Acad Psychiatry current issue

[EDITORIALS] Directors of Medical Student Education in Psychiatry and Recruitment Into Psychiatry: An Ethical Issue?

Morreale, M. K., Balon, R., Weiss Roberts, L. — 2009-07-02

[POSITION STATEMENT] ADMSEP Position Statement on Recruitment

2009-07-02

[COMMENTARIES] Training Psychiatrists in Nonpsychiatric Medicine: What Do Our Patients and Our Profession Need?

Wright, M. T. — 2009-07-02

[COMMENTARIES] Planning the Future Mental Health Workforce: With Progress on Coverage, What Role Will Psychiatrists Play?

Vernon, D. J., Salsberg, E., Erikson, C., Kirch, D. G. — 2009-07-02

[RESEARCH ARTICLES] Three Ds and Three More Ds

Bourgeois, J. A. — 2009-07-02

[RESEARCH ARTICLES] The Perceptions and Habits of Alcohol Consumption and Smoking Among Canadian Medical Students

2009-07-02

OBJECTIVE: The authors aim to quantify the extent, and to assess student perception, of alcohol and tobacco use among medical students at the University of Calgary, and the relationship of these attitudes to problem drinking (according to the CAGE questionnaire). METHODS: A questionnaire was distributed to first-, second-, and third-year medical students attending the University of Calgary medical school. RESULTS: Of the 327 students enrolled, 175 of students responded to the questionnaire. Six percent of the students currently smoke while 24% of students reported cigarette smoking at some point in their life. Eighty-six percent of students currently drink, with a majority drinking fewer than 11 drinks per week. Fifteen percent of students were at an increased risk for problem drinking according to the CAGE questionnaire. An increased risk for problem drinking was significantly related to believing more strongly that getting drunk is acceptable on occasion and less strongly that increased alcohol has many negative health consequences, as well as feeling less in control of alcohol consumption. CONCLUSION: Medical students at the University of Calgary consume less alcohol and cigarettes than a comparable population. However, a high proportion of students are at risk for alcohol abuse according to the CAGE questionnaire. The results of this study suggest that although the quantity of alcohol consumed is not a substantial concern at this time, students might be at risk for future alcohol abuse.

[RESEARCH ARTICLES] Balint-Style Case Discussion Groups in Psychiatric Training: An Evaluation

Graham, S., Gask, L., Swift, G., Evans, M. — 2009-07-02

OBJECTIVES: The authors aim to identify any benefits or limitations of psychiatric residents attending a Balint-style case discussion group, to explore those experiences, to study the process of the learning experience, and to identify potential educational implications. METHODS: Seventeen psychiatric residents and counselors completing two parallel case discussion groups at a U.K. psychotherapy service were given in-depth interviews about their experiences of this training. Interview transcripts were analyzed using qualitative methodology. RESULTS: The groups were anxiety provoking; most participants were able to progressively accommodate to and benefit from the psychological learning process, but some struggled to adapt. CONCLUSION: Basic psychological competency and the awareness of the self in relation to the patient can be fostered through attendance at a case discussion group. With some limitations, Balint groups continue to be a useful way of introducing young psychiatrists to psychological processes.

[RESEARCH ARTICLES] Student Experiences with Competency Domains During a Psychiatry Clerkship

West, D. A., Nierenberg, D. W. — 2009-07-02

OBJECTIVES: The authors reviewed medical student encounters during 3 years of a required psychiatry clerkship that were recorded on a web-based system of six broad competency domains (similar to ACGME-recommended domains). These were used to determine diagnoses of patients seen, clinical skills practiced, and experiences in interpersonal and communications skills, professionalism, practice-based learning and improvement, and system-based practice. The authors aim to understand how students are learning and growing in these domains and to modify the clerkship in an ongoing manner. METHODS: Data were collected from the Dartmouth Medical Encounter Documentation System (DMEDS) for all student encounters in required third-year psychiatry clerkships during academic years 2004–2007, in which students had intensive involvement in patient care. RESULTS: One hundred seventy three students reported a total of 4,676 patient encounters, averaging 27.2 encounters per student and 1.8 psychiatric diagnoses per patient. Students met "learning targets" for anxiety disorder, bipolar affective disorder, depression, personality disorder (borderline), posttraumatic stress disorder, psychosis, schizophrenia, and substance abuse (alcohol), but not for disorders more likely seen in outpatient settings. For the 10 counseling skills learning targets, students only met those for family issues. In the four "newer" competency domains, students reported struggling with issues in 0.3% to 12.6% of encounters. Students documented being challenged by professionalism issues most often and recorded examples of how these competencies played out for them during the clerkship. CONCLUSION: Use of a required web-based medical encounter reporting system for student-patient-faculty encounters during a psychiatry clerkship can be of significant value in assessing what students are seeing, doing, and learning on this required third-year experience. The results provide helpful current information to the clerkship director and data that help the director modify the clerkship on an ongoing basis to better meet students’ educational needs.

[INTERNATIONAL EDUCATION REPORT] The Effect of Clinical Clerkship on Students' Attitudes Toward Psychiatry in Karachi, Pakistan

Sajid, A., Khan, M. M., Shakir, M., Moazam-Zaman, R., Ali, A. — 2009-07-02

OBJECTIVE: Attitudes of medical students toward a specialty is strongly related to their future choice of specialty. In developing countries like Pakistan, where there is a shortage of psychiatrists, there is a need to assess the effect of exposure to psychiatry on medical students. METHODS: The authors conducted a survey of fourth-year medical students at Aga Khan University in Karachi, Pakistan. RESULTS: Psychiatry clerkship had an overall positive attitude toward psychiatric illness, patients, and psychiatrists, but no effect on students’ choice of psychiatry as a career. CONCLUSION: Psychiatry teaching needs to be made more relevant to the rest of the medical curricula. This may improve students’ interest and their future choice of psychiatry as an area of specialization.

[RESEARCH ARTICLES] Ensuring Research Competency in Psychiatric Residency Training

Roane, D. M., Inan, E., Haeri, S., Galynker, I. I. — 2009-07-02

OBJECTIVE: This article discusses the importance of research training in psychiatric residency programs and makes recommendations for enhancement. METHODS: The authors examine the literature detailing the shortage of psychiatrist-researchers and the limitations of research training during residency. The authors then describe the Psychiatrists Acquiring Research Training (PART) program at Beth Israel Medical Center that attempts to address this problem. Data collected on resident scholarly activity, including publications and presentations, is presented. RESULTS: Since its inception, all scholarly activities have increased under the PART program. The 89 residents, followed over 5 academic years, co-authored 32 publications, gave 56 presentations, and received prestigious honors such as NIMH fellowships and national research awards. CONCLUSION: Residents’ participation in research has been advanced through participation in PART. Ensuring research competency among all psychiatrists is crucial to providing the best science-based care; PART represents a cost-effective way to integrate research training with psychiatric residency. The authors also discuss opportunities and obstacles to developing research programs as part of psychiatric residency training.

[RESEARCH ARTICLES] Survival Flight

Cheng, J. E. — 2009-07-02

[RESEARCH ARTICLES] Integrating Statistical and Clinical Research Elements in Intervention-Related Grant Applications: Summary From an NIMH Workshop

2009-07-02

OBJECTIVE: The authors summarize points for consideration generated in a National Institute of Mental Health (NIMH) workshop convened to provide an opportunity for reviewers from different disciplines—specifically clinical researchers and statisticians—to discuss how their differing and complementary expertise can be well integrated in the review of intervention-related grant applications. METHODS: A 1-day workshop was convened in October, 2004. The workshop featured panel presentations on key topics followed by interactive discussion. This article summarizes the workshop and subsequent discussions, which centered on topics including weighting the statistics/data analysis elements of an application in the assessment of the application’s overall merit; the level of statistical sophistication appropriate to different stages of research and for different funding mechanisms; some key considerations in the design and analysis portions of applications; appropriate statistical methods for addressing essential questions posed by an application; and the role of the statistician in the application’s development, study conduct, and interpretation and dissemination of results. RESULTS: A number of key elements crucial to the construction and review of grant applications were identified. It was acknowledged that intervention-related studies unavoidably involve trade-offs. Reviewers are helped when applications acknowledge such trade-offs and provide good rationale for their choices. Clear linkage among the design, aims, hypotheses, and data analysis plan and avoidance of disconnections among these elements also strengthens applications. CONCLUSION: The authors identify multiple points to consider when constructing intervention-related grant applications. The points are presented here as questions and do not reflect institute policy or comprise a list of best practices, but rather represent points for consideration.

[RESEARCH ARTICLES] The Future of Psychiatry Will Become What They Behold

Fox, G. — 2009-07-02

[RESEARCH ARTICLES] Procedural Challenges in International Collaborative Research

Loo, K. K. — 2009-07-02

OBJECTIVE: Knowledge of the procedural requirements for international research is not widely disseminated to investigators involved in the administration of a federal grant with a foreign component. The purpose of this article is to highlight the major challenges in administrative, procedural, and equipment management aspects of grant implementation when federal funding is involved in international collaborative research. METHODS: The author describes the procedural requirements for international research from the time of priority score receipt to the implementation of the grant. RESULTS: There is tremendous promise for rewarding experiences in international research projects due to the collaboration, mutual learning, and cultural bridging that intrinsically occur. However, there are also inherent cross-national procedural requirements that can be demanding in time and effort for the investigator and other stakeholders of the grant. CONCLUSIONS: It is hoped that awareness of these difficulties and demystification of the process for future investigators can minimize the potential encumbrances in such international research.

[RESEARCH ARTICLES] An Institutional Postdoctoral Research Training Program: Predictors of Publication Rate and Federal Funding Success of Its Graduates

Ross, R. G., Greco-Sanders, L., Laudenslager, M., Reite, M. — 2009-07-02

OBJECTIVE: The National Institute of Mental Health funds institutional National Research Service Awards (NRSA) to provide postdoctoral research training. While peer-reviewed publications are the most common outcome measure utilized, there has been little discussion of how publications should be counted or what factors impact the long-term publication rates of trainees in these programs. METHODS: The authors reviewed current curricula vitae from 92 graduates of an institutional NRSA and from the faculty mentors of that program to assess publications through 2005. Publications were weighted based on peer versus non-peer-reviewed and authorship position. Trainee and mentor factors were assessed for their impact on publication rates and on becoming principal investigators of larger scale federal grants such as a National Institutes of Health (NIH) R01. RESULTS: Weighted publication scores correlate with total publication rates at such a high rate that the two scores can be used interchangeably. Forty-three percent of graduates average at least one publication per year after completing the postdoctoral program; 20% were listed as an independent investigator on a larger federal grant. The number of publications published during postdoctoral training and additional funded training beyond that provided by the institutional NRSA are correlated with increased posttraining program publication rates; other factors including gender, terminal degree, number of publications prior to postdoctoral training, and mentor variables had no significant impact. Additional funded training, male gender, and increased time since completion of the training are associated with increased likelihood of larger grant federal funding. CONCLUSION: Weighting publications by whether they were peer-reviewed and by authorship position appears to have little benefit over a simple counting of the number of publications. Publication during research training and the pursuit of funding for additional individual research training may be appropriate short-term goals within an institutional research training program.

[RESEARCH ARTICLES] Understanding the Challenges of Integrating Scientists and Clinical Teachers in Psychiatry Education: Findings from an Innovative Faculty Development Program

Martimianakis, M. A., Hodges, B. D., Wasylenki, D. — 2009-07-02

OBJECTIVE: Medical schools and departments of psychiatry around the world face challenges in integrating science with clinical teaching. This project was designed to identify attitudes toward the integration of science in clinical teaching and address barriers to collaboration between scientists and clinical teachers. METHODS: The authors explored the interactions of 20 faculty members (10 scientists and 10 clinical teachers) taking part in a 1-year structured faculty development program, based on a partnership model, designed to encourage collaborative interaction between scientists and clinical teachers. Data were collected before, during, and after the program using participant observations, surveys, participant diaries, and focus groups. Qualitative data were analyzed iteratively using the method of meaning condensation, and further informed with descriptive statistics generated from the pre- and postsurveys. RESULTS: Scientists and clinicians were strikingly unfamiliar with each other’s worldviews, work experiences, professional expectations, and approaches to teaching. The partnership model appeared to influence integration at a social level, and led to the identification of departmental structural barriers that aggravate the divide between scientists and clinical teachers. Issues related to the integration of social scientists in particular emerged. CONCLUSION: Creating a formal program to encourage interaction of scientists and clinical teachers provided a forum for identifying some of the barriers associated with the collaboration of scientists and clinical teachers. Our data point to directions for organizational structures and faculty development that support the integration of scientists from a wide range of disciplines with their clinical faculty colleagues.

[BRIEF REPORTS] A Progress Report on a Department of Psychiatry Faculty Practice Plan Designed to Reward Educational and Research Productivity

Hales, R. E., Shahrokh, N. C., Servis, M. — 2009-07-02

OBJECTIVE: The authors provide a progress report on a faculty practice plan that assigns a monetary value to administrative duties, teaching, scholarship, community service, and research. METHODS: Modifications to the original plan are described and quantifiable results in the areas of scholarship and research are summarized. RESULTS: During a 4-year period reported, the total direct costs of all grants increased 40% and the total number of publications increased 108% during this same time frame. CONCLUSION: The authors believe that a practice plan which assigns a monetary value to administrative duties, teaching, scholarship, community service, and research can incentivize faculty to be successful in each of these areas.

[RESOURCE] Introducing Psychiatrists to Qualitative Research: A Guide for Instructors

Whitley, R. — 2009-07-02

[RESOURCE] Surviving the Night

Roberts, L. W. — 2009-07-02

[SPECIAL ARTICLES] How to Write an NIH R13 Conference Grant Application

Sonis, J. H., Triffleman, E., King, L., King, D. — 2009-07-02

OBJECTIVE: The purpose of this article is to provide recommendations for writing a successful R13 conference grant proposal for the National Institutes of Health (NIH). METHODS: The authors reviewed successful NIH conference grant proposal abstracts. They also reflect on their own experience in writing an NIH conference grant proposal and implementing a successful annual conference on research methods in the area of psychological trauma. RESULTS: The key to a strong proposal is linkage among all of its sections, from the specific aims to the budget. The specific aims should be justified by the need for the conference and articulated in the background and significance section, and the aims, in turn, should drive the content and format of the conference. CONCLUSION: Conferences can be an important way to promote NIH scientific goals, by disseminating new findings, facilitating collaborations, and stimulating new lines of research.

[SPECIAL ARTICLES] Educational Research Questions and Study Design

Horn, C., Plazas Snyder, B., Coverdale, J. H., Louie, A. K., Roberts, L. W. — 2009-07-02

[LETTERS] Teaching Psychiatric Residents Research Literacy: Use of Existing Epidemiological Databases

Messias, E. — 2009-07-02