Academic Psychiatry Current Issue

An Argument for Conducting Methodologically Strong, Randomized, Controlled Trials in Educational Research

Coverdale JH, Balon R, Beresin EV, et al. — Wed, 01 May 2013 00:00:00 GMT

Best-evidence medical education is an approach that promotes a culture emphasizing the use of sound empirical evidence by teachers, curriculum designers, and leaders in the medical and health professions (1). Best-evidence medical education is, therefore, conceptually opposed to decisions in medical education that are made on the basis of “pseudoscience, anecdotes, and flawed comparison groups” (1). A mission of Academic Psychiatry is to help advance evidence in psychiatric education. Rigorously-designed evidence is, however, a rare thing. Study designs should aim to minimize the possibility of bias when determining the efficacy of educational interventions; and demands for both efficiency and effectiveness in teaching are especially vital given increasing clinical service demands of clinical faculty, threatened decreases in funding for graduate medical education (2), and the possibility of a reduction in length of medical school training (3).

A Systematic Review of Stress-Management Programs for Medical Students

Shiralkar MT, Harris TB, Eddins-Folensbee FF, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.

Method

The authors searched the published English-language articles on PsycINFO and PubMed, using a combination of the following search terms: stress-management, distress, burnout, coping, medical student, wellness. Both randomized, controlled trials and controlled, non-randomized trials of stress-management programs were selected and critically appraised.

Results

A total of 13 randomized, controlled trials or controlled, non-randomized trials were identified. Interventions included self-hypnosis, meditation, mindfulness-based stress-reduction, feedback on various health habits, educational discussion, changes in the length and type of curriculum, and changes in the grading system. Only one study was identified to be of very high quality, although several had described group differences at baseline, used blinding, had good follow-up, and used validated assessment tools. There was a wide heterogeneity of outcome measures used. Interventions that were supported by a reduction in stress and anxiety in medical students included mindfulness-based stress-reduction or meditation techniques, self-hypnosis, and pass/fail grading.

Conclusions

Significant opportunities to advance educational research in this field exist by developing more high-quality studies with particular attention to randomization techniques and standardizing outcome measures.

Academic Performance in the Context of a “Three Excused Absences” Psychiatry Clerkship Policy

Schillerstrom JE, Lutz M. — Wed, 01 May 2013 00:00:00 GMT

Objective

In order to better manage medical student absences during the psychiatry clerkship, a policy allowing students to miss up to 3 days without penalty was developed. The purpose of this study was to describe absence patterns and compare academic performance between students with and without absences.

Method

Authors reviewed the academic record of 3rd-year medical students rotating through the psychiatry clerkship between July 1, 2009 and June 30, 2011. The number of clerkship absences during the 6-week rotation, NBME shelf performance, and clinical evaluation scores were extracted. The sample was dichotomized into “absent” and “non-absent” groupings, and mean NBME shelf exam and subjective grades were compared by Student’s t-test.

Results

During this period of observation, 249 students (57.5%) had no absences; 96 (22.1%) had one absence; 62 (14.3%) had two absences; 25 (5.8%) had three absences; and 1 (0.2%) had four absences. Students with no absences had higher mean NBME psychiatry shelf exam scores than students with ≥1 absences. Mean clinical grades, which include a professionalism component, and final course letter grade distribution did not differ significantly between absent and non-absent students.

Conclusion

Given that students with absences seemed as academically successful as students who were not absent, we conclude that this policy may effectively manage commonly-expressed attendance concerns.

Attitudes of Medical Students Toward Psychiatry and Psychiatry as a Career: A Systematic Review

Lyons Z. — Wed, 01 May 2013 00:00:00 GMT

Objective

The discipline of psychiatry, and psychiatry as a career option, have been negatively regarded by medical students for decades. There is a large amount of literature on attitudes of students and the factors that attract them to and detract from psychiatry. The aim of this article is to systematically review this literature from 1990 to the present time.

Method

The author undertook a systematic review searching a number of electronic databases using the following key words: medical students, attitudes, psychiatry, career. Studies were included in the review if they had been published in an English-language, peer-reviewed journal. Data extracted included year of publication, country where the study was conducted, study design and aim, sample size and response rate, year of study that students were in when they participated in the research, and main results.

Results

A total of 32 papers from 22 different countries were selected for inclusion; 12,144 students from 74 medical schools were surveyed. A mix of positive and negative attitudes toward psychiatry were identified, and, overall, attitudes were found to be positive. However, psychiatry as a career choice was rated poorly and found to be unpopular for many students.

Conclusion

The studies undertaken to-date have identified and raised awareness of a wide range of negative and positive factors toward psychiatry. In order to encourage more students to consider psychiatry as a career, attention needs to focus more closely on the psychiatry curriculum and the development of innovative teaching strategies. This may overcome the negativity that students express toward psychiatry, improve recruitment rates to training programs, and put psychiatry on a more positive foundation for the future.

Web-Streamed Didactic Instruction on Substance Use Disorders Compares Favorably With Live-Lecture Format

Maher K, Brower KJ, Mullan PB, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

Education about substance use disorders in medical schools and, subsequently, physicians’ identification of and intervention in these diagnoses lag behind that of most other disabling disorders. To reduce barriers and improve access to education about this major public health concern, medical schools are increasingly adopting web-based instruction on substance use and other psychiatric disorders as part of their curricula; however, it is not well known how a web-streamed lecture compares with a traditional one. The authors hypothesized that both these formats would be equally efficacious in terms of knowledge acquisition and student satisfaction.

Method

Authors conducted a prospective study to test this hypothesis among third-year medical students who received web-streamed lecture on substance use/addiction versus those who received a traditional live lecture.

Results

Of the 243 students, significantly more students completed the on-line lecture series. Of the 216 students in the final study sample, 130 (60%) were assigned to the web-streamed lecture and 86 (40%) to the live lecture. Within-subject comparisons of pre- and post-lecture scores for the entire cohort indicated a significant improvement in the percentage of correct answers (21.0% difference). Although no differences in improved scores between the two groups were found, students in the live-lecture group reported small, but significantly higher levels of satisfaction.

Conclusions

This preliminary work supports the hypothesis that a web-streamed lecture can be at least equally efficacious as a traditional lecture in terms of knowledge acquisition. However, attention needs to be paid to the lower satisfaction levels associated with using the web-streamed format.

Influence of Clerkship on Attitudes of Medical Students Toward Psychiatry Across Cultures: United States and Qatar

Burgut F, Polan H. — Wed, 01 May 2013 00:00:00 GMT

Objective

To assure adequate treatment for patients with mental illness worldwide, medical schools must impart positive attitudes toward psychiatry. The authors examined the effect of culture on changes in attitudes toward psychiatry among medical students receiving the same psychiatry clerkship curriculum in two different countries.

Methods

A group of 74 students from Weill Cornell Medical College–New York and 32 from Weill Cornell Medical College–Qatar completed pre- and post-clerkship questionnaires assessing their attitudes toward psychiatry.

Results

On the pretest, the Qatar students had less positive attitudes than the New York students, as evidenced by lower group mean total scores. During the clerkship, the attitudes of students at both schools improved, but more markedly in Qatar, narrowing the group differences.

Conclusion

A psychiatry clerkship with a U.S.-derived curriculum had a positive effect on medical students’ attitudes toward psychiatry in Qatar, suggesting the usefulness of applying such curricula across cultures.

Psychiatry Student Interest Groups: What They Are and What They Could Be

Reardon CL, Dottl S, Krahn D. — Wed, 01 May 2013 00:00:00 GMT

Objective

Medical student interest groups across all specialties help students explore various specialties. There are no published reports on psychiatry student interest group (PSIG) curricula. The aim was to develop elements of a curriculum for such groups, based on data elicited from medical students and faculty members through a multi-institutional online survey.

Method

The authors electronically surveyed 172 United States psychiatric residency training directors to determine the activities they felt to be important for inclusion in PSIG curricula. Similarly, they surveyed U.S. medical student PSIG leaders to ascertain the activities they felt important to include in such groups, and the current content of their groups.

Results

Authors received responses from 64 program directors and 44 PSIG leaders. Based on integration of the results of both surveys, and the practices of existing groups, they propose elements of a curriculum for PSIGs. Medical student PSIG leaders are particularly interested in activities that involve residents. Other curricular topics of interest both to students and training directors include those that focus on student/physician mental health and various psychiatry subspecialties or practice settings. Training directors are willing to be involved with a wide variety of PSIG activities.

Conclusions

The results of these surveys should help to guide PSIG leaders and faculty members in optimizing their PSIG curricula by helping them to include those activities felt to be of most interest by students and of most relevance by training directors.

Subspecialty Exposure in a Psychiatry Clerkship Does Not Improve Student Performance in the Subject Examination

Retamero C, Ramchandani D. — Wed, 01 May 2013 00:00:00 GMT

Objective

The authors compared the NBME subject examination scores and subspecialty profiles of 3rd-year medical students who were assigned to psychiatry subspecialties during their clerkship with those who were not.

Method

The authors collated and analyzed the shelf examination scores, the clinical grades, and the child psychiatry and emergency psychiatry shelf profiles of 361 junior medical students in two medical schools during their psychiatry clerkship.

Results

There were no significant differences on these parameters between the students assigned to subspecialty sites and those who were not.

Conclusion

This study, like some similar previous studies in other clerkships, calls attention to the lack of measurable academic benefit of fragmenting and compartmentalizing the psychiatry clerkship experience for 3rd-year medical students.

Substance Use and Attitudes on Professional Conduct Among Medical Students: A Single-Institution Study

Choi D, Tolova V, Socha E, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

This study sought to examine how specific substance-use behavior, including nonmedical prescription stimulant (NPS) use, among U.S. medical students correlates with their attitudes and beliefs toward professionalism.

Method

An anonymous survey was distributed to all medical students at a private medical university (46% response rate). Participants were asked to report alcohol and marijuana use patterns, NPS use, stress levels, and history of suicidal ideation.

Results

Over one-third of medical students reported excessive drinking during the past month, and 5% reported NPS use during the past year. Students who endorsed such behavior were significantly less likely to view it as unprofessional and warranting intervention. A large number of students seemed unfamiliar with how to help a classmate with an NPS use problem.

Conclusions

Medical students’ substance use behaviors appear to influence attitudes and beliefs toward professional issues regarding substance use.

Telemedicine for Peer-to-Peer Psychiatry Learning Between U.K. and Somaliland Medical Students

Keynejad R, Ali FR, Finlayson AT, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

The proportion of U.K. medical students applying for psychiatry training continues to decline, whereas, in Somaliland, there are no public-sector psychiatrists. This pilot study assessed the usefulness and feasibility of online, instant messenger, peer-to-peer exchange for psychiatry education between cultures.

Method

Twenty medical students from King’s College, London, and Hargeisa University (Somaliland) met online in pairs every 2 weeks to discuss prearranged psychiatric topics, clinical cases, and treatment options, completing online evaluations throughout.

Results

Average ratings of the enjoyment, academic helpfulness, and interest of sessions were 4.31, 3.56, and 4.54 (of a maximum of 5), respectively; 83% would recommend the partnership to a friend.

Conclusion

This partnership enabled students on both sides to exploit psychiatry-learning resources at the other’s disposal, outside the standard medical education context, illustrating the benefits to medical students in dramatically different locations of partnership through telemedicine. This pilot study presents an innovative, cost-effective, under-used approach to international medical education.

An Approach to Improving Psychiatry NBME and USMLE Performance

Spollen J, Cluver J. — Wed, 01 May 2013 00:00:00 GMT

The role of the National Board of Medical Examiners (NBME) and their testing services, specifically, the subject examinations and the United States Medical Licensing Examinations (USMLE), continues to be a prominent one. Most medical schools require passing scores on USMLE Steps 1 and 2 before graduation, and medical boards across the United States require passing scores on the USMLE for licensure. Also, USMLE scores are a significant factor in the residency application and match process (1, 2).

Using Mutual Invitation in Educational and Professional Small-Group Settings

Tsao C. — Wed, 01 May 2013 00:00:00 GMT

Though interpersonal and communication skills are one of the six ACGME general competencies (1), little formal guidance is provided to physician trainees on the subject of participation in and/or leading group discussions. Although group work can be structured, as in the case of “buzz groups” or “think-pair-share (2),” observation suggests that physician trainees usually devolve into one of three common group processes: 1) volunteering, speaking when one cares to; 2) taking turns, going around in a circle; and 3) awaiting selection, speaking when called upon by a leader or facilitator.

Call for Papers: Mental Health in Students

Wed, 01 May 2013 00:00:00 GMT

Academic Psychiatry invites manuscripts focusing on the topic of mental health in students. We welcome papers that focus on the mental health and well-being of college students, medical students, residents, and fellows across specialties of medicine, postdoctoral graduate students, and students in the health professions, including psychology, nursing, dentistry, and other fields. Original research and evidence-based review papers are also welcome on special topics such as sleep and sleep-related issues, self-care, the use of substances by students, the use of stimulants, including those for performance enhancement, by students, aggressive or disruptive behavior of students, and suicide. Papers should be submitted by October 1, 2013, to Manuscript Central (http://mc.manuscriptcentral.com/appi-ap). Please indicate in the cover letter that the submission is for this special topic. All manuscripts will undergo peer review, and publication is not guaranteed. Queries regarding possible submissions are welcome. If you wish to discuss manuscript ideas, please contact the editor-in-chief via e-mail at acadpsych@gmail.com.

Call for Papers: Psychiatric Education and Neuroscience

Wed, 01 May 2013 00:00:00 GMT

Over the past few decades, psychiatric research has increasingly converged on the importance of neuroscience for understanding psychopathology, the mechanisms of current treatments, and avenues for novel therapeutics. Despite these large scientific advances, education of psychiatrists in neuroscience has lagged significantly. This lag may be attributable to numerous factors, the result of which is a psychiatric workforce presently unprepared for understanding these innovations, interfacing with patients over them, and integrating neuroscientific advances into their clinical care.

Call for Papers: Public Health Training

Wed, 01 May 2013 00:00:00 GMT

Academic Psychiatry invites manuscripts focusing on the topic of public health training in psychiatric education. We welcome papers on innovative curricula, special educational experiences for trainees, and descriptions of programs that allow trainees to obtain advanced degrees in public health and their outcomes. The value and future career paths of individuals with public health training are topics of interest. We welcome empirical papers looking at, for example, the representation of individuals with public health training in academic psychiatry, public policy, and other segments of the psychiatry workforce. Papers should be submitted by September 1, 2013, to Manuscript Central (http://mc.manuscriptcentral.com/appi-ap). Please indicate in the cover letter that the submission is for this special topic. All manuscripts will undergo peer review, and publication is not guaranteed. Queries regarding possible submissions are welcome. If you wish to discuss manuscript ideas, please contact the editor-in-chief via e-mail at acadpsych@gmail.com.

Call for Papers: Suicide Prevention, Nontraditional Career Paths, and Lessons of Leadership

Wed, 01 May 2013 00:00:00 GMT

Academic Psychiatry requests papers on suicide prevention and intervention training for medical students, residents, and fellows. Despite the serious public health impact and life-threatening nature of illnesses and conditions associated with suicide, they have received little attention in society and are poorly understood and profoundly stigmatized. Learning to understand and evaluate people at risk for self-harm is an important element of medical student and resident education. New evidence-based models for prevention of suicide are emerging, and these new models have inspired optimism. Integrating these new models is an exciting challenge for medical educators. We are working with the Kubly Foundation to create a special issue of articles that support the development of novel curricula and innovative teaching in the important area of suicide prevention, evaluation, and intervention.

Nigerian Medical Students' Opinions About the Undergraduate Curriculum in Psychiatry

James B, Omoaregba J, Okogbenin E, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

The number of psychiatrists in Nigeria is inadequate to meet the treatment needs for neuropsychiatric disorders. Developing mental health competency in the future Nigerian physician workforce is one approach to filling the treatment gap. The authors aimed to assess medical students’ attitudes to this training and its relevance to their future practice and to assess whether they are getting adequate or relevant training.

Method

A cross-sectional, questionnaire-based survey was undertaken among a sample (N=375) of 5th- and 6th-year students across four medical schools in Nigeria.

Results

Over one-tenth (12%) chose psychiatry as a future career choice. Most expressed positive attitudes toward psychiatry and its relevance to their future careers. A majority were enthusiastic about receiving training in psychiatry in primary-care settings and welcomed a curriculum that emphasized the learning and management of common psychiatric disorders seen in general practice.

Conclusion

Medical students surveyed would welcome an undergraduate curriculum that integrates the learning of psychiatry with other specialties and skills-training relevant for primary care. Efforts to modify the current curriculum in psychiatry in Nigerian medical schools should be encouraged.

Resident and Medical Student Viewpoints on Their Participation in a Telepsychiatry Rotation

Dzara K, Sarver J, Bennett JI, et al. — Wed, 01 May 2013 00:00:00 GMT

Telepsychiatry involves the use of electronic communication and information technologies to provide psychiatric care from a distance (1, 2). Treatment may be provided through the telephone, e-mail, the Internet, and television (1, 2). Videoconferencing is a useful and effective way for psychiatrists to treat patients (2, 3). Patients and providers are satisfied with the use of telepsychiatry, which provides therapeutic outcomes similar to those of face-to-face encounters (2, 3). Because telepsychiatry is an evolving form of treatment provision, we have much to learn about its effective incorporation into medical training (4–6).

Senior Medical Students’ Attitudes Toward Psychiatry as a Career Choice Before and After an Undergraduate Psychiatry Internship in Iran

Amini H, Moghaddam Y, Nejatisafa A, et al. — Wed, 01 May 2013 00:00:00 GMT

Objectives

The study aimed to assess 1) the attitudes of medical students in the sixth and seventh years (known as interns in Iran) toward psychiatry as a career choice, and 2) the degree of attractiveness of psychiatry as a career choice, with regard to various defined aspects, before and after an undergraduate psychiatry internship (similar to the medical school psychiatry rotation in the United States, but mandatory in Iran) in three major medical schools in Tehran, the capital of Iran.

Method

Sixth- and seventh-year medical students (locally called interns, N=347) at Tehran, Shahid Beheshti, and Iran Universities of Medical Sciences were consecutively invited to complete anonymous self-report questionnaires designed to assess their perceptions of careers in psychiatry before and after internship in psychiatry wards. Also, students evaluated psychiatry in terms of the factors that reflected the degree of attractiveness of this specialty.

Results

Positive responses toward choosing psychiatry as a career were seen in 18.8% before and 20.0% after psychiatry rotation. No significant differences were observed in the positive responses before and after psychiatry internship. The students’ opinions changed to a more attractive degree in terms of only 3 out of the 13 defined aspects. There was also no significant difference in the total score on attractiveness of psychiatry before and after the psychiatry internship.

Conclusions

The study indicated that undergraduate psychiatry internship might not induce more students to consider psychiatry as a possible career. The present pattern of psychiatry education in Iran seems not to positively affect most aspects of medical students' attitudes toward psychiatry.

ERRATA

Wed, 01 May 2013 00:00:00 GMT

In the November-December 2012 issue, the title of the article from Korszun A, et al., “Response to Prabhakar et al. Letter” (Acad Psychiatry 2012; 36:500) should be “Response to Vahabzadeh et al. Letter.”