Acad Psychiatry current issue

Stigma, Hope, and Challenge in Psychiatry: Trainee Perspectives From Five Countries on Four Continents [EDITORIALS]

Roberts, L. W. — Wed, 13 Jan 2010 17:26:45 PST

Psychotherapy Training for Residents: Reconciling Requirements With Evidence-Based, Competency-Focused Practice [RESEARCH ARTICLES]

Weerasekera, P., Manring, J., Lynn, D. J. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) and the Royal College of Physicians and Surgeons of Canada (RCPSC) changed the training requirements in psychotherapy, moving toward evidence-based therapies and emphasizing competence and proficiency as outcomes of training. This article examines whether the therapies selected for training are evidence based and the authors review research concerning methods for training and assessment that effectively lead to competence in these psychotherapies. METHODS: The authors searched PsycINFO and PubMed for studies from 2000 to 2009 using the terms meta-analysis, meta-analyses, and psychotherapy combined with specific psychotherapies listed in the ACGME and RCPSC requirements to determine if high-level evidence supported the use of these therapies in patients with psychiatric disorders. A similar systematic search was carried out using the same search engines for all years with the terms psychotherapy, competence, training, evaluation, and therapist rating scales for the specific therapies selected by the ACGME and the RCPSC to determine if empirically validated therapist competency scales and specific teaching methods that enhance competence could be identified. RESULTS: Meta-analyses support the use of several psychotherapies in the treatment of patients with psychiatric disorders and specifically those selected for training. Empirically validated rating scales assess therapist competence in several therapies, and specific teaching methods enhance therapist skill. CONCLUSION: The Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada have incorporated evidence-based psychotherapies in their new guidelines. Evidence-based methods for assessing competence and for teaching psychotherapy are available and could be encouraged or required in the future.

Psychiatric Residents' Views of Quality of Psychotherapy Training and Psychotherapy Competencies: A Multisite Survey [RESEARCH ARTICLES]

Calabrese, C., Sciolla, A., Zisook, S., Bitner, R., Tuttle, J., Dunn, L. B. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: Few studies of residents’ attitudes toward psychotherapy training exist. The authors examined residents’ perceptions of the quality of their training, support for training, their own competence levels, and associations between self-perceived competence and perceptions of the training environment. METHODS: An anonymous, web-based questionnaire was distributed to residents at 15 U.S. training programs in 2006–2007. Likert-scaled items were used to evaluate attitudes regarding psychotherapy training and self-perceived competence in five modes of psychotherapy: brief, cognitive-behavioral, combined psychotherapy and psychopharmacology, psychodynamic, and supportive. RESULTS: Surveys were completed by 249 of 567 residents (43.9%). Over one-half agreed that their program provided high-quality psychotherapy training. Concerns about the adequacy of the time and resources provided by their programs were expressed by 28%. Although residents generally believed that their training directors supported psychotherapy training, approximately one-third did not believe that other key department leaders were supportive. Across years of training and modes of therapy, residents perceived their own competence in neutral to slightly positive terms, with self-perceived competence increasing with years of training. CONCLUSION: Given the current residency training requirements, these data provide a mixed picture about how residents experience psychotherapy training. Residency programs may need to reassess the quality and quantity of resources dedicated to psychotherapy training. Critical appraisal of support provided by key departmental leadership is also warranted.

The Role of Personal Therapy in Psychiatric Residency Training: A Survey of Psychiatry Training Directors [RESEARCH ARTICLES]

Habl, S., Mintz, D. L., Bailey, A. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: The authors examine the current place of personal therapy for residents in U.S. training programs. METHODS: All U.S. training directors were provided an anonymous survey assessing current attitudes and practices with regard to personal therapy and training director perception of their residents’ use of therapy. RESULTS: Training directors generally believed that personal therapy is useful during training, but fewer than one-third of residents seek therapy during residency. Program characteristics associated with the use of personal therapy by residents included training director beliefs in the value of therapy to mitigate personal problems, active encouragement by the training director to seek therapy, programmatic supports to reduce the cost of therapy to residents, and geographic location. CONCLUSION: The proportion of residents seeking personal therapy is falling, despite training directors’ perceptions of the benefit of therapy to residents. This study identified practices promoting a culture in which residents seek therapy.

Using Media to Teach How Not to Do Psychotherapy [RESEARCH ARTICLES]

Gabbard, G., Horowitz, M. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: This article describes how using media depictions of psychotherapy may help in teaching psychiatric residents. METHODS: Using the HBO series In Treatment as a model, the authors suggest how boundary transgressions and technical errors may inform residents about optimal psychotherapeutic approaches.RESULTS: The psychotherapy vignettes depicted in In Treatment show how errors in judgment may grow out of therapists’ good intentions. These errors can be understood and used constructively for teaching. CONCLUSION: With the growing interest in depicting psychotherapy on popular TV series, the use of these sessions avoids confidentiality problems and may be a useful adjunct for teaching psychotherapy.

A Neurosciences-in-Psychiatry Curriculum Project for Residents in Psychiatry [RESEARCH ARTICLES]

Dunstone, D. C. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: The author describes a 20-session, student-centered course relating contemporary neuroscience to psychiatry for second-year psychiatric residents. METHODS: Twenty residents who took the course (2003–2007) completed pre- and postcourse surveys and were contacted for more remote follow-up regarding the course. RESULTS: Survey results are predominantly qualitative and positive. CONCLUSION: This course is intended to be an active, student-centered learning experience as one exploration of practice-based learning, and it also explores the use of various applications of emerging telecommunications and information technology as a further learning goal. The course may have particular relevance for training programs with a dearth of local expertise in neuroscience relevant to psychiatry.

Kubler-Ross [RESEARCH ARTICLES]

Tsao, C. — Wed, 13 Jan 2010 17:26:45 PST

Geriatrics Education in Psychiatric Residencies: A National Survey of Program Directors [RESEARCH ARTICLES]

Warshaw, G. A., Bragg, E. J., Layde, J. B., Meganathan, K., Brewer, D. E. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: The authors describe the current characteristics of geriatrics training within general psychiatry training programs. METHODS: In the fall of 2006, a survey was mailed and made available online to all U.S. psychiatric residency program directors (N=181). RESULTS: The response rate was 54% (n=97). Of the responding psychiatry programs, 96% (n=93) required a clinical experience in geriatrics, with a mean of 54.9 half days of required clinical training. The predominant training sites were inpatient geriatric psychiatry acute care units, ambulatory care experiences precepted by one or more geriatric psychiatrists, and outpatient geriatric psychiatry assessment centers. The mean number of physician faculty per residency program available to teach geriatrics was 2.8 full-time equivalents, and the mean number of physicians certified in geriatric psychiatry was 3.2 per program. Conflicting time demands with other curricula was ranked as the most significant barrier to expanding geriatrics training. CONCLUSION: Variability in the amount of time devoted to geriatrics training exists across general psychiatric residency programs. Some residents spend very little time in specific required geriatric psychiatry clinical experiences and have limited exposure to well-trained geriatric psychiatrists. Therefore, some psychiatrists who will take care of older patients in the future may be ill prepared to do so.

Terminating the Frame [RESEARCH ARTICLES]

Taskiran, S. — Wed, 13 Jan 2010 17:26:45 PST

Don't Leave Teaching to Chance: Learning Objectives for Psychodynamic Psychotherapy Supervision [BRIEF REPORTS]

Rojas, A., Arbuckle, M., Cabaniss, D. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: The way in which the competencies for psychodynamic psychotherapy specified by the Psychiatry Residency Review Committee of the Accreditation Council for Graduate Medical Education translate into the day-to-day work of individual supervision remains unstudied and unspecified. The authors hypothesized that despite the existence of competencies in psychodynamic psychotherapy, residents did not know what they should be learning in psychodynamic psychotherapy supervision. METHODS: Twenty-four psychiatric residents in PGYs 3 and 4 at Columbia University were asked to complete an anonymous course evaluation about their learning experience in psychodynamic psychotherapy supervision. The evaluation had eight items: seven yes/no questions and one open-ended question. RESULTS: Sixteen of 24 surveys were returned, a response rate of 66.6%. Of the residents who responded, eight said they did not know what they were supposed to be learning in psychodynamic psychotherapy supervision, nine had not discussed this with their supervisor, and six did not believe that their discussions in psychodynamic psychotherapy supervision correlated with didactic courses. CONCLUSION: These results support the need for specific learning objectives for psychodynamic psychotherapy supervision that can be communicated to both supervisors and supervisees to facilitate the process of learning and assessment.

Excuses [BRIEF REPORTS]

Buckler, M. — Wed, 13 Jan 2010 17:26:45 PST

Adequacy of Psychiatric Training: A Singaporean Perspective [BRIEF REPORTS]

Tor, P.-C., Ng, T.-P., Kua, E.-H. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: The specialty training program for psychiatry in Singapore is transitioning to a seamless 5-year training program. It is timely to assess the perceived adequacy of current psychiatric specialty training. METHODS: An anonymous survey was sent to all psychiatry trainees and psychiatrists in the public sector to assess the current adequacy and perceived importance of 11 aspects of psychiatric specialist training. RESULTS: Forty-nine percent of those surveyed (54 of 110) replied. The current adequacy of training was rated lower than the perceived importance of training for all 11 aspects of training. Those aspects of training rated most important were disorder and diagnosis, pharmacological treatment, clinical interview, and treatment skills. Psychiatrists rated most aspects of training as being more important than did trainees except for cultural aspects, research, and basic neuroscience. Psychiatrists rated adequacy of training better than did trainees, except in the aspect of research. The difference between psychiatrists’ and trainees’ ratings for adequacy of psychotherapy treatment knowledge was significant (p<0.05). CONCLUSION: There were perceived deficiencies in all 11 aspects of training. Psychiatrists and trainees have different perceptions of adequacy and importance of training.

The Beautician [BRIEF REPORTS]

Shakespear, J. — Wed, 13 Jan 2010 17:26:45 PST

An Anonymous Survey of Psychosomatic Medicine Fellowship Directors Regarding Breaches of Contracts and a Proposal for Prevention [BRIEF REPORTS]

Levenson, J. L., Bialer, P. — Wed, 13 Jan 2010 17:26:45 PST

OBJECTIVE: The authors studied how often applicants accept positions at more than one program, or programs offer positions to applicants who have already signed contracts with other programs. METHODS: An anonymous survey was distributed to all psychosomatic medicine fellowship program directors. RESULTS: It is fairly common for applicants to sign contracts for fellowship positions and then back out of the contracts. Only one program reported ever knowingly offering a contract to an applicant who had accepted a position elsewhere. Programs are divided over whether there are extenuating circumstances under which it would be acceptable to offer a position to an applicant who has already signed a contract with another program. CONCLUSION: Guidelines for fellowship programs that do not use the National Resident Match Program can improve the recruitment process.

Supportive Psychotherapy: A Crash Course for Medical Students [RESOURCE]

Philip, N. S., Rost-Banik, D., Shaffer, S., Johnson, B., Boland, R. — Wed, 13 Jan 2010 17:26:45 PST

Passing of the Renaissance Man and Woman [RESOURCE]

Bauer, A. — Wed, 13 Jan 2010 17:26:45 PST

Views of Psychiatry: A Comparison Between Medical Students From Barcelona and Medellin [INTERNATIONAL EDUCATION REPORT]

Pailhez, G., Bulbena, A., Lopez, C., Balon, R. — Wed, 13 Jan 2010 17:26:45 PST

The Unit [INTERNATIONAL EDUCATION REPORT]

Shakespear, J. — Wed, 13 Jan 2010 17:26:45 PST

Medical Students' Beliefs and Attitudes Toward Mental Illness: Effects of a Psychiatric Education [INTERNATIONAL EDUCATION REPORT]

Aghukwa, C. N. — Wed, 13 Jan 2010 17:26:45 PST

Splitting [INTERNATIONAL EDUCATION REPORT]

Ley, R. — Wed, 13 Jan 2010 17:26:45 PST

Students' Attitudes Toward Psychiatry at Al-Hassa Medical College, Saudi Arabia [INTERNATIONAL EDUCATION REPORT]

El-Gilany, A.-H., Amr, M., Iqbal, R. — Wed, 13 Jan 2010 17:26:45 PST

Attitudes Towards Psychiatry: A Survey of Romanian Medical Residents [INTERNATIONAL EDUCATION REPORT]

Voinescu, B. I., Szentagotai, A., Coogan, A. — Wed, 13 Jan 2010 17:26:45 PST

Safety and Respectful Treatment of Medical Students and Residents [LETTERS]

Ellwood, A. — Wed, 13 Jan 2010 17:26:45 PST

Comparing Psychiatrists' and Primary Care Physicians' Knowledge of Nonpsychiatric Medicine [LETTERS]

Grace, G. D., Christensen, R. C. — Wed, 13 Jan 2010 17:26:45 PST

Disclosure of Competing Interests [ANNOUNCEMENT]

Wed, 13 Jan 2010 17:26:45 PST