured Clinical Examination scores were uncorrelated with clinical evaluations of "knowledge and skill" and "interpersonal behavior." Personality variables explained a moderate amount of variance in clinical evaluations. "Knowledge and skill" was positively associated with the domain of conscientiousness, the extraversion trait of warmth, and the conscientiousness traits of competence and achievement striving. "Interpersonal behavior" was negatively associated with the neuroticism trait of angry hostility and positively associated with the domain of agreeableness; the extraversion traits of warmth, gregariousness, and positive emotions; and the agreeableness traits of trust, altruism, compliance, and tender-mindedness. CONCLUSION: Clinical evaluations of medical students may favor personality styles that reflect positive elements of extraversion, agreeableness, and conscientiousness. The present findings raise questions regarding the validity of clinical evaluation elements in clerkship performance appraisal.

[RESEARCH ARTICLES] Divergent Fates of the Medical Humanities in Psychiatry and Internal Medicine: Should Psychiatry be Rehumanized?

Rutherford, B. R., Hellerstein, D. J. — 2008-05-08

OBJECTIVE: To determine the degree to which the medical humanities have been integrated into the fields of internal medicine and psychiatry, the authors assessed the presence of medical humanities articles in selected psychiatry and internal medicine journals from 1950 to 2000. METHODS: The journals searched were the three highest-ranking psychiatry and internal medicine journals on the Institute for Scientific Information’s Impact Factor rankings that were published in English and aimed at a clinical audience. Operationalized criteria defining the medical humanities allowed the percentage of text in the selected journals constituting medical humanities to be quantified. Journals were hand searched at 10-year intervals from 1950 to 2000. Mixed effects models were used to describe the change in medical humanities over time. RESULTS: The percentage of text within psychiatry journals meeting the criteria for medical humanities declined from a peak of 17% in 1970 to a low of 2% in 2000, while the percentage of humanities articles in internal medicine journals roughly doubled from 5% to 11% over the same time period. A linear model increasing over time best fit the medical humanities in the internal medicine journals, while a cubic model decreasing over time best fit the psychiatry humanities data. Humanities articles in medical journals had a greater breadth and diversity than those in psychiatry journals. CONCLUSION: Medical humanities publications dramatically decreased over time in psychiatry journals while they more than doubled in internal medicine journals. These data suggest the need for further empirical research and discussion of the potential roles of the humanities in psychiatry.

[RESEARCH ARTICLES] Psychiatric Resident and Attending Diagnostic and Prescribing Practices

Tripp, A. C., Schwartz, T. L. — 2008-05-08

OBJECTIVE: This study investigates whether two patient population groups, under resident or attending treatment, are equivalent or different in the distribution of patient characteristics, diagnoses, or pharmacotherapy. METHODS: Demographic data, psychiatric diagnoses, and pharmacotherapy data were collected for 100 random patient charts of psychiatric residents, and were then compared with 100 random patient charts of attending psychiatrists. RESULTS: Student’s t test and chi square analysis suggested no statistically significant differences in the average number of comorbid Axis I diagnoses, percentages of patients with Axis II diagnoses, or major differences in the specific percentages of the 10 most common Axis I diagnoses. Furthermore, there were no statistically significant differences in the average number of psychiatric medications prescribed for pharmacological management of mental illness, or ratios of specific drug classes utilized. CONCLUSION: There seems to be no major differences in patient characteristics or in the treatment techniques that were utilized.

[RESEARCH ARTICLES] "Attitude is a Little Thing That Makes a Big Difference": Reflection Techniques for Addiction Psychiatry Training

Ballon, B. C., Skinner, W. — 2008-05-08

OBJECTIVE: The authors aim to incorporate educational reflection techniques in an addiction psychiatry postgraduate core rotation in order to increase critical self-awareness of attitudes, values, and beliefs related to working with people with substance use and other addictive disorders. METHODS: Reflection discussion times, reflection journaling, and mandatory end-of-rotation reflection papers were embedded into a core addiction psychiatry postgraduate training block. Qualitative analysis of 28 reflection papers was performed to determine key factors and constructs that impacted on the development of attitudes and professionalism. RESULTS: A number of constructs emerged that demonstrated the attitudes, beliefs, stereotypes, and stigmas students have regarding addictive disorders. Some constructs also highlighted that students felt much more comfortable dealing with addictive disorders after the training and would treat individuals with these conditions in a more effective manner. CONCLUSION: Reflection techniques were endorsed as extremely valuable by students, especially in the development of professional attitudes that will help clinicians effectively engage and provide appropriate care for individuals suffering from addictive disorders. The authors suggest that reflective practices be used more extensively in psychiatric training in order to build and establish reflexive self-awareness as a core professional competence essential to work effectively in clinical practice, especially in the most demanding contexts.

[RESEARCH ARTICLES] Poor Intentions or Poor Attention: Misrepresentation by Applicants to Psychiatry Residency

Caplan, J. P., Borus, J. F., Chang, G., Greenberg, W. E. — 2008-05-08

OBJECTIVE: This study examines the veracity of self-reported data by applicants to psychiatry residency. METHODS: The authors reviewed the reported publications of all applicants to a psychiatry residency training program over a 2-year span. RESULTS: Nine percent of applicants reporting publications were found to have misrepresented them. International medical graduates were found to be more likely to have misrepresented their publications than U.S. medical graduates. CONCLUSION: A small but significant number of applicants to psychiatry residency training misrepresent their publications. Identification of misrepresentation may provide valuable information about the applicant and their future performance in training and practice.

[RESEARCH ARTICLES] Peer Group Mentoring of Junior Faculty

Moss, J., Teshima, J., Leszcz, M. — 2008-05-08

OBJECTIVE: The purpose of this article is to document and evaluate the initiation of a mentoring model for junior faculty utilizing a peer group approach rather than the traditional dyadic model. METHODS: Junior faculty members in an academic department of psychiatry at Sunnybrook Hospital, University of Toronto, were invited to take part in a peer mentoring program involving evening meetings every 2 months over a 1-year period from 2004–2005. Of the 12 invitees, 10 agreed to participate in the program. The group participants developed the program agenda collectively. Learning objectives as well as a list of topics of interest were established at the inaugural meeting. A focus group was held at the end of 12 months to provide a descriptive, qualitative evaluation. The focus group leader prepared a report based on observations and notes taken during the focus group. RESULTS: The report prepared by the focus group leader identified six main themes that included: program development, knowledge gains, interpersonal gains, psychological/emotional gains, process of the program, and future directions. The overall response was clearly favorable with a unanimous decision to maintain the group and continue meeting into the next year. CONCLUSION: A peer group mentoring format for junior faculty in an academic department of psychiatry can be an effective model of mentoring.

[RESEARCH ARTICLES] Growing Our Own: A Regional Approach to Encourage Psychiatric Residents to Enter Research

2008-05-08

OBJECTIVE: This article describes a regional program developed by the Department of Veterans Affairs South Central Mental Illness Research, Education and Clinical Center for training psychiatry residents in research and attracting them to academic careers. METHODS: The authors describe a low-cost, innovative program developed to increase the number of psychiatry residents entering postresidency research training fellowships by providing them with mentorship and exposure to seasoned researchers, didactic coursework, and a stipend to cover academic expenses. RESULTS: Over the first 4 years, the program has generated enthusiastic participation among postgraduate year 3 (PGY-3) residents, with a high percentage of underrepresented ethnic minorities and women. Products include publication of four first-authored and two coauthored manuscripts, one first-authored abstract, submission of six additional papers, 28 academic presentations and development of research projects. Half of graduating awardees have gone on to pursue research careers. CONCLUSION: Our regional approach provides sufficient academic expertise to make residency training feasible in a cost-effective manner.

[SPECIAL ARTICLES] The ABPN Maintenance of Certification Program for Psychiatrists: Past History, Current Status, and Future Directions

2008-05-08

OBJECTIVE: To describe the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification Program, its underlying rationale, how it will be implemented now, and what it might look like in the future. METHODS: The authors describe the philosophical foundation, specific components, and the implementation timeline of the ABPN Maintenance of Certification Program; the development of specific products that might be used by ABPN diplomates to meet its requirements; and several unanswered questions about its current status and future development. RESULTS: The ABPN Maintenance of Certification Program consists of specific requirements pertaining to professional standing, self-assessment and lifelong learning, performance in practice, and cognitive expertise that will be implemented incrementally over the next decade. CONCLUSION: The ABPN Maintenance of Certification Program has been implemented in a manner that is as consistent as possible with its underlying philosophical beliefs as well as the current and expected public and political concerns, diplomate needs, and the requirements of organizations responsible for licensure, credentialing, privileging, accreditation, professional development, and physician reimbursement.

[SPECIAL ARTICLES] The Doctoring Curriculum at the University of California, Davis School of Medicine: Leadership and Participant Roles for Psychiatry Faculty

2008-05-08

OBJECTIVE: The authors describe in detail the 3-year model of the Doctoring curriculum plus an elective fourth-year Doctoring course at University of California, Davis School of Medicine (UCDSOM) and University of California, Los Angeles (UCLA) School of Medicine and the critical role for psychiatry faculty leadership and participation. METHODS: The authors present a review of curricular materials and course operations for the different Doctoring courses for first-, second-, third-, and fourth-year curriculum. The authors describe the role of psychiatry faculty in both leadership and in group facilitation. RESULTS: The Doctoring curriculum offers case-based, small-group learning that relies heavily on standardized patients to teach core content around doctor-patient communication, ethics, behavioral medicine, and counseling approaches. There are frequent psychosocial issues woven in to these encounters. Psychiatry faculty members and other mental health professionals are well-prepared by virtue of their training to lead small group discussions and facilitate the supportive elements of the small groups in medical education. CONCLUSION: The Doctoring curriculum is both a biopsychosocial educational endeavor and a high-visibility leadership opportunity for the Department of Psychiatry. Other medical schools and departments of psychiatry may wish to pursue similar roles in their didactic programs.

[BRIEF REPORTS] Teaching an Interdisciplinary Approach to the Treatment of Chronic Mental Illness: Challenges and Rewards

Steiner, J. L., Ponce, A. N., Styron, T., Aklin, E. E., Wexler, B. E. — 2008-05-08

OBJECTIVE: National policy makers and psychiatric educators have established the goals of teaching and promoting interdisciplinary care as high priorities. This article describes the implementation of an interprofessional seminar for which the dual aims were to provide a knowledge base for treating individuals with serious mental illness and to teach how to work collaboratively with other disciplines. METHOD: A seminar, the "Treatment of chronic or recurrent mental illness: recovery, rehabilitation and interdisciplinary collaboration," was developed in an academic community mental health center. Pre- and postseminar surveys were administered in order to test the hypothesis that the seminar would have a positive impact on trainees’ attitudes about working with the seriously mentally ill and within an interdisciplinary team. A combination of 5-point Likert scales and open-ended questions were used to gather the data. Paired samples t tests were conducted to test for significant differences between the pre- and postmeasures. RESULTS: The seminar participants included 24 students from psychiatry, nursing, social work, and psychology with a wide range of experience. Complete pre- and postseminar data were obtained from 14 participants. Although participants valued the seminar experience, they reported that the actual interdisciplinary work with the seriously mentally ill was less gratifying than expected. They described several advantages and challenges of care-oriented collaboration and shared learning. CONCLUSION: Bringing together a diverse group of graduate and postgraduate trainees to learn together and to learn about each other’s disciplines appeared to be a successful venture, but the authors were not able to detect a positive impact on their actual work life during the course of the year. Further development of strategies to inspire professionals to engage in and promote interdisciplinary care of the seriously mentally ill is needed.

[SPECIAL ARTICLES] Teaching the Teachers: A Model Course for Psychodynamic Psychotherapy Supervisors

Riess, H., Herman, J. B. — 2008-05-08

OBJECTIVE: There are no standard training programs for teaching psychotherapy supervisors effective, ethical, and legal aspects of supervision. This article describes an eight session training course containing essential information for supervisors. METHODS: The literature on psychotherapy supervision was reviewed and an evening seminar series was offered to veteran supervisor. The seminars were then translated into a course for faculty supervisors and trainees interested in becoming supervisors. RESULTS: Participants completed a postcourse survey and ranked as high the quality and content of the course and course satisfaction on Likert scales. Participants felt well prepared and reported increased confidence in going forward in their supervisory roles. CONCLUSION: While current Residency Review Committee guidelines do not define standards for competency in psychotherapy supervision, the authors suggest that a course containing these principles of psychodynamic psychotherapy supervision be a prerequisite for those supervising residents. New and veteran supervisors reported learning essential aspects of supervision unknown before their course enrollment.

[CORRECTION] CORRECTION

2008-05-08