Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review.

PURPOSE: In this systematic review, the authors examine the prevalence and extent of stigmatizing attitudes among health care professionals (HCPs) and trainees against patients with substance use disorders (SUDs), including research on interventions to reduce stigma. METHOD: The authors searched 7 databases for articles published from January 1, 2011, through February 15, 2023, that quantified SUD stigma among HCPs or trainees. Inclusion criteria allowed both observational and intervention studies from the United States or Canada to be included in this review. Quality assessment was applied to all included studies; studies were not excluded based on quality. RESULTS: A total of 1,992 unique articles were identified of which 32 articles (17 observational studies and 15 intervention studies), all conducted in the United States, met the inclusion criteria. Half of the included studies (16 of 32) were published in 2020 or later. Most of the intervention studies (13 of 15) used a single-group pre-post design; interventions involved didactics and/or interactions with persons with SUDs. The 32 included studies used a total of 19 different measures of stigma. All 17 observational studies showed some degree of HCP or trainee stigma against patients with SUDs. Most intervention studies (12 of 15) found small but statistically significant reductions in stigma after intervention. CONCLUSIONS: SUD stigma exists among HCPs and trainees. Some interventions to reduce this stigma had positive impacts, but future studies with larger, diverse participants and comparison groups are needed. Heterogeneity among studies and stigma measures limits the ability to interpret results across studies. Future rigorous research is needed to determine validated, consensus measures of SUD stigma among HCPs and trainees, identify stigma scores that are associated with clinical outcomes, and develop effective antistigma interventions for HCPs and trainees.

Responding to the Opioid Epidemic: Educational Competencies for Pain and Substance Use Disorder from the Medical Schools of the University of California.

OBJECTIVE: The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). METHODS: The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. RESULTS: The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis. CONCLUSIONS: The authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).

Exploration of Mistreatment and Burnout Among Resident Physicians: a Cross-Specialty Observational Study.

PURPOSE: Resident physician mistreatment and burnout are widespread issues in medical training, but the association between the two remains unclear. This study examines the prevalence and types of mistreatment among resident physicians in core specialties and its association with burnout syndrome as well as feelings of depression/anxiety. METHODS: A cross-sectional, survey-based observational study of medical residents was conducted at the University of California, Davis Medical Center in 2014. Current residents (PGY2 or higher) in the internal medicine, family medicine, obstetrics/gynecology, surgery, and pediatrics programs completed anonymous questionnaires addressing topics such as workplace mistreatment, feelings of depression/anxiety, and stress management. Burnout was measured using the Maslach Burnout Inventory. RESULTS: Forty-four out of 105 residents (41.9%) witnessed mistreatment of their co-residents while 26 residents (24.8%) disclosed personal accounts of mistreatment. Seventy-one percent of residents met the criteria for burnout. Residents who had been personally mistreated were almost eight times more likely to report burnout (OR 7.6, 95% CI = 1.7-34.4) and almost four times more likely to report symptoms of anxiety and depression (OR 3.8, 95% CI = 1.6-9.1). Public belittlement or humiliation was the most common type of mistreatment. CONCLUSION: Encountering mistreatment was associated with higher rates of burnout, as well as depression/anxiety. While it is uncertain if mistreatment in the workplace has a causative impact on burnout syndrome, the findings reveal the need to address work-related environmental factors that may contribute to both resident physician mistreatment and burnout.

The milestones for psychosomatic medicine subspecialty training.

BACKGROUND: The Accreditation Council of Graduate Medical Education Milestones project is a key element in the Next Accreditation System for graduate medical education. On completing the general psychiatry milestones in 2013, the Accreditation Council of Graduate Medical Education began the process of creating milestones for the accredited psychiatric subspecialties. METHODS: With consultation from the Academy of Psychosomatic Medicine, the Accreditation Council of Graduate Medical Education appointed a working group to create the psychosomatic medicine milestones, using the general psychiatry milestones as a starting point. RESULTS: This article represents a record of the work of this committee. It describes the history and rationale behind the milestones, the development process used by the working group, and the implications of these milestones on psychosomatic medicine fellowship training. CONCLUSIONS: The milestones, as presented in this article, will have an important influence on psychosomatic medicine training programs. The implications of these include changes in how fellowship programs will be reviewed and accredited by the Accreditation Council of Graduate Medical Education and changes in the process of assessment and feedback for fellows.

The office of student wellness: innovating to improve student mental health.

OBJECTIVE: Despite increasing mental health needs among medical students, few models for effective preventive student wellness programs exist. METHODS: This paper describes a novel approach developed at the University of California (UC) Davis School of Medicine: the Office of Student Wellness (OSW). RESULTS: Improved access and mental health service utilization have been documented, with over half of all students receiving support and clinical care. UC Davis student satisfaction mean scores on the Association of American Medical Colleges Graduation Questionnaire wellness questions have reached or exceeded national average over the last 4 years, since the OSW was founded. CONCLUSIONS: This program may serve as a blueprint for other medical schools in developing effective student wellness programs.

Clinician-educator tracks for residents: three pilot programs.

OBJECTIVE: Over the past 30 years, clinician-educators have become a prominent component of medical school faculties, yet few of these individuals received formal training for this role and their professional development lags behind other faculty. This article reviews three residency tracks designed to build skills in teaching, curriculum development and assessment, education research, and career development to meet this need. METHODS: The residency clinician educator tracks at University of Michigan, Baylor College of Medicine, and University of California Davis are described in detail, with particular attention to their common elements, unique features, resource needs, and graduate outcomes. RESULTS: Common elements in the tracks are faculty mentorship, formal didactics, teaching opportunities, and an expectation of scholarly productivity. Essential resources include motivated faculty, departmental support, and a modest budget. Favorable outcomes include a high percentage of graduates in clinical faculty positions, teaching programs created by the residents, positive effects on recruitment, and enhancement of faculty identity as clinician educators. CONCLUSION: Clinician-educator tracks in residency present a viable means to address the training needs of clinical track faculty. The programs described in this article provide a model to assist other departments in developing similar programs.

A progress report on a department of psychiatry faculty practice plan designed to reward educational and research productivity.

OBJECTIVE: The authors provide a progress report on a faculty practice plan that assigns a monetary value to administrative duties, teaching, scholarship, community service, and research. METHODS: Modifications to the original plan are described and quantifiable results in the areas of scholarship and research are summarized. RESULTS: During a 4-year period reported, the total direct costs of all grants increased 40% and the total number of publications increased 108% during this same time frame. CONCLUSION: The authors believe that a practice plan which assigns a monetary value to administrative duties, teaching, scholarship, community service, and research can incentivize faculty to be successful in each of these areas.

The chief resident in psychiatry: roles and responsibilities.

OBJECTIVE: Psychiatric residency programs have had chief residents for many years, and several articles previously published describe the chief residents' unique role as both faculty and resident. This article describes chief resident roles and responsibilities and explores trends in academic psychiatry departments from 1995 to 2006. METHODS: The authors mailed a survey about the roles and responsibilities of chief resident positions to psychiatric residency training directors using the American Association of Directors of Psychiatric Residency Training (AADPRT) mailing list in 1995 and e-mailed the AADPRT e-mail list in 2006. Data were collected by mail in 1995 and collected in 2006 by a web-based survey similar to the instrument used in 1995. RESULTS: Joint selection of chief resident by faculty and residents, 12-month terms, protected time for administrative duties, and written job descriptions were helpful features common to most programs. CONCLUSION: Our results demonstrate that the majority of general psychiatry residency programs use the joint selection method with a negotiated job description, as well as a 12-month term.

Evaluating a lecture on cultural competence in the medical school preclinical curriculum.

OBJECTIVE: The authors aim to evaluate the effectiveness of a presentation designed to increase cultural competence. METHODS: A measure was developed to evaluate the attainment of knowledge and attitude objectives by first-year medical students who watched a presentation on the effect of culture on the doctor-patient relationship and effective methods of interpretation for non-English-speaking patients. The test was administered before and after the presentation and data were analyzed using a linear mixed-effects regression model. RESULTS: Both knowledge and attitudes improved over the course of the lecture. CONCLUSIONS: Those who give individual presentations in multiple instructor medical school courses should supplement their course evaluations with lecture-specific surveys targeted to their specific learning objectives for knowledge and attitudes.

The doctoring curriculum at the University of California, Davis School Of Medicine: leadership and participant roles for psychiatry faculty.

OBJECTIVE: The authors describe in detail the 3-year model of the Doctoring curriculum plus an elective fourth-year Doctoring course at University of California, Davis School of Medicine (UCDSOM) and University of California, Los Angeles (UCLA) School of Medicine and the critical role for psychiatry faculty leadership and participation. METHODS: The authors present a review of curricular materials and course operations for the different Doctoring courses for first-, second-, third-, and fourth-year curriculum. The authors describe the role of psychiatry faculty in both leadership and in group facilitation. RESULTS: The Doctoring curriculum offers case-based, small-group learning that relies heavily on standardized patients to teach core content around doctor-patient communication, ethics, behavioral medicine, and counseling approaches. There are frequent psychosocial issues woven in to these encounters. Psychiatry faculty members and other mental health professionals are well-prepared by virtue of their training to lead small group discussions and facilitate the supportive elements of the small groups in medical education. CONCLUSION: The Doctoring curriculum is both a biopsychosocial educational endeavor and a high-visibility leadership opportunity for the Department of Psychiatry. Other medical schools and departments of psychiatry may wish to pursue similar roles in their didactic programs.

A general framework for approaching residents in difficulty.

The general framework for approaching residents in difficulty that we present here includes (1) explicit criteria that separate suggestions for improvement from formal remedial action, (2) categorization of the problem into three areas with different approaches (competence, laws and professional standards, and performance and disability), and (3) a method for clarifying faculty roles in the remediation efforts. This framework, along with clear written policies and procedures, helps to organize and streamline a response to residents with difficulties.