Addressing the Health Needs of LGBTQ Persons in Medical Curricula: A Review of Educational Programs.

OBJECTIVE: Given the vulnerability of and the importance of caring for the specific health care needs of the growing lesbian, gay, bisexual, transgender, and queer (LGBTQ) population, the authors attempted to identify all educational interventions in psychiatric settings with quantitative outcomes targeting medical students, residents, and physicians in postgraduate settings. To gain insight from other disciplines that have published research in this area, a second objective was to review studies in teaching in those other disciplines. The authors sought to describe the methods of selected studies. METHODS: The authors searched the published English-language literature indexed in PubMed, EMBASE, and PsycINFO using key terms for health care education concerning LGBTQ populations. The authors described and critically appraised studies with quantitative outcomes designed to enhance knowledge, skills, and attitudes in treating the LGBTQ community. RESULTS: Of the 15 trials identified, 10 included medical students, 4 included internal medicine residents or medical school faculty, and 1 included oncologists. We did not find any randomized controlled trials or controlled nonrandomized trials of curricula dedicated to teaching learners in psychiatry. All of the studies included a presurvey, followed by an educational intervention and then a postsurvey assessment. The educational interventions, outcome measures, and quality of studies varied widely. Four studies enrolled self-identified members of the LGBTQ community as trainers and facilitators of the educational interventions. CONCLUSIONS: The lack of high-quality controlled studies indicates the need to develop evidence-based curricula to support the education of the psychiatric workforce to provide for the special needs of LGBTQ persons.

Palliative Care Psychiatry: Building Synergy Across the Spectrum.

PURPOSE OF REVIEW: Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS: PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Education Innovations in the Department of Psychiatry at Washington University.

The Department of Psychiatry at Washington University has been innovating psychiatric education during the second millennium at all levels of training - undergraduate medical, general residency, and child and adolescent psychiatry (CAP) fellowship training. Undergraduate medical education now occurs in three phases. The 18-month pre-clerkship phase is divided into seven multidisciplinary modules that span basic, social, and clinical sciences. Psychiatry is part of the seven-week long Brain and Behavior module. The yearlong second phase includes a six-week traditional psychiatry clerkship-like experience bracketed by an introductory foundational week and a one-week consolidation period. The third phase is 18 months in length and provides in-depth exploration of both clinical and non-clinical areas. The residency training program has enlarged the number of residents undergoing training and simultaneously greatly expanded the clinical exposure to include rotations in eating disorders and perinatal psychiatry. In addition, our residents can choose to enhance their training in either our research or leadership focused options, both of which are also available to trainees in our child and adolescent program. Additionally, our CAP trainees are exposed to several unique areas including eating disorders and substance use disorders. We believe that these innovations across the educational spectrum allow us to prepare our learners for the practice of psychiatry in the 21st century.

Medical students' attitude towards psychiatry: a comparison of past and present.

Attitude to psychiatry influences motivation for medical students to successfully achieve in studying psychiatry. With a new generation of students, it would be interesting to investigate how attitudes have changed. This study aimed to compare the attitude of fifth-year medical students toward psychiatry in recent and in the past 24 years. Two samples of fifth-year medical students at Chiang Mai University completed the 30-item attitude to psychiatry (ATP-30); 118 students completed it in 1996, whereas 242 medical students completed it in 2019. Rasch analysis was employed for examining the differences between the total score and individual item scores between the two groups. The total score of ATP in the 2019 group was significantly higher than that in the 1996 group. After misfitting individuals and biased items were removed, only 15 items were valid and useful for a comparison. Of 15 items, 11 were found highly significantly different between two groups (p < 0.001). Negatively worded items, e.g., no strong evidence indicating effectiveness, became easier to score items (increased positive attitude) whereas some positively worded items, e.g., I would like to be a psychiatrist. Nine items, became more difficult (less positive attitude) comparing between 1996 and 2019. In a comparison between the two methods using the traditional t-test and Rasch analysis, only 5 of 30 items (16.7%) agreed with each other. The overall attitude to psychiatry was significantly higher at the present compared with that in the past. Most items did not differ between the two times. Further studies regarding improving the attitude scale using item response theory such as Rasch should be encouraged.

Assessing the competitiveness of medical humanities research on psychiatry, otolaryngology, and ophthalmology residency program applications.

Medical humanities research is an increasing area of interest for students as medical schools become more aware of the benefits of humanities and the arts on patient care. However, medical students may feel dissuaded from pursuing medical humanities work for fear of how it will be perceived on their residency applications. In this study, residency program directors (PDs) in New York state in psychiatry, ophthalmology, and otolaryngology were surveyed about their opinions on the competitiveness of students doing medical humanities research applying to their programs. Of the 64 PDs contacted, twenty submitted responses (31.3%). When asked if a residency applicant who only had medical humanities research experience would be seriously considered for their program, 95% of PDs said yes. Furthermore, 65% of PDs said that having medical humanities research experience in addition to clinical research increased a student's chance of being accepted to their program. Thirty percent of PDs indicated that the medical humanities were an important selection criteria for their program. Qualitative responses emphasized that non-traditional projects, such as personal essays, were as valid as published journal articles when conducted with academic rigor. Many PDs also believed that the medical humanities increased compassion, empathy, and communication skills in their residents. Considering these results, medical students should feel empowered to pursue medical humanities research, even if they are applying into a competitive surgical specialty. It should not diminish their chances of being seriously considered for a program, and may even confer an advantage over their clinical research peers.

Peer-to-Peer Trauma-Informed Training for Surgical Residents Facilitated by Psychiatry Residents.

OBJECTIVE: This article describes the implementation of trauma-informed care (TIC) didactic training, using a novel, interdisciplinary peer-to-peer teaching model to improve confidence surrounding trauma-informed practices in a surgical residency program. METHODS: Eight psychiatry residents and two medical students with a background in psychological trauma and TIC and an interest in medical education were recruited to participate in three 2-hour "train the trainer" sessions led by a national expert in TIC. Eight psychiatry residents and two medical students subsequently developed and delivered the initial TIC training to 29 surgical interns. Training included the neurobiology of psychological trauma, principles of trauma-informed care, and developing trauma-informed curricula. RESULTS: Surgical interns reported significantly improved understanding of the physiology of trauma, knowledge of TIC approaches, and confidence and comfort with TIC and practices. Among surgical interns, understanding of the physiology of the fear response increased from 3.36 to 3.85 (p = 0.03). Knowledge of the neurobiology of trauma improved between pre- and post-training surveys (2.71 to 3.64, p = 0.006). Surgery interns also expressed an improved understanding of the connection between fear, trauma, and aggression (3.08 to 4.23, p = 0.002) from pre- to post-training surveys. Post-training knowledge of trauma-informed approaches increased from 2.57 to 4.71 (p < 0.001) and confidence in delivering TIC on the wards increased from 2.79 to 4.64 (p < 0.001). CONCLUSION: This TIC curriculum delivered via a peer-to-peer training model presents an effective way to improve comfort and confidence surrounding TIC practices and approaches in a surgical residency training program.

Capacitación no escolarizada en psicoterapia: problemas y perspectivas / Non-school training in psychotherapy: problems and perspectives

Introducción: la capacitación no escolarizada en psicoterapia se define como la enseñanza de esta intervención por fuera de los entornos clínicos universitarios y de la normativa de educación universitaria. Aunque esta forma de estudios es bastante aceptada por psiquiatras y otros profesionales de la salud mental, esta podría no garantizar una adecuada capacitación y certificación. La presente revisión describe las características de la capacitación no escolarizada en psicoterapia en el Perú y aborda los potenciales problemas con la capacitación y certificación. Método: se realiza un análisis de la capacitación no escolarizada de psicoterapia y se la compara con el modelo formativo en psicoterapia de la residencia de Psiquiatría. Resultados: la capacitación no escolarizada en psicoterapia es una modalidad válida de estudios. Sin embargo, su alcance académico y profesional debe ser mejor valorado ya que estos programas podrían no contar con los recursos para reemplazar la capacitación universitaria, y no cuentan con el valor legal para facultar el ejercicio profesional de la psicoterapia de acuerdo a las normativas actuales de la educación universitaria y de licenciamiento profesional. Conclusión: es necesario fortalecer la capacitación de psicoterapia en la residencia de Psiquiatría y la apertura de programas universitarios de postgrado (programas de especialización, maestría o doctorado) para que la capacitación y certificación de psicoterapia sigan los canales formativos y de licenciamiento profesional oficiales.

Introduction: non-school training in psychotherapy is defined as the teaching of this intervention outside of university clinical settings and university education regulations. Although this form of study is widely accepted by psychiatrists and other mental health professionals, it may not guarantee adequate training and certification. This review describes the characteristics of non-school training in psychotherapy in Peru and addresses possible problems with training and certification. Method: an analysis of the non-schooled psychotherapy training is carried out and compared with the training model in psychotherapy of the psychiatric residency. Results: non-school training in psychotherapy is a valid study modality. However, their academic and professional scope should be better valued since these programs may not have the resources to replace university training, and they do not have the legal value to license the professional practice of psychotherapy according to current regulations of college education and professional licensing. Conclusion: it is necessary to strengthen psychotherapy training in psychiatry residency and the opening of postgraduate university programs (specialization, master or doctorate programs) so that psychotherapy training and certification follow the official training and professional licensing channels.

Palliative Care Training for Geriatric Psychiatry Fellows: A National Survey Project.

OBJECTIVES: Palliative care is an essential part of the standard of care for individuals with serious medical illnesses. Integration of palliative care and mental health is important for elderly patients with medical and psychiatric comorbidities. Geriatric psychiatrists are natural stewards of palliative care-mental health integration, however this is contingent on palliative care training. Currently, palliative care training in geriatric psychiatry fellowship programs is uncharacterized. We surveyed geriatric psychiatry fellowship program directors in the United States to assess current palliative care training practices. METHODS: Web-based anonymous survey of geriatric psychiatry fellowship training directors RESULTS: Forty-six percent (28/61) of program directors responded. Seventy one percent (20/28) of programs provide didactics on palliative care. Seventy-seven percent (20/26) of programs provide clinical experiences in palliative care. Sixty-three percent (15/24) have formalized interactions between geriatric psychiatry and palliative care fellows. CONCLUSIONS: Palliative care training for geriatric psychiatry fellows is robust but unstandardized. Operationalizing palliative care training for geriatric psychiatrists may improve mental health integration into serious illness care.

Prevalent Gaps in Understanding the Features of Catatonia Among Psychiatrists, Psychiatry Trainees, and Medical Students.

Background: Catatonia is often overlooked, and a key factor for underdiagnosis may be an inadequate understanding of catatonia's heterogeneous phenotypes. The aim of this study was to identify the current state of theoretical and applied knowledge of catatonic features among psychiatry trainees and practitioners using the Bush-Francis Catatonia Rating Scale (BFCRS), the most commonly used instrument to identify and score catatonia.Methods: We created an online 50-item multiple-choice test and 3-minute standardized patient video to be scored using the BFCRS. Email invitations were sent to medical students and psychiatry residents and fellows through listservs of psychiatry clerkship and residency directors and to consultation-liaison psychiatrists through the Academy of Consultation-Liaison Psychiatry. Participants could access the exam from October 1 to December 31, 2020.Results: In our sample (n = 482), participants correctly answered an average of 55% of test questions and identified 69% of BFCRS items on the standardized patient exam. Multivariable regression adjusting for demographics revealed that, compared to medical students, psychiatrists scored 7 points higher on the multiple-choice test and identified only 2 more items correctly on the BFCRS. Older participants performed worse than younger participants. No meaningful performance differences were identified by region or gender. Several items were consistently misidentified.Conclusions: We found significant inaccuracies in clinicians' understanding of catatonic features irrespective of their stage of training and years of experience. These data suggest prevalent gaps in catatonia recognition among psychiatrists, psychiatry trainees, and medical students utilizing the BFCRS. This has important implications for clinical research and patient care.

[Improvement of Medication Adherence in Psychiatry and Mental Health Literacy Education].

In Japan, the number of patients with mental illness is increasing; therefore, the need for national measures, such as suicide prevention measures and measures against alcohol health disorders, and multiple social concerns and needs, such as depression and dementia problems, are increasing. As such, measures for mental health are emphasized. Mental health is a common issue; however, there is still prejudice regarding mental illness, and its understanding and awareness by local residents and medical staff need to be improved. The author introduced a medication self-management module in the psychiatric ward to improve medication adherence, and constructed a program for mental health literacy education in the faculty of pharmacy. This paper outlines these studies.

Estigma y enfermedad mental: intervención en estudiantes de Medicina / Mental illness and stigma: an intervention in medical students / Estigma e doença mental: intervenção em estudantes de medicina

Resumen: El estigma generado por el personal de salud constituye una barrera que limita la accesibilidad a la asistencia de las personas que padecen enfermedades mentales. Por este motivo, la Clínica Psiquiátrica de la Universidad de la República generó estrategias didácticas aplicables durante el pasaje de los estudiantes de Medicina por la especialidad, para concientizar acerca de la estigmatización hacia las personas con enfermedad mental. Para ello, se diseñó un trabajo cuyos objetivos fueron valorar el impacto de la pasantía mediante la utilización de cuestionarios confeccionados por las autoras, autoaplicados al inicio y al final de ésta, así como revisar y adecuar las estrategias propuestas. Se encuestaron 1.356 estudiantes al inicio y 933 (68,8%) al final de la pasantía entre los años 2013 y 2016. Se evidenció una disminución en las actitudes estigmatizantes, una mayor comprensión de la enfermedad mental y un aporte en la formación integral de los médicos generales luego de la rotación. El procesamiento estadístico de los datos se realizó con el programa Graph Pad Prism versión 4.0. Se utilizó la estadística descriptiva para el análisis de los datos y el test no paramétrico de Mann-Whytney para la comparación de medias. Fueron considerados significativos valores de p menores de 0,05. Se concluyó que el contacto de los estudiantes con las personas con enfermedad mental, junto con una intervención específica en esta temática, constituyen una estrategia útil para la reducción del estigma.

Summary: Health professionals' stigma towards mental illness creates serious barriers to access healthcare services by patients who suffer from them. Therefore, the Psychiatric Clinique of the University of the Republic devised didactic strategies to apply during the time medical students complete this specialization, to raise awareness about stigma towards people with mental illness. To that end, a study was designed with the objective of assessing the impact of this internship by means of questionnaires that had been prepared and applied by the students themselves at the beginning and at the end of the internship. It also aimed to revise and adapt the proposed strategies. 1.356 students were interviewed the beginning and 933 (68.8%) at the end of the internship, between 2013 and 2016. A decrease in stigmatizing attitudes was evidenced, as well as a greater understanding of mental illness and a contribution to the comprehensive training of general practitioners after covering the different specializations. Statistic processing of data was done with Graph Pad Prism version 4.0 software. Descriptive statistics was used to analyse date and the Mann-Whytney non-parametric test was used to compare medians. Values below 0.05 were considered significant. The study concluded that both the contact between medical students and patients with mental illnesses and specific interventions on this issue constitute a useful strategy to reduce stigma.

Resumo: O estigma gerado pelo pessoal de saúde constitui uma barreira que limita o acesso aos cuidados para pessoas com doença mental. Por esse motivo, a Clínica Psiquiátrica da Universidad de la República gerou estratégias didáticas aplicáveis durante a passagem dos alunos de medicina pela especialidade, para conscientizar sobre a estigmatização das pessoas com doença mental. Com esse fim foi elaborado um estudo cujos objetivos eram avaliar o impacto do estágio aplicando questionários elaborados pelas autoras, autopreenchidos no início e ao final do mesmo, bem como revisar e adaptar as estratégias propostas. Foram pesquisados 1.356 alunos no início e 933 (68,8%) ao final do estágio entre 2013 e 2016. Houve evidências de diminuição das atitudes estigmatizantes, de uma maior compreensão da doença mental e de contribuição para a formação integral dos médicos de medicina geral após o estágio na especialidade. O tratamento estatístico dos dados foi realizado com o programa Graph Pad Prism versão 4.0. A análise dos dados foi realizada por estatística descritiva e o teste não paramétrico de Mann-Whytney para comparação de médias. Valores de p menores que 0,05 foram considerados significativos. Concluiu-se que o contacto dos alunos com pessoas com doença mental, juntamente com uma intervenção específica sobre este tema, constituem uma estratégia útil para a redução do estigma.

Hungarian Psychiatrists' Recognition, Knowledge, and Treatment of Catatonia.

DSM-5 introduced a number of modifications to the catatonic syndrome, which is now closer to Kahlbaum's original concept. The aim of the present study was to assess residents' and qualified psychiatrists' knowledge, experience and views about the treatment of catatonia in acute psychiatric care in Budapest, Hungary. Authors approached all psychiatric units that provide acute psychiatric care (N = 11) in Budapest and invited all psychiatrists and residents, who consented, to participate in the survey, completing a 13 items questionnaire. Ninety-eight fully qualified and trainee psychiatrists completed the questionnaire. Although 84.7% of the participants rated their knowledge of catatonia as moderate or significant, there were a number of obvious mistakes in their answers. Most catatonic signs and symptoms were not identified by almost 50% of the respondents and the frequency of catatonia was also underestimated. The views of the majority of the participants reflected the Kraepelinian concept, in which catatonia is primarily associated with schizophrenia. Although benzodiazepines are widely recommended as a first line treatment for catatonia, only 69.4% of participants chose them as a treatment option. In view of its clinical importance, catatonia deserves more attention in the education and training of medical students and psychiatric residents.

Optimizing Fit: Targeting a Residency Psychiatry Consultation-Liaison Rotation to Various Levels of Training.

BACKGROUND: Determining the optimal timing and structure for a core residency rotation in consultation-liaison psychiatry (CLP) remains a key challenge for program directors and rotation leaders. Previous surveys have been conducted regarding these questions, and guidelines from national organizations have been issued, but practices remain varied among institutions. METHODS: We conducted a narrative review of the literature related to the timing of CLP rotations and generated consensus recommendations based on our experience as program directors, rotation leaders, and residents. RESULTS: Explicit goals of CLP training in residency include identifying and treating psychiatric manifestation of medical illness and communicating effectively with primary teams. Implicit goals of training may includeconflict management, limit setting, and "thinking dirty." DISCUSSION: Although CLP rotations earlier in residency often create a better fit within the overarching curriculum and allow for generating early interest in the field, significant amounts of supervision are required, and consultees may look to attendings as the primary consultant. Conversely, while later rotations are sometimes challenging to structure with other outpatient responsibilities, they allow for greater autonomy and may map better onto the informal curriculum. A hybrid model, with training spread across multiple years, is another approach that may mitigate some of the disadvantages of confining consultation-liaison training to a single year. Compelling arguments can be made for placing the core CLP rotation in postgraduate year 2 or 3 or using a hybrid model. Regardless of placement, program directors and rotation leaders should be mindful of tailoring the rotation to the trainees' developmental stage.

Prescription patterns in patients with schizophrenia in Japan: First-quality indicator data from the survey of "Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE)" project.

BACKGROUND: Guideline for Pharmacological Therapy for Schizophrenia was published by the Japanese Society of Neuropsychopharmacology in 2015. "Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE)" project aimed to standardize medical practice using quality indicators (QIs) as indices to evaluate the quality of medical practice. In this study, we have reported the quality indicator values of prescription before the beginning of the guideline lectures in the EGUIDE project to ascertain the baseline status of treating patients with schizophrenia. METHODS: A cross-sectional, retrospective case record survey was conducted, involving 1164 patients with schizophrenia at the time of discharge. We checked all types and dosage of psychotropic drugs. RESULTS: Forty-three percent of patients had antipsychotic polypharmacy, and substantial concomitant medication was observed (antidepressants; 8%, mood stabilizers: 37%, anxiolytics or hypnotics: 68%). CONCLUSIONS: In the results obtained in this study, we plant to report changes in the effectiveness of education in the EGUIDE project near the future.

Work Environment Evaluation Instrument (WEEI): development, validation, and association with burnout

Abstract Introduction Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results The final version had high reliability (Cronbach's alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p < 0.01). Cutoffs defining the environment as healthy (>32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts.

Palliative Care Training for Consultation-Liaison Psychiatry Fellows: A National Survey Project.

BACKGROUND: Provision of palliative care is part of the standard of care for patients with serious, life-limiting medical illnesses. Patients in the palliative care setting have high rates of psychiatric co-morbidity. However, integration of mental health care into palliative care remains a significant gap. With appropriate training, consultation-liaison (C-L) psychiatrists are well-positioned to improve integration of mental health into palliative care. PURPOSE: To understand current palliative care training practices for C-L psychiatry fellows in the United States. METHOD: We invited all U.S. C-L psychiatry fellowship program directors to participate in a 17-item online structured survey aimed at understanding palliative care training in their fellowship programs. RESULTS: 37/61 (61%) of C-L psychiatry fellowship program directors responded to the survey. Eighty-six percent of programs provide some palliative care didactics, but the topics covered vary widely. Programs are closely split between offering a required, elective, or no clinical palliative care experiences. Only about half (45%) of programs identify formal opportunities for interaction between palliative care and C-L psychiatry fellows. Program directors identified topics such as goals-of-care discussions, systems issues in end-of-life care, and pain management as important for fellows to learn. Barriers to teaching these topics included time, lack of teaching faculty, and disciplinary siloes. CONCLUSIONS: Although C-L psychiatry fellowship program directors identify a number of key teaching topics in palliative care for C-L psychiatry fellows, there are wide discrepancies in the depth and content of existing palliative care didactic and clinical experiences in C-L psychiatry fellowships.