Implementing a Holistic Review Process for Psychiatry Residency Screening and Interviewing.

Within psychiatry, the proportions of individuals underrepresented in medicine (URM) are lower than are the proportions among the general U.S. population. Holistic review of residency applications may alleviate deficiencies in representation and disparities in care. A holistic review process was implemented (2021-2022) in the University of California, San Diego, psychiatry residency program. The data (2016-2022) were extracted from the Electronic Residency Application Service to compare differences in the applicant pool before and after implementation of the holistic review. A total of 6,602 individuals applied to the program between 2016 and 2022, increasing from 762 in 2016 to 1,148 in 2021. The proportion of women applying significantly increased (χ2=12.6, p<0.002), from 42.3% in 2016 to 50.6% in 2022. Across all years, a significantly greater proportion (χ2=22.0, p<0.001) of those selected to interview were women (55.1%), with the greatest proportion in 2022 (64.5%), after implementation of the holistic review. The proportion of applicants from URM groups significantly increased (χ2=28.0, p<0.001), from 13.4% in 2016 to 21.3% in 2022. There were no significant differences in the proportion of these applicants selected to interview across all years and no increase following the holistic review. The proportion of women interviewed was greater than the proportion of women who applied, particularly after implementing the holistic review. The proportion of applicants from URM groups increased over time and, although the proportion interviewed remained greater than the number applying, that number did not change across the years studied.

Delivering Bad News in Amyotrophic Lateral Sclerosis: Proposal of Specific Technique ALS ALLOW.

PURPOSE OF REVIEW: Physician communication skills are a critical part of care for amyotrophic lateral sclerosis (ALS) patients and caregivers. They shape the development of autonomy and quality of life, and they mitigate emotional trauma. Communication skills are especially critical at 2 different time points in the course of the disease: early when delivering and establishing the diagnosis, and later when clarifying goals of care. RECENT FINDINGS: Several techniques for physician communication of difficult information are available, including SPIKES (Setting up the interview, assessing the patient's Perception, obtaining the patient's Invitation, giving Knowledge and information to the patient, addressing the patient's Emotions with Empathetic responses, and Strategy and Summary), ABCDE (Advance preparation, Build a therapeutic environment/relationship, Communicate well, Deal with patient and family reactions, Encourage and validate emotions), and BREAKS (Background, Rapport, Exploring, Announce, Kindling, Summarize). These emphasize the physician's accountability and responsibility for communicating effectively. Formal training in these techniques is limited, and their applicability specifically to ALS is inexact. SUMMARY: We propose an ALS-specific technique which we call ALS ALLOW to guide physicians in conducting difficult communications with ALS patients and caregivers to develop their understanding, establish autonomy, set goals, and mitigate emotional trauma. The techniques are useful in discussions both early and late stages in the disease.