Twelve tips for mindful teaching and learning in medical education.

Mindfulness practice has been shown to have many positive benefits for patients, clinicians, and trainees. Mindfulness fosters compassion, connection, and enhanced clinical reasoning and can reduce burnout among clinicians. A primary focus of mindfulness is present-moment awareness and may be achieved through openness, curiosity, perspective-taking, and letting go of judgment. We propose that the core principles of mindfulness can be harnessed by educators to enhance their teaching skills specifically around creating a supportive and safe learning environment, using questions effectively, providing feedback, and serving as role models. Mindful teaching promotes mindful learning, which focuses on context, openness to new possibilities, reflection, and critical thinking, as opposed to rote repetition and memorization. This article describes core mindfulness principles and strategies that can be used to become a more mindful teacher.

The Current State of Journal Clubs in Psychiatry Residency Programs: Results from a National Survey of Program Directors.

OBJECTIVE: This study aimed to investigate journal club prevalence, implementation, and perceived effectiveness among psychiatry residency program directors in order to highlight best practices. METHODS: The authors distributed a 44-item thoughtfully designed and peer-reviewed questionnaire electronically via Qualtrics to 235 accredited U.S. psychiatry residency program directors identified using the American Medical Association database. RESULTS: Eighty-nine programs (38%) responded. Of these, 83 (93%) had a journal club. Journal clubs were mandatory in 80 programs (96%), met biweekly or monthly in 62 programs (75%), and lasted 46-60 min in 66 programs (80%). Twenty-three programs (28%) offered a list of articles to choose from, and 22 programs (27%) provided a critical appraisal tool. Only 7 programs (8%) measured learner outcomes from journal clubs. Respondents believed that promoting lifelong learning and practicing evidence-based psychiatry were the most relevant educational goals of journal club (2.57 and 2.51 on a Likert scale of 0 to 3). Journal club's effectiveness in achieving those goals was believed to be lower (2.16 and 2.09). CONCLUSIONS: Journal clubs are common in U.S. psychiatry residency programs and tend to follow a traditional format. In order to boost journal club's effectiveness in achieving the desired educational goals, more programs might elect to infuse elements known to augment learning.

Conceptual and historical evolution of psychiatric nosology.

Psychiatric taxonomies exist within conceptual frameworks which presuppose certain conceptions of psychiatric distress and offer guiding principles. This article provides an overview of the historical development of psychiatric classifications with an emphasis on their methodological assumptions. After identifying roots of scientific psychiatric classifications in the works of Sydenham and Linnaeus and discussing early classification systems, our survey focuses on the Kahlbaum-Hecker-Kraepelin paradigm (with its emphasis on longitudinal course of illness), the Wernicke-Kleist-Leonhard tradition (with its emphasis on neural systems), the development of the ICD and the DSM classifications (with their roots in medical statistics, their pragmatic nature, and their emphasis on descriptive and operationalized criteria), psychodynamic and idiographic perspectives (e.g. the Psychodynamic Diagnostic Manual), and transdiagnostic approaches (e.g. Research Domain Criteria). The central philosophical questions of nosology (descriptive vs aetiological, symptoms vs course of illness, idiographic vs nomothetic, categorical vs dimensional, etc.) have appeared and reappeared throughout this evolution. Ongoing controversies reflect the epistemological and ontological difficulties inherent in defining and classifying mental illness. It may be that no single taxonomy can satisfy all clinical, research, and administrative needs, and that, echoing the ideas of Aubrey Lewis, multiple systems may be required to serve different needs.

Pilot Study of an Online Self-Directed Learning Module for Medical Decision-Making Capacity.

OBJECTIVE: This study assessed the impact of an online, self-directed learning module on medical student knowledge and attitudes regarding decision-making capacity. METHODS: The authors created a 15-min didactic video on decision-making capacity and sorted medical students on the psychiatry clerkship to teaching as usual or teaching as usual plus watching the video. The authors assessed student knowledge about and attitudes toward decisional capacity assessment using a pre/posttest design. RESULTS: Thirty-eight students completed the study (24% of all psychiatry clerkship students in one academic year). Students who watched the video (n = 14) achieved higher scores on the posttest compared with students who did not watch the video (n = 24) (90% vs 84% on general knowledge and case examples), though this difference was small and not statistically significant. The degree of improvement from pretest to posttest was higher for students who watched the video but did not reach statistical significance. CONCLUSIONS: Overall, students found the online teaching module to be a helpful augmentation strategy for learning decisional capacity assessment. The authors incorporated student feedback and additional review to create an enhanced video, which is available on ADMSEP's Clinical Simulation Initiative website.

Functional Coma: Two Case Reports and a Review of the Literature.

BACKGROUND: Psychiatric illness can mimic a comatose state. The most common is a conversion reaction resulting in a functional coma, which poses a unique diagnostic challenge to the clinician. Little is known about this condition, and the literature is limited by inconsistent terminology and by a lack of high-quality evidence. OBJECTIVE: To provide a conceptual definition of functional coma, describe case examples, summarize management, and increase recognition of this often underacknowledged entity. METHODS: We present two cases and provide a comprehensive review of the literature on the differential diagnosis, pathophysiology, workup, and management. RESULTS: Functional coma is defined as an involuntary coma-like state that occurs in the absence of structural or metabolic damage to the brain and that is distinct from catatonia. This term should supplant the previous phrase of "psychogenic coma." Psychiatric disorders are frequently present premorbidly, but are not required for the diagnosis. About half of the cases occur in the perioperative setting. Physical exam can provide helpful clues, including passive resistance to eye opening or avoidance of the face with arm drop. Additional work-up, including laboratory studies, brain imaging, and electroencephalography, should be obtained but are unremarkable in functional coma. Case studies suggest that the episodes last for several hours, with a range of 45 minutes to 4 days. Treatment includes supportive management and careful psychoeducation. CONCLUSIONS: Functional coma should be conceptualized as a distinct condition from catatonia and psychogenic non-epileptic seizures. Additional clinical and translation research is needed to further explore the etiology of this condition.

Child maltreatment: promising approaches and new directions.

PURPOSE OF REVIEW: This review summarizes the key articles in the field of child maltreatment, addressing abusive head trauma, physical abuse, sexual abuse, and global issues surrounding maltreatment. This topic is salient for both general pediatricians as well as specialists. RECENT FINDINGS: Many articles this year focus on the importance of making an accurate diagnosis when considering child maltreatment, whether in the form of physical or sexual abuse. There is also a focus on understanding the epidemiology of abuse, as some data show a decrease in numbers, which is felt by many in the field to be a misleading impression. SUMMARY: An appreciation of the scope of Child Abuse Pediatrics requires an understanding of physical abuse, sexual abuse, and neglect. The authors summarize notable advances in our understanding of these key areas in a review of the year's best literature.

Identity and uncertainty: art-mediated medical student reflections in a time of transition.

Medical education comprises intense periods of transition, which can significantly impact student well-being, as well as personal and professional development. In 2020, medical students navigating transitions from pre-clinical to clinical roles were also experiencing the historic forces of the COVID-19 pandemic and ongoing societal reckoning with systemic injustice and racism, likely heightening the usual challenges associated with these transitions. Reflection has been suggested as a tool for facilitating such transitions, and arts-mediated approaches hold promise in inspiring authentic reflection, yet they are rarely used to prompt medical student reflection. This article describes common themes in medical students' reflections on a specific period of transition during a unique moment in history, via qualitative analysis of their narrative responses to visual arts-mediated reflective prompts. The authors used a visual arts-based activity to explore medical students' hopes and concerns as they transitioned to clinical clerkships between the 2019-2020 and 2020-2021 academic years at one academic institution. Qualitative analysis using an exploratory constructivist approach revealed that students' reflections often focused on identity within three main themes: the personal self, the professional self, and the social self. Within these categories, subthemes included uncertainty and concerns focusing on medical training and knowledge, the sense of hope and value inherent to their social connections, critiques of the culture of medical education, and reflections on complicity and responsibility in racial injustice. This article not only provides a cross-sectional snapshot of the experiences of medical students during a historic moment, but also provides themes to guide discussions on training transitions and describes a low-cost, adaptable approach to facilitating deep exploration and reflection on tumultuous moments in training.

Understanding humerus fractures in young children: Abuse or not abuse?

Fractures are the second most common abusive injury occurring in young children, particularly those under 2 years of age. The humerus is often affected. To better identify factors discriminating between abusive and non-abusive humerus fractures, this retrospective study examined the characteristics and mechanisms of injuries causing humerus fractures in children less than 18 months of age. Electronic medical records were reviewed for eligible patients evaluated between September 1, 2007 and January 1, 2012 at two children's hospitals in Chicago, IL. The main outcome measures were the type of fracture and the etiology of the fracture (abuse vs not abuse). The 97 eligible patients had 100 humerus fractures. The most common fracture location was the distal humerus (65%) and the most common fracture type was supracondylar (48%). Child Protection Teams evaluated 44 patients (45%) and determined that 24 of those had 25 fractures caused by abuse (25% of the total study population).Among children with fractures determined to have been caused by abuse, the most common location was the distal humerus (50%) and the most common types were transverse and oblique (25% each); however, transverse and oblique fractures were also seen in patients whose injuries were determined to have been non-abusive. A younger age, non-ambulatory developmental stage, and the presence of additional injuries were significantly associated with abusive fractures. Caregivers did not provide a mechanism of injury for half of children with abusive fractures, whereas caregivers provided some explanation for all children with non-abusive fractures.

Understanding forearm fractures in young children: Abuse or not abuse?

This retrospective study describes the characteristics and mechanisms of forearm fractures in children <18 months adding to the evidence-base about forearm fractures. It also examines which features of forearm fractures in young children may help discriminate between abusive and noninflicted injuries. Electronic medical records were reviewed for eligible patients evaluated between September 1, 2007 and January 1, 2012 at two children's hospitals in Chicago, IL. The main outcome measures were the type of fracture and the etiology of the fracture (abuse versus not abuse). The 135 included patients sustained 216 forearm fractures. Most were buckle (57%) or transverse (26%). Child protection teams evaluated 47 (35%) of the patients and diagnosed 11 (23%) as having fractures caused by abuse. Children with abusive versus non-inflicted injuries had significant differences in age (median age 7 versus 12 months), race, and presence of additional injuries. Children with abusive forearm fractures often presented without an explanation or a changing history for the injury. Children with non-inflicted forearm fractures often presented after a fall. No particular type of forearm fracture was specific for child abuse. Any forearm fracture in a young child should be evaluated with special attention to the details of the history and the presence of other injuries. Young age, additional injuries, and an absent or inconsistent explanation should increase concern that the fracture was caused by child abuse.