Senior Residents' Perceived Competence in Evidence-Based Treatments for Major Depressive Disorder.

OBJECTIVE: The current study aims to assess the self-reported competence of graduating psychiatry residents in Canada to provide pharmacotherapy and psychotherapy for major depressive disorder as recommended in national practice guidelines. METHODS: Canadian psychiatry residents who participated in an optional national review course to prepare for licensing were anonymously surveyed regarding their experience and competence in providing treatments recommended by the 2016 Canadian Network for Mood and Anxiety Treatments guidelines. RESULTS: The majority (89%, 130/146) reported competence in ≥ 5 medication monotherapies (e.g., selective serotonin/norepinephrine reuptake inhibitors, bupropion, mirtazapine) and ≥ 3 adjuncts (e.g., mirtazapine, second-generation antipsychotics). While 76% expressed interest in practicing multiple psychotherapeutic modalities, only 47% reported self-assessed competence in delivering multiple modalities. Only 42% reported pharmacological competence (≥ 5 monotherapies, ≥ 3 adjuncts) and competence in ≥ 2 psychotherapies. Only 9% reported competence in offering medication, psychotherapy, and electroconvulsive therapy. Less than two-thirds endorsed sufficient didactic teaching (58%) or supervision in pharmacotherapy (50%) for treatment-resistant depression. CONCLUSIONS: Canadian psychiatry residents report competence in prescribing many first-line medications. However, only a minority report competence in prescribing medications and competence in psychotherapies and/or electroconvulsive therapy. Given known biases in assessments by self-report, real-world competence may be even lower. This study identifies gaps between national practice guidelines and the comfort of the emerging psychiatric workforce in delivering recommended treatments. These gaps in resident competence may lead to under-use of effective treatments for depression. Residency programs should consider how to improve resident competence in providing the full range of evidence-based treatments for depression.

Resident Evaluation of a Required Telepsychiatry Clinical Experience.

OBJECTIVE: The authors explored resident experiences of telepsychiatry clinical training. This paper describes an analysis of evaluation forms completed by psychiatry residents following a required training experience in telepsychiatry. METHODS: Retrospective numeric and narrative data were collected from 2005 to 2012. Using a five-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), residents ranked the session based on the following characteristics: the overall experience, interest in participating in telepsychiatry in the future, understanding service provision to underserved areas, telepsychiatry as mode of service delivery, and the unique aspects of telepsychiatry work. The authors also conducted a content analysis of narrative comments in response to open-ended questions about the positive and negative aspects of the training experience. RESULTS: In all, 88% of residents completed (n = 335) an anonymous evaluation following their participation in telepsychiatry consultation sessions. Numeric results were mostly positive and indicated that the experience was interesting and enjoyable, enhanced interest in participating in telepsychiatry in the future, and increased understanding of providing psychiatric services to underserved communities. Narrative data demonstrated that the most valuable aspects of training included the knowledge acquired in terms of establishing rapport and engaging with patients, using the technology, working collaboratively, identifying different approaches used, and awareness of the complexity of cases. Resident desire for more training of this nature was prevalent, specifically a wish for more detail, additional time for discussion and debriefing, and further explanation of the unique aspects of telepsychiatry as mode of delivery. CONCLUSIONS: More evaluation of telepsychiatry training, elective or required, is needed. The context of this training offered potential side benefits of learning about interprofessional and collaborative care for the underserved.

A framework for telepsychiatric training and e-health: Competency-based education, evaluation and implications.

Telepsychiatry (TP; video; synchronous) is effective, well received and a standard way to practice. Best practices in TP education, but not its desired outcomes, have been published. This paper proposes competencies for trainees and clinicians, with TP situated within the broader landscape of e-mental health (e-MH) care. TP competencies are organized using the US Accreditation Council of Graduate Medical Education framework, with input from the CanMEDS framework. Teaching and assessment methods are aligned with target competencies, learning contexts, and evaluation options. Case examples help to apply concepts to clinical and institutional contexts. Competencies can be identified, measured and evaluated. Novice or advanced beginner, competent/proficient, and expert levels were outlined. Andragogical (i.e. pedagogical) methods are used in clinical care, seminar, and other educational contexts. Cross-sectional and longitudinal evaluation using quantitative and qualitative measures promotes skills development via iterative feedback from patients, trainees, and faculty staff. TP and e-MH care significantly overlap, such that institutional leaders may use a common approach for change management and an e-platform to prioritize resources. TP training and assessment methods need to be implemented and evaluated. Institutional approaches to patient care, education, faculty development, and funding also need to be studied.

Developing a mentorship program for psychiatry residents.

OBJECTIVE: The authors sought to evaluate a formal mentorship program for second-year psychiatry residents at the University of Toronto after the program's first year of implementation. METHODS: Ten mentees and ten faculty mentors were interviewed by fellow second-year residents and an independent researcher, respectively, about their experiences in the program. Interview data were thematically coded and analyzed using a grounded theory approach. RESULTS: Three major themes were identified. First, participants emphasized the importance of a natural, flexible, and engaging matching process for mentors and mentees. Many experienced the random assignment approach to matching and the mandatory nature of the program as barriers to developing a meaningful relationship with their mentors. Second, participants expressed a preference for geographic proximity between mentor and mentee workplaces and for meetings to take place in informal settings in order to improve the quality and quantity of their interactions. Lastly, participants felt that clear directions and expectations about the program's goals should be communicated, and that a forum for information sharing among mentors was needed. CONCLUSIONS: Overall, the majority of participants believed that the program facilitated growth and development and provided positive opportunities for both mentors and mentees. While challenges were present in the program, participants provided tangible recommendations to improve the process.

Psychiatry clerkship core curriculum renewal: assessing the shift to larger-group learning.

BACKGROUND/OBJECTIVE: A curriculum renewal of the third-year psychiatry clerkship rotation at University of Toronto Medical School resulted in a shift from case-based, small-group teaching at multiple teaching sites to the delivery of core material in a larger-group format. The authors examine the effects of this change in curriculum delivery. METHOD: Student examination performance and student evaluations of the clerkship rotation and teaching were compared for the years before and after adoption of the updated, larger-group format curriculum. RESULTS: Student examination performance was unchanged, comparing those who participated in small-group seminars versus those receiving larger-group core teaching. Student evaluations of the curriculum as a whole and of the core teaching were also unchanged, other than more negative evaluation of the course organization in the year immediately after implementation of the new curriculum. CONCLUSIONS: Delivering core curriculum in larger- versus smaller-group format did not have any discernible effect on student psychiatry clerkship performance, and overall student assessment of the rotation remained largely positive. The involvement of highly-rated teachers and the higher number of uninterrupted clinical days may balance out with the trend for students to generally prefer small-group to larger-group learning. Ongoing evaluation and refinement of the psychiatry clerkship experience and core curriculum will be crucial to continued assurance of a high-quality learning experience for our medical students.

Transforming Child and Youth Mental Health Care via Innovative Technological Solutions.

Live interactive videoconferencing and other technologies offer innovative opportunities for effective delivery of specialized child and adolescent mental health services. In this article, an example of a comprehensive telepsychiatry program is presented to highlight a variety of capacity-building initiatives that are responsive to community needs and cultures; these initiatives are allowing children, youth and caregivers to access otherwise-distant specialist services within their home communities. Committed, enthusiastic champions, adequate funding and infrastructure, creativity and a positive attitude represent key elements in the adaptation of this demonstrated user-friendly modality.

Defining Professional Development in Medicine, Psychiatry, and Allied Fields.

Professional development refers to training, formal education, and/or advanced professional learning intended to help clinicians, teachers, researchers, and administrators improve their professional knowledge and effectiveness. Institutions have been trying to adapt to a rapidly changing internal and external environment, with resource constraints and competitive health care. Professional development may be contextualized using adult development, educational, and organizational perspectives, and most best practices overlap. Key partners are faculty, departments, institutions, and national organizations. Interprofessional, team-based and project-based longitudinal initiatives may ignite educational innovations, and serve as a method to learn authentically in the workplace, promote socialization, and change attitudes.

Developmental Approaches to Faculty Development.

An academic career goes through developmental stages and faculty have different needs as they progress through these stages. Faculty development initiatives can target these developmental needs. Early career faculty develop their clinical and academic identities and benefit from orientation programs and mentorship. Mid-career faculty engage in role transitions, consolidating their careers, and focusing on productivity and generativity. They benefit from programs that provide new skills, including leadership skills. Advanced career faculty focus on professional-personal integration, contributing to a community, and changes in roles and power. They can benefit from mentorship, from peers locally and at a distance.

Using technology to deliver mental health services to children and youth: a scoping review.

OBJECTIVE: To conduct a scoping review on the use of technology to deliver mental health services to children and youth in order to identify the breadth of peer-reviewed literature, summarize findings and identify gaps. METHOD: A literature database search identified 126 original studies meeting criteria for review. Descriptive numerical summary and thematic analyses were conducted. Two reviewers independently extracted data. RESULTS: Studies were characterized by diverse technologies including videoconferencing, telephone and mobile phone applications and Internet-based applications such as email, web sites and CD-ROMs. CONCLUSION: The use of technologies plays a major role in the delivery of mental health services and supports to children and youth in providing prevention, assessment, diagnosis, counseling and treatment programs. Strategies are growing exponentially on a global basis, thus it is critical to study the impact of these technologies on child and youth mental health service delivery. An in-depth review and synthesis of the quality of findings of studies on effectiveness of the use of technologies in service delivery are also warranted. A full systematic review would provide that opportunity.

OBJECTIF: Mener une étude de portée sur l'utilisation de la technologie pour dispenser des services de santé mentale aux enfants et aux adolescents, afin de déterminer l'ampleur de la littérature révisée par des pairs, de résumer les résultats et d'identifier les lacunes. MÉTHODE: Une base de données de recherche de la littérature a recensé 126 études originales satisfaisant aux critères de l'étude. Des analyses thématiques et des résumés numériques descriptifs ont été menés. Deux analystes ont extrait les données indépendamment. RÉSULTATS: Les études étaient caractérisées par diverses technologies dont la vidéoconférence, le téléphone et les applications de téléphone cellulaire ainsi que les applications sur Internet comme le courriel, les sites Web et les CD-ROM. CONCLUSION: L'utilisation de la technologie joue un rôle majeur dans la prestation de services et de soutien de santé mentale aux enfants et aux adolescents car elle intervient dans la prévention, l'évaluation, le diagnostic, la consultation et les programmes de traitement. Les stratégies connaissent mondialement une croissance exponentielle, il est donc essentiel d'étudier l'impact de ces technologies sur la prestation de services de santé mentale aux enfants et aux adolescents. Une revue approfondie et une synthèse de la qualité des résultats des études sur l'efficacité de l'utilisation des technologies dans la prestation de services sont également justifiées. Une revue systématique complète conviendrait à cet exercice.

Continuing education to go: capacity building in psychotherapies for front-line mental health workers in underserviced communities.

OBJECTIVE: To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers. METHODS: Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus groups with 25 participants were also analyzed. RESULTS: Significant pre- and postintervention changes in knowledge (P < 0.001) were found in course completers. Counselling self-efficacy improved in participants who took the first course offered (P = 0.001). Dropouts were much less frequent in peer-led, small-group learning than in a self-directed format. Qualitative analysis revealed improved confidence, morale, self-reported practice behaviour changes, and increased comfort in working with difficult clients. CONCLUSION: This work-based, multimodal, interactive, interprofessional curriculum for knowledge translation of psychotherapeutic techniques is feasible and helpful. A peer-led group format is preferred over self-directed learning. Its application can build capacity of front-line health workers in helping patients who suffer from common mental disorders.

Objectif : Aborder l'écart entre les besoins et l'accès, et entre les lignes directrices de traitement et leur mise en œuvre pour la maladie mentale, par la création de capacité des travailleurs de première ligne de la santé. Méthodes : À la suite d'une évaluation des besoins d'apprentissage, des cours de formation continue en milieu de travail sur les psychothérapies fondées sur des données probantes ont été mis au point à l'intention des travailleurs de première ligne dans des milieux communautaires sous-desservis. Les cours de 5 heures sur les fondements de la thérapie cognitivo-comportementale, la psychothérapie interpersonnelle, la technique d'entrevue motivationnelle, et la thérapie comportementale dialectique comportaient tous des simulations enregistrées sur vidéo, des plans de leçon interactifs, et des rappels de comportement en pratique clinique. Deux cours, offerts en ordre séquentiel dans 7 milieux sous-desservis, ont été soumis à une évaluation de méthodes mixtes. Quatre-vingt-treize travailleurs de première ligne non médicaux se sont inscrits au programme. Une analyse de variance des mesures répétées a servi à évaluer les changements des connaissances et de l'auto-efficacité avant et après l'intervention. Les données qualitatives de 5 groupes de discussion semi-structurés de 25 participants ont également été analysées. Résultats : Des changements significatifs des connaissances (P < 0,001) avant et après l'intervention ont été observés chez ceux qui ont terminé le cours. L'auto-efficacité en counseling s'est améliorée chez les participants qui ont suivi le premier cours offert (P = 0,001). Les décrocheurs étaient beaucoup moins fréquents dans les petits groupes d'apprentissage menés par les pairs que dans le format autodirigé. L'analyse qualitative a révélé une confiance améliorée, un meilleur moral, des changements du comportement dans la pratique auto-déclaré, et une plus grande assurance de travailler avec des clients difficiles. Conclusion : Ce programme d'études en milieu de travail, multimodal, interactif, interprofessionnel pour la transmission des connaissances en techniques psychothérapeutiques est faisable et utile. Le format du groupe mené par les pairs est préféré à l'apprentissage autodirigé. Son application peut renforcer la capacité des travailleurs de la santé de première ligne d'aider les patients qui souffrent de troubles mentaux communs.

Child and youth telepsychiatry in rural and remote primary care.

Young people with psychological or psychiatric problems are managed largely by primary care practitioners, many of whom feel inadequately trained, ill equipped, and uncomfortable with this responsibility. Accessing specialist pediatric and psychological services, often located in and near large urban centers, is a particular challenge for rural and remote communities. Live interactive videoconferencing technology (telepsychiatry) presents innovative opportunities to bridge these service gaps. The TeleLink Mental Health Program at The Hospital for Sick Children in Toronto offers a comprehensive, collaborative model of enhancing local community systems of care in rural and remote Ontario using videoconferencing. With a focus on clinical consultation, collaborative care, education and training, evaluation, and research, ready access to pediatric psychiatrists and other specialist mental health service providers can effectively extend the boundaries of the medical home. Medical trainees in urban teaching centers are also expanding their knowledge of and comfort level with rural mental health issues, various complementary service models, and the potentials of videoconferencing in providing psychiatric and psychological services. Committed and enthusiastic champions, a positive attitude, creativity, and flexibility are a few of the necessary attributes ensuring viability and integration of telemental health programs.

Teaching child psychiatry in ethiopia: challenges and rewards.

INTRODUCTION: Ethiopia is a country of 81 million people, half of whom are children. The prevalence of psychiatric disorders in children ranges from 3.5-23.2%. However, there are very limited mental health resources in the country, including few psychiatrists. Thus the training of more psychiatrists, including providing them with expertise in child psychiatry, is an imperative. METHOD: The article briefly reviews the development of the Toronto Addis Ababa Psychiatry Project (TAAPP), a collaborative program between the University of Toronto and Addis Ababa University designed to help train psychiatry residents in Ethiopia. The article then focuses on the author's experiences on one recent trip to Ethiopia to provide some of this training. RESULTS: Formal teaching sessions as well as clinical supervision were provided to the Ethiopian residents. Content had to be adapted to be relevant to the Ethiopian context, but teaching approaches did not have to be modified significantly. The Ethiopian residents were very enthusiastic learners and made quick changes to their practices based on the teaching. CONCLUSION: Collaborative programs such as TAAPP may be important mechanisms to improve the training of psychiatrists internationally, especially when there are limited local educational resources.

Peer group mentoring of junior faculty.

OBJECTIVE: The purpose of this article is to document and evaluate the initiation of a mentoring model for junior faculty utilizing a peer group approach rather than the traditional dyadic model. METHODS: Junior faculty members in an academic department of psychiatry at Sunnybrook Hospital, University of Toronto, were invited to take part in a peer mentoring program involving evening meetings every 2 months over a 1-year period from 2004-2005. Of the 12 invitees, 10 agreed to participate in the program. The group participants developed the program agenda collectively. Learning objectives as well as a list of topics of interest were established at the inaugural meeting. A focus group was held at the end of 12 months to provide a descriptive, qualitative evaluation. The focus group leader prepared a report based on observations and notes taken during the focus group. RESULTS: The report prepared by the focus group leader identified six main themes that included: program development, knowledge gains, interpersonal gains, psychological/emotional gains, process of the program, and future directions. The overall response was clearly favorable with a unanimous decision to maintain the group and continue meeting into the next year. CONCLUSION: A peer group mentoring format for junior faculty in an academic department of psychiatry can be an effective model of mentoring.

CME for child psychiatrists: recommendations for learners, planners and presenters.

INTRODUCTION: Medical school and residency are only the beginning of a child psychiatrist's education. For the rest of her/his career, a child psychiatrist will need to learn on an ongoing basis. There will always be new understandings, new treatments, new issues to master. Child psychiatrists will always need to further their knowledge, develop new skills, and improve existing skills. For these reasons at very least, all child psychiatrists will need to participate in Continuing Medical Education (CME) activities. Many child psychiatrists will also be involved in the design and delivery of these CME activities. In both cases, understanding more about the effectiveness of CME will be important to the decisions they make. METHOD: This article itself is not a systematic review of the literature, but it will highlight some of the important findings from existing systematic reviews of the CME literature. Based on these findings, the article will make recommendations for both child psychiatrists as learners and child psychiatrists as CME presenters. RESULTS: As learners, child psychiatrists need to be able to select CME activities that are most likely to lead to improvements in their practices. As planners and presenters, child psychiatrists need to design and deliver CME activities that are most likely to improve the practices of their target audiences. However, not all child psychiatrists have the time to review the CME literature in addition to reviewing the other bodies of literature relevant to their practices. CONCLUSION: Thus, the purpose of this article is to provide an overview of the key findings in the CME literature, focusing on the effectiveness of CME.