Acad Psychiatry recent issues

[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

[INTRODUCTION] Special Issue: Reaching Out to Families and Overcoming Stigma

2008-03-18

[EDITORIALS] Stigma in Mental Health Care

Ping Tsao, C. I., Tummala, A., Roberts, L. W. — 2008-03-18

[COMMENTARIES] Does a Clerkship in Psychiatry Affect Medical Students' Attitudes Toward Psychiatry?

Balon, R. — 2008-03-18

[RESEARCH ARTICLES] Reintegrating Family Therapy Training in Psychiatric Residency Programs: Making the Case

Rait, D., Glick, I. — 2008-03-18

OBJECTIVE: Given the marginalization of couples and family therapy in psychiatric residency programs over the past two decades, the authors propose a rationale for the reintegration of these important psychosocial treatments into the mainstream of general psychiatric residency education. METHODS: After reviewing recent trends in the field that call for a more prominent role for couples and family therapy in residency training, the authors summarize the literature on family therapy training in psychiatry over the past four decades. RESULTS: Because biopsychosocial systemic thinking provides a powerful framework for looking at multiple levels of systems and their interrelationships, developing a strong family-systems perspective and acquiring basic "family skills" represent the minimum requirement for general psychiatric training. The authors argue for the addition of couples and family therapy to the five required psychotherapy competencies defined by the residency review committee in psychiatry. CONCLUSION: A rationale for a family-systems training model is proposed with the objective of encouraging residency programs to integrate the family-systems model more fully into their curricula.

[RESEARCH ARTICLES] A Model for Reintegrating Couples and Family Therapy Training in Psychiatric Residency Programs

Rait, D., Glick, I. — 2008-03-18

OBJECTIVE: The authors propose a family-systems training model for general residency training programs in psychiatry based on the couples and family therapy training program in Stanford’s Department of Psychiatry and Behavioral Sciences.METHODS: The authors review key elements in couples and family therapy training. Examples are drawn from the family therapy training curriculum in a general psychiatric residency program. RESULTS: Conceptual and practical skills taught over the span of a psychiatric residency training program are described, focusing on: joining with the couple or family; seeing systemic patterns, recognizing the family’s developmental stage, history, and culture; identifying family structure; and intervening systemically. CONCLUSION: This family-systems training model can serve as a resource for residency programs interested in integrating the couples and family therapy model more fully into their curricula.

[RESEARCH ARTICLES] The Stigma of Families with Mental Illness

Larson, J. E., Corrigan, P. — 2008-03-18

OBJECTIVE: This article describes family stigma, which is defined as the prejudice and discrimination experienced by individuals through associations with their relatives. METHODS: The authors describe family stigma and present current research related to mental illness stigma experienced by family members. Research indicates this type of stigma negatively impacts family members and relatives with mental illness. RESULTS: The authors also present strategies to eliminate stigma and discuss implications for the training goals of psychiatrists throughout the text. CONCLUSION: The authors end this article with recommendations for psychiatry training goals.

[RESEARCH ARTICLES] Family Physicians' Interventions with Young People in Distress and Their Parents: Managing Confidentiality and Levels of Engagement

Stanley, N., Manthorpe, J., Gillespie, L. — 2008-03-18

OBJECTIVE: This study aimed to interrogate the decisions and approaches used by family doctors in responding to the needs of young people in distress. The research sought to explore how practitioners balanced young people’s needs for confidentiality and self-determination with their parents’ concerns and needs as caregivers. METHODS: Interviews were undertaken with 30 family physicians in the United Kingdom using a semi-structured schedule to elicit reactions to a case scenario. RESULTS: While family physicians identified the ethical and clinical benefits of patient confidentiality for young adults, a wide range of approaches was adopted with respect to providing feedback and reassurance to parents. Likewise, there were substantial variations in the extent to which clinicians were prepared to adopt a proactive stance to engage a young person who was reluctant to seek help. CONCLUSION: These diverging practice examples can be used to inform training programs and offer a means by which the caregiver’s need for information and support can be emphasized in psychiatric and clinical education.

[RESEARCH ARTICLES] Does Mental Illness Stigma Contribute to Adolescent Standardized Patients' Discomfort With Simulations of Mental Illness and Adverse Psychosocial Experiences?

2008-03-18

OBJECTIVE: Adolescent mental illness stigma-related factors may contribute to adolescent standardized patients’ (ASP) discomfort with simulations of psychiatric conditions/adverse psychosocial experiences. Paradoxically, however, ASP involvement may provide a stigma-reduction strategy. This article reports an investigation of this hypothetical association between simulation discomfort and mental illness stigma. METHODS: ASPs were randomly assigned to one of two simulation conditions: one was associated with mental illness stigma and one was not. ASP training methods included carefully written case simulations, educational materials, and active teaching methods. After training, ASPs completed the adapted Project Role Questionnaire to rate anticipated role discomfort with hypothetical adolescent psychiatric conditions/adverse psychosocial experiences and to respond to open-ended questions regarding this discomfort. A mixed design ANOVA was used to compare comfort levels across simulation conditions. Narrative responses to an open-ended question were reviewed for relevant themes. RESULTS: Twenty-four ASPs participated. A significant effect of simulation was observed, indicating that ASPs participating in the simulation associated with mental illness stigma anticipated greater comfort with portraying subsequent stigma-associated roles than did ASPs in the simulation not associated with stigma. ASPs’ narrative responses regarding their reasons for anticipating discomfort focused upon the role of knowledge-related factors. CONCLUSION: ASPs’ work with a psychiatric case simulation was associated with greater anticipated comfort with hypothetical simulations of psychiatric/adverse psychosocial conditions in comparison to ASPs lacking a similar work experience. The ASPs provided explanations for this anticipated discomfort that were suggestive of stigma-related knowledge factors. This preliminary research suggests an association between ASP anticipated role discomfort and mental illness stigma, and that ASP work may contribute to stigma reduction.

[RESEARCH ARTICLES] Caregivers as Money Managers for Adults with Severe Mental Illness: How Treatment Providers Can Help

Elbogen, E. B., Wilder, C., Swartz, M. S., Swanson, J. W. — 2008-03-18

OBJECTIVE: To review the prevalence, benefits, and problems associated with families who, either informally or formally as representative payees, manage money for adults with severe mental illness. METHODS: Based on empirical research and clinical cases, suggestions are offered for minimizing downsides and capitalizing upon benefits of family money management. RESULTS: The findings and case vignettes demonstrate four specific strategies for treatment providers: facilitating collaboration, increasing knowledge about disability funds, improving money-management skills, and developing plans for financial decision-making.CONCLUSION: By following these recommendations and becoming aware of whether their clients had family money managers, clinicians can promote independent functioning and family support for a substantial number of people with severe mental illness.

[SPECIAL ARTICLES] Family-Oriented Patient Care through the Residency Training Cycle

2008-03-18

OBJECTIVE: Because family oriented patient care improves patient outcome and reduces family burden, clinical family skills of communication, assessment, alliance, and support are part of core competencies required of all residents. Teaching residents to "think family" as part of core competencies and to reach out to families requires change in the teaching environment. METHODS: This article advocates teaching residents family skills throughout the training years as an integrated part of routine patient care rather than in isolated family clinics or a course in "family therapy." It reviews family skills required of residents in all treatment settings and family skills that are specific to inpatient, emergency room, outpatient, and consultation-liaison services. RESULTS: Families can be seen in multiple treatment settings throughout resident training using recent research to support appropriate interventions for patients and caregivers. CONCLUSION: The process of establishing change in the training environment requires a commitment on the part of the training faculty to include families, but is possible within the current training framework.

[SPECIAL ARTICLES] How are the Experiences and Needs of Families of Individuals with Mental Illness Reflected in Medical Education Guidelines?

Riebschleger, J., Scheid, J., Luz, C., Mickus, M., Liszewski, C., Eaton, M. — 2008-03-18

OBJECTIVE: This descriptive study explored the extent that medical education curriculum guidelines contained content about the experiences and needs of family members of people with serious mental illness. METHODS: Key family-focused-literature themes about the experiences and needs of families of individuals with mental illness were drawn from a review of over 6,000 sources in the mental health practice literature that were identified within a systematic search and thematic development process. The study identified the extent and nature of family-focused key literature themes as reflected in medical education curriculum guidelines for psychiatry and primary care practice specialties of family practice, internal medicine, and pediatrics. An iterative process was used to retrieve and analyze text data drawn from the curriculum guidelines of national accrediting organizations for undergraduate, graduate, and continuing medical education. RESULTS: The key family-focused themes, as drawn from the mental health practice research literature, were: mental illness stigma; family caregiver burden; information exchange and referral; family stress, coping, and adaptation; family support; crisis response; and family psychoeducation. Two of these seven themes appeared in medical education curriculum guidelines: information exchange and caregiver burden. The most frequently appearing family-focused key literature theme was information exchange. Psychiatry and undergraduate medical education reflected the most family content. CONCLUSION: It appears that medical education curriculum guidelines have insufficient content about families of people with mental illness. The educational experiences of psychiatrists and primary care physicians may not adequately prepare them for working with family members of their patients. It is recommended that medical education curriculum guidelines incorporate information about family stigma; family/caregiver burden; information exchange; family stress, coping, and adaptation; family support; crisis response; and multiple family group psychoeducation.

[SPECIAL ARTICLES] Overcoming Stigma: Involving Families in Medical Student and Psychiatric Residency Education

Schmetzer, A. D., Lafuze, J. E. — 2008-03-18

OBJECTIVE: The primary purpose of this article is to present a possible mechanism for increasing communication about psychiatric matters such as diagnoses, treatment, and stigma between the physicians, including psychiatrists, and the families of persons with mental illness through a NAMI presentation. METHODS: Included are a description of a stigma-reduction presentation to junior medical students; information about an instrument to evaluate pre- and postclerkship student attitudes; and a discussion of consumer and family participation in the education of first-year psychiatric residents. RESULTS: Moving the NAMI presentation from the freshman year to the junior year rotation and first year resident experience has been more efficacious, possibly because clinically oriented students and medical and psychiatric residents seem more receptive to communication about stigma and the family situation. CONCLUSION: The educational collaborations between advocacy groups and academia show promise for increasing communication about psychiatric disorders, treatment, and stigma issues between families and psychiatric patients.

[SPECIAL ARTICLES] The After-Death Call to Family Members: Academic Perspectives

LoboPrabhu, S., Molinari, V., Pate, J., Lomax, J. — 2008-03-18

OBJECTIVE: The authors discuss clinical and teaching aspects of a telephone call by the treating clinician to family members after a patient dies. METHODS: A MEDLINE search was conducted for references to an after-death call made by the treating clinician to family members. A review of this literature is summarized. RESULTS: A clinical application of the after-death call is proposed, with emphasis on a "no regrets" approach. The authors also discuss the management of "at risk" situations, and end with teaching points. CONCLUSION: The after-death call is an example of "best practices" in the care of every patient, and can be used to teach residents and students of all disciplines. Primary care providers and consultation psychiatrists may find this valuable as they communicate with families in the sensitive and often traumatic context after a patient dies.

[SPECIAL ARTICLES] Suicide and Stigma: A Review of the Literature and Personal Reflections

Sudak, H., Maxim, K., Carpenter, M. — 2008-03-18

OBJECTIVE: The authors aim to educate mental health practitioners and trainees regarding the issues of stigma and suicide and how stigma impacts this diverse population of suicide attempters, completers, their families, friends, therapists, and others both personally and therapeutically. METHODS: The authors draw upon their own experiences as survivors and review pertinent literature illustrating the history and general impacts of this stigmatization. The authors present suggestions to diminish stigma both for survivors and the general public. RESULTS: Although there appears to have been some diminution in the stigmatization of the mentally ill over the past few decades, there appears to be less diminution in the stigma associated with suicide and suicide-survivorship. CONCLUSION: Mental illness, in general, has become less stigmatized in recent years, but suicide remains nearly as stigmatized as ever.

[BRIEF REPORTS] Factors Influencing the Choice of a Psychiatric Residency Program: A Survey of Applicants to the Johns Hopkins Residency Program in Psychiatry

Davydow, D., Bienvenu, O. J., Lipsey, J., Swartz, K. — 2008-03-18

OBJECTIVE: The authors set out to determine what general factors are important in the selection of a psychiatric residency program, the views applicants have of several aspects of the Johns Hopkins Hospital Psychiatric Residency Program, and what relationships exist among these elements. METHODS: A survey mailed to Johns Hopkins Hospital psychiatric residency-interviewed applicants asked applicants to rate six factors in relation to choosing a psychiatric residency program. A second section asked applicants to rate five factors more specific to the Johns Hopkins Hospital residency. RESULTS: The most important general factors in choosing a residency program included the perceived philosophical orientation of a psychiatric department, exposure to different psychotherapy modalities, and the perceived prestige of the department. Several statistically significant correlations were evident among factors. CONCLUSION: Knowledge of applicants’ views could assist residency program directors in their assessment of factors influencing program choices.

[BRIEF REPORTS] Does a Clerkship in Psychiatry Contribute to Changing Medical Students' Attitudes Towards Psychiatry?

Fischel, T., Manna, H., Krivoy, A., Lewis, M., Weizman, A. — 2008-03-18

OBJECTIVE: The psychiatric clerkship is perceived as an intervention point in medical students’ attitude toward psychiatry and career choice after graduation. The authors aim to assess the impact of the psychiatric clerkship in students from Israeli and U.S. origin on their attitude toward psychiatry. METHODS: A modified Nielsen’s questionnaire was administered at the start and end of the clerkship in two groups of students. RESULTS: There was no statistically significant difference in attitude scores between the start and endpoint of a clerkship on both the Israeli and the United States groups. Item analysis did not reveal significant impact of clerkship. CONCLUSION: The psychiatry clerkship does not change students’ view on the attitude assessed in this study, regardless of their origin (Israeli or U.S.). Further research is needed in order to find more clerkship-dependent contributors to positive or negative attitudes toward psychiatry.

[SERIES] Globalization of Medical and Psychiatric Education and the Focus of Academic Psychiatry on the Success of "International" Authors

Balon, R., Roberts, L. W., Coverdale, J., Louie, A., Beresin, E. — 2008-03-18

[SERIES] Attitudes Toward Psychiatry: A Survey of Medical Students at the University of Nairobi, Kenya

2008-03-18

OBJECTIVES: The authors aim to determine the attitudes of University of Nairobi, Kenya, medical students toward psychiatry. METHODS: The study design was cross-sectional. Self-administered sociodemographic and the Attitudes Toward Psychiatry-30 items (ATP-30) questionnaires were distributed sequentially to every third medical student in his or her lecture theater before or immediately after the lectures. Analysis was done using SPSS version 11.5 and the results are presented in tables. RESULTS: Nearly 75% of the students had overall favorable attitudes toward psychiatry but only 14.3% considered psychiatry as a potential career choice. Sixty-six percent reported that they would not choose psychiatry as a career while the remaining 19.7% were not decided. CONCLUSIONS: There is dissonance between positive attitudes toward psychiatry and the choice of psychiatry as a potential career. Therefore, there is a need to bridge the gap by addressing the various factors that potentially account for this dissonance.

[SERIES] Attitudes of Pakistani Medical Students Towards Psychiatry as a Prospective Career: A Survey

2008-03-18

OBJECTIVE: Pakistan is facing a shortage of psychiatrists; there are about 350 psychiatrists in a country of 150 million. Medical specialty choice surveys of medical students have approached this issue from various angles. The authors’ objective is to explore the attitudes of Pakistani medical students toward psychiatry as their future career. METHODS: Third-year medical students from four medical colleges in different regions of Pakistan participated. A questionnaire was hand distributed and collected in each medical college by a contact person who was not affiliated with the department of psychiatry in any of the medical colleges included in the survey.RESULTS: The response rate was 60% out of a sample of 381 students. The mean age was 21 years, and 57% were female. The majority (98.4%) were Muslims. Respondents were similar in all demographic characteristics except household income. Only 7.6% reported psychiatry to be either their chosen career or a highly likely choice. A Friedman test found a significant difference in mean scores of ratings of the attractiveness of various career aspects of different specialties. CONCLUSIONS: Relatively small numbers of students identified psychiatry as their specialty of choice. This trend is similar to many other studies. Given the small number of practicing psychiatrists in Pakistan, this finding is not very encouraging.

[EDITORIALS] The Other Side of the Stethoscope

Adams Greenup, R. — 2008-02-12

[COMMENTARIES] The Role of Academic Psychiatry Faculty in the Treatment and Subsequent Evaluation and Promotion of Medical Students: An Ethical Conundrum

Kavan, M. G., Malin, P. J., Wilson, D. R. — 2008-02-12

OBJECTIVES: This article explores ethical and practical issues associated with the Liaison Committee on Medical Education (LCME) provision that states health professionals who provide psychiatric/psychological care to medical students must have no involvement in the academic evaluation or promotion of students receiving those services. METHOD: The authors address the pros and cons of this provision as they relate to the overall well-being of the student. RESULTS: Arguments in support of this provision include students’ desire for confidentiality, avoidance of dual-relationships, and fear of documentation in the academic record. Arguments against this provision include the elimination of student autonomy to select a psychiatrist, the suitability and accessibility of academic psychiatrists to treat students, and the delimiting nature of this standard. CONCLUSION: In general, the LCME provision eliminates potential barriers to the mental health treatment of medical students. However, research and debate on its impact and appropriateness on a case-by-case basis should continue.

[RESEARCH ARTICLES] Our Fallen Peers: A Mandate for Change

Worley, L. L. M. — 2008-02-12

OBJECTIVE: The author identifies and seeks to remove barriers contributing to physician/medical students’ decisions NOT to seek mental health care. METHODS: Following a cluster of medical student and physician suicides in one medical community, medical trainees anonymously shared their views regarding seeking mental health treatment in light of the current disclosure requirements for medical licensure. In an effort to identify medical licensure questions that more accurately assess for potential impairment—replacing the stigmatizing global inquiry about past mental health treatment—47 states’ medical licensure questions available on the web were examined. Representatives from the state’s psychiatric and medical societies joined efforts to formally request the State Medical Board to revise the licensure questions. RESULTS: The State Medical Board unanimously approved the recommended changes. CONCLUSION: Overcoming stigma within the medical profession regarding seeking psychiatric care is a difficult process requiring ongoing education of our colleagues. Physicians must have the opportunity to seek confidential mental health treatment at their earliest signs of distress in order to maximize their optimal functioning in an effort to prevent impairment.

[RESEARCH ARTICLES] Observations on Burnout in Family Medicine and Psychiatry Residents

Woodside, J. R., Miller, M. N., Floyd, M. R., McGowen, K. R., Pfortmiller, D. T. — 2008-02-12

OBJECTIVE: To investigate the relationship between burnout, work environment, and a variety of personal variables, including age, gender, marital, parental and acculturation status within a population of family medicine and psychiatry resident physicians. METHODS: Between 2002 and 2005, 155 residents in family medicine and psychiatry at East Tennessee State University College of Medicine were surveyed at intervals using the Maslach Burnout Inventory and Work Environment Scale, form R, to assess their current state of emotional health and job satisfaction. RESULTS: Female residents had lower scores on the Depersonalization scale of the Maslach Burnout Inventory (t=3.37, p=0.001). Parenting was associated with lower Depersonalization (t=3.98, p<0.001) and Emotional Exhaustion (t=2.59, p=0.011). Residents from the United States culture reported higher Depersonalization and Emotional Exhaustion (t=–3.64, p<0.001; t=–3.85, p<0.001). On the Work Environment Scale, residents from United States culture reported less Task Orientation and Control but higher Work Pressure (t=2.89, p=0.005; t=2.24, p=0.027; t=–2.79, p=0.006). Psychiatry residents reported less burnout than family medicine residents on the Depersonalization and Emotional Exhaustion scales (t=2.49, p=0.014: t=2.05, p=0.042) and higher Physical Comfort on the Work Environment Scale (t=–2.60, p=0.011); while family medicine residents reported higher Peer Cohesion, Supervisor Support, and Autonomy (t=3.41, p=0.001; t=2.38, p=0.019; t=2.27, p=0.025). CONCLUSION: This study design, using well established, standard, and valid measures, identified important issues for further exploration: the relationship between acculturation to burnout, the potential role of parenting as a protective factor from burnout, and the recognition that women residents may not be as vulnerable to burnout as previously reported.

[RESEARCH ARTICLES] Personal Health Care of Residents: Preferences for Care Outside of the Training Institution

Dunn, L. B., Moutier, C., Green Hammond, K. A., Lehrmann, J., Weiss Roberts, L. — 2008-02-12

OBJECTIVE: The personal health care issues of residents are important but have received minimal study. Available evidence suggests that residents experience difficulties obtaining care, partly related to both the demands of medical training and concerns about confidentiality and privacy. METHODS: A self-report survey was distributed in 2000–2001 to advanced residents at the University of New Mexico Health Sciences Center. Questions related to personal health and health care attitudes, behaviors, preferences, and experiences, and vignettes related to personal illness and treatment. Here the authors report findings regarding preferences for obtaining health care "at" versus "outside" of one’s training institution. RESULTS: Data from 141 residents are presented. A substantial minority of residents had obtained care outside of their institution in the preceding year. Residents expressed concerns about their medical privacy and confidentiality related to obtaining care within their own institution, including concerns about being seen by other residents or by past or future attendings. Women expressed more concern than did men on numerous issues, as did residents in primary care versus specialty training. Residents expressed a preference for care outside the training institution when taking into account confidentiality and prevention of embarrassment; care at their own institution was preferred when considering expense and scheduling. Outside care was more strongly preferred for more stigmatizing illnesses (e.g., mental health-related). Most residents felt poorly informed regarding their personal health care confidentiality rights and did not know whether their institution had confidentiality policies regarding residents who develop physical or mental health problems. CONCLUSION: Residents worry about confidentiality and privacy when deciding where to obtain personal medical care. Trainees’ concerns are relevant to crafting policies on resident health care. Programs should strive to inform residents thoroughly about policies and rights pertaining to personal health care.

[RESEARCH ARTICLES] Prevalence of Health-Related Behaviors Among Physicians and Medical Trainees

Hull, S. K., DiLalla, L. F., Dorsey, J. K. — 2008-02-12

OBJECTIVE: The authors studied the prevalence of health-promoting and health-risking behaviors among physicians and physicians-in-training. Given the significant potential for negative outcomes to physicians’ own health as well as the health and safety of their patients, examination of the natural history of this acculturation process about physician self-care and wellness is critical to the improvement of the western health care delivery system. METHODS: 963 matriculating medical students, residents, or attending physicians completed the Empathy, Spirituality, and Wellness in Medicine (ESWIM) survey between the years 2000 and 2004. Items specific to physician wellness were analyzed. These included healthy behaviors as well as risk behaviors. RESULTS: Both medical students and attending physicians scored higher in overall wellness than did residents. Residents were the lowest scoring group for getting enough sleep, using seatbelts, and exercising. Medical students were more likely to smoke tobacco and drink alcohol. Medical students reported less depression and anxiety and more social contacts. CONCLUSION: Medical school training may prevent students from maintaining healthy behaviors, so that by the time they are residents they exercise less, sleep less, and spend less time in organizational activities outside of medical school. If physicians do not engage in these healthy behaviors, they are less likely to encourage such behaviors in their patients and patients are less likely to listen to them even if they do talk about it.

[SPECIAL ARTICLES] Physician Impairment: Is It Relevant To Academic Psychiatry?

Myers, M. F. — 2008-02-12

OBJECTIVE: This article examines the relevance of physician impairment to the discipline of academic psychiatry. METHOD: The author reviews the scientific literature, the proceedings of previous International Conferences on Physician Health, and held discussions with experts in the physician health movement, department chairs, program directors, and residents. RESULTS: Psychiatric illness and impairment in physicians impact academic psychiatry in several ways. Mental illnesses in physicians are being studied by some researchers, but the subject requires more scholarly attention. Training directors are interested in resident well-being and illness and how to reach out to symptomatic residents in a more timely way. Leaders in psychiatry are eager to learn the first steps in identifying colleagues at risk and the route to assessment and care. They are especially concerned about disruptive behavior in the workplace, including harassment and boundary transgressions in doctor-patient and supervisor-supervisee relationships. Academic psychiatrists wish to be more responsive to nonpsychiatrists appealing to them for guidance with impaired members of their departments. CONCLUSIONS: Physician impairment is an emerging field of study and interest to psychiatrists in academic settings.

[SPECIAL ARTICLES] A Conceptual Model of Medical Student Well-Being: Promoting Resilience and Preventing Burnout

Dunn, L. B., Iglewicz, A., Moutier, C. — 2008-02-12

OBJECTIVE: This article proposes and illustrates a conceptual model of medical student well-being. METHOD: The authors reviewed the literature on medical student stress, coping, and well-being and developed a model of medical student coping termed the "coping reservoir." RESULTS: The reservoir can be replenished or drained by various aspects of medical students’ experiences. The reservoir itself has an internal structure, conceptualized as consisting of the individual’s personal traits, temperament, and coping style. The coping reservoir metaphor is used to highlight the dynamic nature of students’ experiences, with potential outcomes including enhanced resilience and mental health versus distress and burnout. CONCLUSION: Medical student well-being is affected by multiple stressors as well as positive aspects of medical training. Attention to individual students’ coping reservoirs can help promote well-being and minimize burnout; formal and informal offerings within medical schools can help fill the reservoir. Helping students cultivate the skills to sustain their well-being throughout their careers has important payoffs for the overall medical education enterprise, for promotion of physician resilience and personal fulfillment, and for enhancement of professionalism and patient care. This and other models of coping should be empirically validated.

[SPECIAL ARTICLES] Work Hours Regulations for House Staff in Psychiatry: Bad or Good for Residency Training?

Rasminsky, S., Lomonaco, A., Auchincloss, E. — 2008-02-12

OBJECTIVE: The movement to limit work hours for house staff has gained momentum in recent years. The authors set out to review the literature on work hours reform, particularly as it applies to psychiatric residency training, and to provide two different viewpoints on the controversy. METHODS: The authors present the historical background of work hours reform in the United States and review recent literature about resident work hours limitations. Using a debate format, the authors discuss whether the new regulations are having a positive or negative impact on residency training in psychiatry. RESULTS: Drs. Lomonaco and Auchincloss argue that currently-existing work hours restrictions may have unintended consequences for the health of patients and an untoward impact on residents’ professional development and academic medicine’s overall structure. Dr. Rasminsky argues that work hours restrictions do not go far enough in protecting residents and patients from the harmful effects of fatigue, and that our definition of professionalism needs to be reexamined in light of emerging scientific literature. CONCLUSION: There should be some limitation on resident work hours, with exact numbers to be determined by growing scientific knowledge about the effects of prolonged wakefulness. More study is needed, particularly in the area of psychiatric residency training.

[BRIEF REPORTS] Linking Learning and Health: A Pilot Study of Medical Students' Perceptions of the Academic Impact of Various Health Issues

Kernan, W. D., Wheat, M. E., Lerner, B. A. — 2008-02-12

OBJECTIVE: To assess medical students’ experience with a wide variety of health concerns and their perceptions of the impact of these health concerns on their academic performance. METHODS: The National College Health Assessment (NCHA) was administered to all students enrolled at a single medical school during the spring term of 2005. RESULTS: Students reported the greatest perceived negative academic impact related to experiencing interpersonal concerns (concerns about troubled friends or family members, death of a friend or family member, and relationship difficulty) and mental health concerns (depression/anxiety/seasonal affective disorder and stress). A total of 315 students participated (48% response rate). CONCLUSION: Medical students perceive their experiences with social and psychological concerns as negatively influential to their academic well-being. Strategies that assist students in coping with these issues support the learning mission of the academic medical center.

[BRIEF REPORTS] Medical Student Health Promotion: The Increasing Role of Medical Schools

Estabrook, K. — 2008-02-12

OBJECTIVE: The author proposes courses of action for medical schools to increase positive health promotion among medical students. METHOD: This article will review the current literature on medical student health care. Strategies of action for medical schools are proposed for increasing student wellness. RESULTS: Medical schools can positively influence medical student well-being. Many options, ranging from expansive program changes to simple, cost-effective initiatives, allow medical schools to promote student wellness. CONCLUSION: Action now by medical schools to create a learning environment where positive self-care is valued could enhance the personal well-being of medical students now and begin a movement toward improved personal health care for physicians in the future.

[COMMENTARIES] Commentary on "Psychiatric Resident Education in Intellectual Disabilities"

O'Grady, J. — 2007-12-13

[COMMENTARIES] Hide and Seek: The Elusive Rural Psychiatrist

Freeman Cook, A., Hoas, H. — 2007-12-13

[RESEARCH ARTICLES] Putting "Rural" Into Psychiatry Residency Training Programs

Nelson, W. A., Pomerantz, A., Schwartz, J. — 2007-12-13

OBJECTIVE: Evidence indicates disparities in the number of psychiatrists practicing in rural America compared to urban areas suggesting the need for a greater emphasis on rural psychiatry in residency training programs. The authors offer suggestions for integrating a rural focus in psychiatry residency training to foster greater competency and interest in rural psychiatry. METHODS: The authors surveyed the limited rural psychiatry training and the more extensive family medicine rural residency literature to review efforts to develop rural focused training curricula. RESULTS: Many factors in the rural environment influence mental health care, including overlapping professional-patient relationships, caregiver isolation and stress, limited availability and access to mental health resources, disease stigma, and economic and health status. To enhance both an interest in and the quality of the training for a rural practice, the authors suggest three levels of training for integrating rural factors into psychiatry programs from a basic didactic understanding of the contextual issues affecting rural psychiatry, to creating rural clinical experiences and preceptors, to developing a rural psychiatry fellowship. CONCLUSIONS: Providing trainees with an understanding of the rural mental health issues and experiences might contribute to trainees’ selecting rural practices and enhance the rural competency of psychiatrists.

[RESEARCH ARTICLES] Psychiatric Resident Education in Intellectual Disabilities: One Program's Ten Years of Experience

Ruedrich, S., Dunn, J., Schwartz, S., Nordgren, L. — 2007-12-13

OBJECTIVE: The authors evaluated the confidence and willingness of resident graduates to treat individuals with intellectual disability (ID), following a residency rotation in developmental disability. METHODS: Thirty-two graduates of a single residency program were surveyed regarding their post-residency experience with patients with intellectual disability. All graduates had completed a 3 month, half-time residency rotation in intellectual disability. The anonymous 12-question survey sought feedback about satisfaction with the rotation, confidence in serving persons with ID, and actual post-residency work with ID patients. RESULTS: Twenty-three of 32 (72%) of graduates returned surveys. On a 6-point scale (1=strongly disagree; 6=strongly agree), residents most strongly endorsed that the rotation had built their capacity in ID (5.78), confidence (5.48), and satisfaction (5.37). Lowest ratings were given to professional contact in ID initiated by the graduate (2.74), identifying expertise to the community (3.22), and post-residency practice with patients with ID (3.30). Differences between respondents who identified post-residency contact with persons with ID (N=8), and respondents who did not (N=15), did not reach statistical significance. CONCLUSIONS: Psychiatric graduates appear to value specialized education and experience in working with ID patients during residency, and feel more confident as a result. In spite of this, the majority of resident graduates did not identify ID training or expertise to their practice community, or choose to work with ID patients following residency.

[RESEARCH ARTICLES] Resident Education and Perceptions of Recovery in Serious Mental Illness: Observations and Commentary

Buckley, P., Bahmiller, D., Kenna, C. A., Shevitz, S., Powell, I., Fricks, L. — 2007-12-13

OBJECTIVE: Recovery is emerging as a guiding influence in mental health service delivery and transformation. As a consequence, the expectations and curricular needs of trainees (as future stakeholders in a transformed, recovery-oriented system) are now of considerable importance. METHOD: To this end, resident-led focus groups were held at the Medical College of Georgia to obtain perceptions of the Recovery Model. Certified Peer Support Specialists (CPSS) attended and topics covered were the Recovery Model, the CPSS training curriculum, and developing a Wellness Recovery Action Plan (WRAP) with consumers.RESULTS: Advantages and disadvantages of the Recovery model were discussed, with residents generally expressing cautious optimism regarding implementation of these principles, yet concern regarding the potential for diminishing confidence and support for traditional professional services. All residents indicated an interest in obtaining more information about the Recovery Model, including how to incorporate WRAPS and the role of CPSS in Recovery. Almost half of the residents selected a recovery-oriented workshop as the best method for further education about these concepts, with less support for other options of didactic handouts and expert lecture. CONCLUSIONS: Future efforts should be directed at implementing recovery curricula into resident education and evaluating the changes in resident knowledge, attitude toward recovery, and plans to implement recovery-oriented principles into their own professional practice.

[RESEARCH ARTICLES] Increasing the Rate of Return of Resident Rotation Evaluations by Their Attending Physicians in an In-Patient Psychiatric Facility

Shah, N., Thompson, B., Averill, P., Searle, N. — 2007-12-13

OBJECTIVE: Psychiatrist’s evaluations of residents are the primary means of determining whether the residents are ready to be promoted. However, the return rate for evaluations is quite low. The purpose of this study was to increase the return rates. METHODS: Feedback from two surveys and open discussion was utilized to develop and implement a system for increasing completion rates. Completion rates before and after the intervention were compared. RESULTS: The survey revealed that the initial evaluation form was too complex and not readily available. In addition, participants indicated that reminders would be helpful for increasing compliance. Completion rates were 48% and 80% for the 4 months prior and after the intervention, respectively. CONCLUSION: Addressing the problem and implementing suggested strategies increased completion rates significantly. However, it is unclear which strategy was most associated with the change. Future directions will focus on determining whether gains will be maintained and what would be necessary to obtain 100% compliance rates.

[RESEARCH ARTICLES] The Structured Clinically Relevant Interview for Psychiatrists in Training (SCRIPT): A New Standardized Assessment Tool for Recruitment in the UK

Rao, R. — 2007-12-13

OBJECTIVE: The multifaceted nature of training and the diverse backgrounds of potential Senior House Officers (Postgraduate Residents) require a novel approach to the selection of trainees wishing to pursue a career in psychiatry. The author reports the properties of a semi-structured interview (the SCRIPT) for assessing doctors short-listed for a large Senior House Officer Training Scheme in psychiatry in South East England.METHODS: Data from 3 recruitment periods between 2005 and 2006 was examined to assess both interrater reliability and variation in scoring between interviewers. All questions were operationally defined and were modeled on General Medical Council (UK) guidelines for Good Medical Practice.Result: For 3 consecutive recruitment periods, interrater reliability (measured by Cronbach alpha) retained a high level of significance (p<0.001). Differences between the maximum and minimum mean scores between panels differed by only 6% of the total possible score and differences between mean scores at the same (p values between 0.8 and 0.9) and different (p values between 0.2 and 0.4) interviews showed no significant differences.CONCLUSIONS: The development of a valid and reliable method for selecting Senior House Officers in Psychiatry shows promise in the recruitment of "tomorrow’s psychiatrists." Prospective data on the positive predictive value of individual scores in career development awaits further exploration. Given the birth of a new ‘Run Through Grade,’ the interview may have its place in the assessment process within Modernising Medical Careers in the United Kingdom.