Considering Culture and Conflict: A Novel Approach to Active Bystander Intervention.

Introduction: Workplace microaggressions are prevalent in clinical settings and contribute to poorer mental health outcomes, as well as to higher rates of burnout for physicians and students experiencing them. While bystander workshops customarily provide guidance on direct interventions to a general audience, the literature does not yet address workshops in an academic setting that consider the individual's motivations and behavior patterns. We implemented a psychologically informed approach to microaggression training to increase participants' understanding and willingness to undergo behavioral change. Methods: We created a survey that included 10 distinct scenarios of discrimination in the clinical setting. Participants' willingness to intervene was assessed on a Likert scale prior to, then following, a 1-hour active bystander intervention workshop conducted virtually. The workshop outlined the role of culture and conflict management style in willingness to intervene. Four modes of intervention were outlined, including direct and indirect methods. Results: A total of 78 medical students, graduate students, residents, and faculty members participated in the workshop. Of those, we compared 68 individuals' pre- and postworkshop responses to our questionnaire. We then focused on the 54 participants with no previous training in psychiatry or psychology. Utilizing a Wilcoxon signed rank test, we compared the average pre/post scores of willingness to intervene and found scores to have improved following workshop attendance (Z = -6.339, p < .001). Discussion: Our findings suggest that a psychiatrically informed and culturally sensitive approach to active bystander intervention workshops may promote upstanding more effectively in academic medicine.

Outcomes From a Novel Graduate Medical Education Leadership Program in Advancing Diversity, Equity, and Inclusion.

BACKGROUND: Academic medicine needs more diverse leadership from racial/ethnic minorities, women, people with disabilities, and LGBTQIA+ physicians. Longitudinal structural support programs that bring together underrepresented in medicine (UiM) and non-UiM trainees are one approach to build leadership and scholarship capacity in diversity, equity, and inclusion (DEI). OBJECTIVE: To describe the creation, satisfaction with, and feasibility of a Leadership Education in Advancing Diversity (LEAD) Program and evaluate scholars' changes in self-efficacy, intended and actual behavior change, and outputs in leadership and DEI scholarship. METHODS: In 2017, we created the LEAD Program, a 10-month longitudinal, single institution program that provides residents and fellows ("scholars") across graduate medical education (GME) with leadership training and mentorship in creating DEI-focused scholarship. In the first 3 cohorts (2017-2020), we assessed scholars' self-efficacy, actual and planned behavior change, and program satisfaction using IRB-approved, de-identified retrospective pre-/post-surveys. We measured scholarship as the number of workshops presented and publications developed by the LEAD scholars. We used descriptive statistics and paired 2-tailed t tests to analyze the data. RESULTS: Seventy-five trainees completed LEAD; 99% (74 of 75) completed the retrospective pre-/post-surveys. There was statistically significant improvement in scholars' self-efficacy for all learning objectives. All trainees thought LEAD should continue. LEAD scholars have created workshops and presented at local, regional, and national conferences, as well published their findings. Scholars identified the greatest benefits as mentorship, developing friendships with UiM and ally peers outside of their subspecialty, and confidence in public speaking. CONCLUSIONS: LEAD is an innovative, feasible GME-wide model to improve resident and fellow self-efficacy and behaviors in DEI scholarship and leadership.

Teaching Practice-Based Learning on Inpatient Psychiatric Services.

OBJECTIVE: Psychiatry residents must learn to incorporate new information into clinical practice as the field quickly evolves. The authors developed a practice-based workshop grounded in active learning principles on the inpatient psychiatric unit. METHODS: Residents rotating on inpatient services observed a patient interview, then brainstormed learner-driven learning objectives. They each independently researched selected topics, then utilized peer instruction and discussion grounded in the clinical case. Topic areas covered over a year were tracked and residents' experiences were surveyed. RESULTS: The material covered included evidence-based treatments, neuroscience, cultural, and systems psychiatry. Residents rated the workshop as highly effective and engaging (91% and 96%, respectively, on Likert Scale) and positively on the Tutorial Group Effectiveness Instrument (3.8 ± 0.6 for cognitive aspects, 3.2 ± 0.7 for motivational aspects, and 2.7 ± 0.6 for demotivational aspects). CONCLUSIONS: This case-based and learner-driven peer teaching model based on an active learning model allows for quick integration of new material into the curriculum with resident satisfaction.

A Process-Oriented Approach to Teaching Religion and Spirituality in Psychiatry Residency Training.

OBJECTIVES: Although the importance of addressing issues of spirituality and religion is increasingly acknowledged within psychiatry training, many questions remain about how to best teach relevant knowledge, skills, and attitudes. Current literature on curricula highlights the importance of maintaining a clinical focus and the balance between didactic content and process issues. The authors present findings from a program evaluation study of a course on religion, spirituality, and psychiatry that deliberately takes a primarily process-oriented, clinically focused approach. METHODS: Two six-session courses were offered. The first course targeted fourth-year psychiatry residents and the second targeted third-year psychiatry residents. Teaching sessions consisted of brief didactics combined with extensive process-oriented discussion. A two-person faculty team facilitated the courses. Clinical case discussions were integrated throughout the curriculum. A panel of chaplains was invited to participate in one session of each course to discuss the interface between spiritual counsel and psychiatry. A modified version of the Course Impact Questionnaire, a 20-item Likert scale utilized in previous studies of spirituality curricula in psychiatry, assessed residents' personal spiritual attitudes, competency, change in professional practice, and change in professional attitudes before and after the course (N = 20). Qualitative feedback was also elicited through written comments. RESULTS: The results from this study showed a statistically significant difference between the pre- and post-test scale for residents' self-perceived competency and change in professional practice. CONCLUSION: The findings suggest improvement in competency and professional practice scores in residents who participated in this course. This points toward the overall usefulness of the course and suggests that a process-oriented approach may be effective for discussing religion and spirituality in psychiatric training.

Helping psychiatry residents cope with patient suicide.

OBJECTIVE: Every clinical specialty has its own high risk patient challenges that threaten to undermine their trainees' professional identity, evolving sense of competence. In psychiatric training, it is patient suicide, an all-too frequently encountered consequence of severe mental illness that may leave the treating resident perplexed, guilt-ridden, and uncertain of their suitability for the profession. This study evaluates a patient suicide training program aimed at educating residents about patient suicide, common reactions, and steps to attenuate emotional distress while facilitating learning. METHODS: The intervention was selected aspects of a patient suicide educational program, "Collateral Damages,"-video vignettes, focused discussions, and a patient-based learning exercise. Pre- and post-survey results were compared to assess both knowledge and attitudes resulting from this educational program. Eight psychiatry residency training programs participated in the study, and 167 of a possible 240 trainees (response rate = 69.58 %) completed pre- and post-surveys. RESULTS: Knowledge of issues related to patient suicide increased after the program. Participants reported increased awareness of the common feelings physicians and trainees often experience after a patient suicide, of recommended "next" steps, available support systems, required documentation, and the role played by risk management. CONCLUSIONS: This patient suicide educational program increased awareness of issues related to patient suicide and shows promise as a useful and long overdue educational program in residency training. It will be useful to learn whether this program enhances patient care or coping with actual patient suicide. Similar programs might be useful for other specialties.