Child Psychotherapy Training in the United States: A National Survey of Child and Adolescent Psychiatry Fellowship Program Directors.

OBJECTIVES: Training in child and adolescent psychotherapy continues to be emphasized by accrediting organizations (ACGME and ABPN) but it is not known how these skills are taught and what types of therapy are highlighted in fellowships across the United States. METHODS: A 16-question anonymous online survey was developed by the authors and covered six main areas: demographics, the priority of psychotherapy in training, the competency goals for different psychotherapy modalities, training strategies, types of supervision, and program directors' satisfaction of their training implementation and assessment of trainees. The survey was sent to every identified CAP program director during a three-month period in early 2017. RESULTS: Data was gathered from 53 of the 131 program directors surveyed, giving a 40% response rate. Ninety percent of CAP program directors strongly agree or agree that it is important to preserve and promote training and practice of psychotherapy. Most (83%) program directors indicated competence or expertise as a training goal for CBT with more variability among programs for other psychotherapies. Seventy percent of program directors agree that their program provides adequate time for learning and practicing psychotherapy but the allotted time for psychotherapy is low across majority of programs over both years of training. CONCLUSIONS: These results indicate that there is a gap between the goals of providing optimal training in psychotherapy with the low amount of protected time for the practice of psychotherapy. These results should provide a foundation for program directors to learn from each other about developing, improving, and implementing effective psychotherapy training.

Psychiatry Residents' Use of Educational Websites: A Pilot Survey Study.

OBJECTIVE: Psychiatry residents have numerous online educational resources readily available to them although currently there are no data regarding residents' use and perception of such websites. METHODS: A survey was offered to 62 residents from all four years of training as well as recent graduates of a single psychiatry residency training program. RESULTS: Residents reported utilizing online resources on average 68 % of the time, in comparison to 32 % on average for printed materials. Residents reported UpToDate, PubMed, and Wikipedia as the most visited websites and ranked each highly but for different purposes. Thirty-five percent of residents felt that insufficient faculty guidance was a barrier to use of these educational websites. CONCLUSIONS: Pilot data indicate psychiatry residents use online resources daily for their education in various settings. Resident perceptions of individual website's trustworthiness, ease of use, and sources of clinical decision-making and personal learning suggest potential opportunities for educators to better understand the current use of these resources in residency training. Reported barriers including lack of faculty guidance suggest opportunities for academic psychiatry. Further study is necessary at multiple sites before such results may be generalized.

Parent and young adult satisfaction with psychiatry consultation services in a children's hospital.

BACKGROUND: Quality of health care services can be improved by promoting patient- and family-centered care informed by patient and family satisfaction with services delivered. Few studies have been conducted looking at satisfaction with psychiatric consultation services within an inpatient pediatric hospital setting. OBJECTIVE: The objective of the quality improvement pilot project was to identify ways to enhance services delivered and to guide the development of more comprehensive quality improvement projects. METHOD: Forty-eight parents of forty-eight patients and 10 adult patients were administered the Pediatric Psychiatry Consultation Satisfaction Survey, which surveyed satisfaction with the psychiatric consultation services received during their stay in a freestanding tertiary pediatric academic hospital. RESULTS: Sixty-nine percent of participants reported overall high satisfaction (i.e., reports of excellent or very good) with the psychiatric consultation service along with 88% reporting that they would recommend this service to a friend. Overall high satisfaction with the service was associated with positive ratings with three core components of a consultation: provisions of impressions and recommendations (P = 0.018), consultant-participant communication and working relationship (P < 0.001), and the helpfulness of the consultation (P < 0.001). CONCLUSIONS: This quality improvement project underscores the importance of having psychiatry consultants convey their clinical impressions and recommendations, communicate effectively, and provide helpful interventions to parents and young adults in the pediatric hospital. It serves as an initial step responding to national consumers' demand for higher levels of quality and service and will provide guidance in future design and implementation of more comprehensive quality improvement projects.

Does early mentorship in child and adolescent psychiatry make a difference? The Klingenstein Third-Generation Foundation Medical Student Fellowship Program.

OBJECTIVE: There is a critical shortage of child and adolescent psychiatrists in the United States. Increased exposure, through mentorship, clinical experiences, and research opportunities, may increase the number of medical students selecting child and adolescent psychiatry (CAP) as a career choice. METHOD: Between 2008 and 2011, 241 first-year participants of a program to increase exposure to CAP, funded by the Klingenstein Third-Generation Foundation (KTGF) at 10 medical schools completed baseline surveys assessing their opinions of and experiences in CAP, and 115 second-year participants completed follow-up surveys to reflect 1 year of experience in the KTGF Program. RESULTS: Students reported significantly increased positive perception of mentorship for career and research guidance, along with perceived increased knowledge and understanding of CAP. CONCLUSIONS: Results suggest that the KTGF Program positively influenced participating medical students, although future studies are needed to determine whether these changes will translate into more medical students entering the field of CAP.

A Novel Medical Student Elective Course in Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Sexually and Gender Diverse Health: Training Tomorrow's Physician-Leaders.

Purpose: Inadequate medical training in lesbian, gay, bisexual, transgender, queer, intersex, asexual, and sexually and gender diverse (LGBTQIA+) health care contributes to health disparities. This article reports on a novel 4-week elective course at Harvard Medical School that prepares students to become physician-leaders in LGBTQIA+ health care. Methods: The course engages students in multidisciplinary clinical placements, self-directed learning, and mentored scholarly projects, all specifically relevant to LGBTQIA+ health. The authors qualitatively reviewed student experiences, and quantitatively analyzed course evaluations. Results: Between 2016 and 2022, 30 students completed the course, and 12 scholarly projects resulted in a published peer-reviewed article authored by the student. Students who completed evaluations rated the course as excellent and reported increased interest and core knowledge in LGBTQIA+ health care. Conclusion: This novel program has demonstrated feasibility and may serve as a model for establishing other advanced medical student clinical and scholarly electives on LGBTQIA+ health care.

Promoting interdisciplinary collaboration: trainees addressing siloed medical education.

OBJECTIVE: Professional siloing within medical institutions has been identified as a problem in medical education, including resident training. The authors discuss how trainees from different disciplines can collaborate to address this problem. METHOD: A group of trainees from psychiatry, developmental medicine, neurology, and education came together to develop a community of practice (CoP) to promote interdisciplinary collaboration. RESULTS: A key outcome was the development of a seminar including speakers and attendees (N=20 to 35) from psychiatry, developmental medicine, neurology, and education. The CoP, developed in 2008, continues to grow and develop through their seminar, which fosters institution-wide interdisciplinary collaboration. CONCLUSION: In an attempt to break down interdisciplinary silos, a CoP and interdisciplinary seminar were created. Trainee organizers benefited from an educational context that embodied adult-learning theory and promoted lifelong learning. The unique seminar that was created continues to promote a community sense of learning and practice. Outcome measures are currently being used to objectively measure these efforts.

Teaching Child and Adolescent Psychiatry in the Twenty-First Century: A Reflection on the Role of Technology in Education.

Technology has become an integral part of everyday life and is starting to shape the landscape of graduate medical education. This article reviews the use of technology in teaching child and adolescent psychiatry (CAP) fellows, and 3 main aspects are considered. The first aspect is use of technology to enhance active learning. The second aspect covers technology and administrative tasks, and the third aspect is the development of a technology curriculum for CAP trainees. The article concludes with a brief review of some of the challenges and pitfalls that have to be considered and recommendations for future research.

Gay adolescents and suicide: understanding the association.

Suicide among gay adolescents is a major public health concern, but it is still under-emphasized within mainstream healthcare. This article brings together information garnered from past studies, articles, and experiences to create a more in-depth understanding of why gay adolescents are at a higher risk for suicide. By creating a better understanding, this article attempts to push forward the significance of this issue and encourages physicians to take a more active role in suicide prevention. The article initially explores why issues involving homosexuality are seldom discussed and provides evidence for an increased risk in suicide among gay adolescents. By addressing major psychosocial issues faced by gay adolescents, it spends the majority of time facilitating an understanding of the increased risk. In this article "gay" refers to homosexual males and females, and bisexuals unless otherwise indicated.

Creating a Pilot Educational Psychiatry Website: Opportunities, Barriers, and Next Steps.

BACKGROUND: While medical students and residents may be utilizing websites as online learning resources, medical trainees and educators now have the opportunity to create such educational websites and digital tools on their own. However, the process and theory of building educational websites for medical education have not yet been fully explored. OBJECTIVE: To understand the opportunities, barriers, and process of creating a novel medical educational website. METHODS: We created a pilot psychiatric educational website to better understand the options, opportunities, challenges, and processes involved in the creation of a psychiatric educational website. We sought to integrate visual and interactive Web design elements to underscore the potential of such Web technology. RESULTS: A pilot website (PsychOnCall) was created to demonstrate the potential of Web technology in medical and psychiatric education. CONCLUSIONS: Creating an educational website is now technically easier than ever before, and the primary challenge no longer is technology but rather the creation, validation, and maintenance of information for such websites as well as translating text-based didactics into visual and interactive tools. Medical educators can influence the design and implementation of online educational resources through creating their own websites and engaging medical students and residents in the process.

A Novel Service-Oriented Professional Development Program for Research Assistants at an Academic Hospital: A Web-Based Survey.

BACKGROUND: Research assistants (RAs) are hired at academic centers to staff the research and quality improvement projects that advance evidence-based medical practice. Considered a transient population, these young professionals may view their positions as stepping-stones along their path to graduate programs in medicine or public health. OBJECTIVE: To address the needs of these future health professionals, a novel program-Program for Research Assistant Development and Achievement (PRADA)-was developed to facilitate the development of desirable professional skill sets (ie, leadership, teamwork, communication) through participation in peer-driven service and advocacy initiatives directed toward the hospital and surrounding communities. The authors hope that by reporting on the low-cost benefits of the program that other institutions might consider the utility of implementing such a program and recognize the importance of acknowledging the professional needs of the next generation of health care professionals. METHODS: In 2011, an anonymous, Web-based satisfaction survey was distributed to the program membership through a pre-established email distribution list. The survey was used to evaluate demographics, level of participation and satisfaction with the various programming, career trajectory, and whether the program's goals were being met. RESULTS: Upon the completion of the survey cycle, a 69.8% (125/179) response rate was achieved with the majority of respondents (94/119, 79.0%) reporting their 3-year goal to be in medical school (52/119, 43.7%) or nonmedical graduate school (42/119, 35.3%). Additionally, most respondents agreed or strongly agreed that PRADA had made them feel more a part of a research community (88/117, 75.2%), enhanced their job satisfaction (66/118, 55.9%), and provided career guidance (63/117, 53.8%). Overall, 85.6% of respondents (101/118) agreed or strongly agreed with recommending PRADA to other research assistants. CONCLUSIONS: High response rate and favorable outlook among respondents indicate that the program had been well received by the program's target population. The high percentage of respondents seeking short-term entry into graduate programs in health care-related fields supports the claim that many RAs may see their positions as stepping-stones and therefore could benefit from a professional development program such as the one described herein. Strong institutional support and sustainable growth and participation are other indications of early success. Further evaluation is necessary to assess the full impact of the program, particularly in areas such as job satisfaction, recruitment, retention, productivity, and career trajectory, but also in reproducibility in other institutions.

Education and depression.

This article is intended to assist educators in the medical field in promoting competency among medical students and trainees on the key issues in child and adolescent depression, including approach, understanding, and management. Using clinical vignettes, up-to-date research, and expert opinion and referencing accessible guidelines, resources, and tools, the authors' goal is to create information that is engaging and useful. It is designed to reach a broad audience with emphasis on trainees who are early in their career path (eg, medical students or interns) and/or who are going into primary care.

Respiratory sinus arrhythmia as an index of vagal activity during stress in infants: respiratory influences and their control.

Respiratory sinus arrhythmia (RSA) is related to cardiac vagal outflow and the respiratory pattern. Prior infant studies have not systematically examined respiration rate and tidal volume influences on infant RSA or the extent to which infants' breathing is too fast to extract a valid RSA. We therefore monitored cardiac activity, respiration, and physical activity in 23 six-month old infants during a standardized laboratory stressor protocol. On average, 12.6% (range 0-58.2%) of analyzed breaths were too short for RSA extraction. Higher respiration rate was associated with lower RSA amplitude in most infants, and lower tidal volume was associated with lower RSA amplitude in some infants. RSA amplitude corrected for respiration rate and tidal volume influences showed theoretically expected strong reductions during stress, whereas performance of uncorrected RSA was less consistent. We conclude that stress-induced changes of peak-valley RSA and effects of variations in breathing patterns on RSA can be determined for a representative percentage of infant breaths. As expected, breathing substantially affects infant RSA and needs to be considered in studies of infant psychophysiology.

Maternal posttraumatic stress symptoms and infant emotional reactivity and emotion regulation.

The current study examined associations between maternal posttraumatic stress disorder (PTSD) symptoms and infant emotional reactivity and emotion regulation during the first year of life in a primarily low-income, urban, ethnic/racial minority sample of 52 mother-infant dyads. Mothers completed questionnaires assessing their own trauma exposure history and current PTSD and depressive symptoms and their infants' temperament when the infants were 6 months old. Dyads participated in the repeated Still-Face Paradigm (SFP-R) when the infants were 6 months old, and infant affective states were coded for each SFP-R episode. Mothers completed questionnaires assessing infant trauma exposure history and infant current emotional and behavioral symptoms when the infants were 13 months old. Maternal PTSD symptoms predicted infants' emotion regulation at 6 months as assessed by (a) infant ability to recover from distress during the SFP-R and (b) maternal report of infant rate of recovery from distress/arousal in daily life. Maternal PTSD symptoms also predicted maternal report of infant externalizing, internalizing, and dysregulation symptoms at 13 months. Maternal PTSD was not associated with measures of infant emotional reactivity. Neither maternal depressive symptoms nor infant direct exposure to trauma accounted for the associations between maternal PTSD symptoms and infant outcomes. These findings suggest that maternal PTSD is associated with offspring emotion regulation difficulties as early as infancy. Such difficulties may contribute to increased risk of mental health problems among children of mothers with PTSD.

Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients.

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.