Implementation and Evaluation of Educational Workshops to Increase Primary Care Provider and Medical Student Comfort in Psychiatric Care.

OBJECTIVE: Mental health treatment is often initiated in primary care settings, but many primary care providers (PCPs), residents, and medical students report discomfort in managing psychiatric conditions. This study evaluated the effect of an educational workshop that featured an evidence-based psychopharmacology clinical decision support tool (CDST) on trainee confidence and willingness to treat psychiatric conditions. METHODS: Participants completed pre- and post-workshop surveys. Nine months after the workshop, a subset of trainees participated in a focus group. RESULTS: Of the participants, 62.5% of the obstetrics-gynecology (OB-GYN) resident physicians (10/16) and 100% of the medical students (18/18) completed both pre- and post-surveys. Following the workshop, OB-GYN resident physicians reported significantly improved confidence in treating psychiatric disorders (p < 0.001), sense of having psychiatric support tools (p < 0.001), and knowledge of treating psychiatric disorders (p = 0.021). Medical students reported significantly improved confidence in treating psychiatric disorders (p < 0.001), willingness to devise treatment plans for psychiatric disorders (p = 0.024), sense of having psychiatric support tools (p < 0.001), knowledge of treating psychiatric disorders (p < 0.001), and comfort in presenting a psychiatric treatment plan to an attending (p = 0.003). Most focus group participants (93.75%; 15/16) reported that they continued to use the CDST, and it increased their confidence in formulating psychiatric treatment plans. CONCLUSIONS: These findings suggest that educational workshops that introduce high-quality psychopharmacology CDSTs may be an effective method for improving provider comfort in treating psychiatric disorders.

Rumination burdens the updating of working memory.

Working memory is a vital, but capacity-limited, cognitive instrument that requires frequent updating as our goals and environment change. Individuals diagnosed with depression have a reduced capacity compared with the general population, as they have a propensity to fixate on negative information, even when it is not relevant for the task at hand. Here we investigated how characteristics of psychiatric illnesses, such as rumination, affect a person's ability to efficiently update emotional information in mind. We used both neutral and negative pictures of scenes in a working memory updating task that required participants to occasionally replace items held in mind during a brief delay period. Participants were presented with a probe item at the end of each trial and asked to report whether that item was in their current memory set. Responses were slowest and least accurate for images that had been replaced (i.e., "lures"), indicating there was some difficulty in successfully updating working memory in this paradigm. Participants who have both a high propensity to ruminate and a low working memory capacity were significantly more likely to false alarm to these lures. While emotional valence did not impact accuracy for these participants, their false alarms were faster for negative stimuli compared with neutral stimuli, indicating that task-irrelevant emotional information was more difficult to remove from working memory. These results demonstrate how rumination impairs goal-directed behavior by obscuring the boundary between relevant and irrelevant information in working memory.

No One Dies Alone: Addressing a Gap in Medical Education.

Medical school curriculum typically consists of didactical experiences with minimal patient interaction for junior students followed by clinical experiences with supplementary didactics for senior students. Due to the focus on understanding basic medical concepts and disease pathophysiology during the first few years of medical school, students have limited exposure to real-life clinical situations that involve complex, difficult concepts such as death and dying. This leaves students ill-prepared to contribute meaningfully to patients' end-of-life (EOL) care that they will inevitably encounter during their clerkship years. We believe that students would benefit from increased exposure to these difficult situations through structured educational environments, such as the No One Dies Alone Program. In this way, students can become more familiar with the difficult concepts of death and dying, learn how to make meaningful contributions in their patients' EOL care, and ultimately provide patients with the "good death" they deserve.