The Cultural Formulation Interview: Progress to date and future directions.

The Cultural Formulation Interview (CFI) developed for DSM-5 provides a way to collect information on patients' illness experience, social and cultural context, help-seeking, and treatment expectations relevant to psychiatric diagnosis and assessment. This thematic issue of Transcultural Psychiatry brings together articles examining the implementation and impact of the CFI in diverse settings. In this editorial introduction we discuss key areas raised by these and other studies, including: (1) the potential of the CFI for transforming current psychiatric assessment models; (2) training and implementation strategies for wider application and scale-up; and (3) refining the CFI by developing new modules and alternative protocols based on further research and clinical experience.

Training on the DSM-5 Cultural Formulation Interview improves cultural competence in general psychiatry residents: A pilot study.

The objective of this study was to assess whether a 1-hour didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves the cultural competence of general psychiatry residents. The main hypothesis was that teaching adult psychiatry residents a 1-hour session on the CFI would improve cultural competence. The exploratory hypothesis was that trainees with more experience in cultural diversity would have a greater increase in cultural competency scores. Psychiatry residents at a metropolitan, county hospital completed demographics and preintervention questionnaires, were exposed to a 1-hour session on the CFI, and were given a postintervention questionnaire. The questionnaire was an adapted version of the validated Cultural Competence Assessment Tool . Paired samples t tests compared pre- to posttest change. Hierarchical linear regression assessed whether pretraining characteristics predicted posttest scores. The mean change of total pre- and posttest scores was significant ( p = .002), as was the mean change in subscales Nonverbal Communications ( p < .001) and Cultural Knowledge ( p = .002). Demographic characteristics did not predict higher posttest scores (when covarying for pretest scores). Psychiatry residents' cultural competence scores improved irrespective of previous experience in cultural diversity. More research is needed to further explore the implications of the improved scores in clinical practice.

Assessing Cultural Psychiatry Milestones Through an Objective Structured Clinical Examination.

OBJECTIVE: Culturally appropriate tools for patient assessment are needed to train psychiatric residents. An objective structured clinical examination (OSCE) can be a helpful tool for evaluating trainees in the psychiatry milestones pertaining to cultural competency. METHODS: Seventeen psychiatry residents and fellows at the University of Massachusetts participated in two small-group OSCE exercises to learn cultural interviewing using the DSM-5 Cultural Formulation Interview. Trainee groups presented a cultural formulation and received feedback. Participants were surveyed about their comfort with cultural interviewing before and after the exercise. RESULTS: Paired t tests (N = 16) showed that mean level of comfort with the Cultural Formulation Interview increased by a mean of 0.5 points after training (t = 3.16, df = 15, p < 01 95 % CI = 163-837). DISCUSSION: The UMass culturally appropriate assessment OSCE enhanced psychiatric trainees' comfort with culturally appropriate interviewing using the Cultural Formulation Interview.

Global Mental Health: Five Areas for Value-Driven Training Innovation.

OBJECTIVE: In the field of global mental health, there is a need for identifying core values and competencies to guide training programs in professional practice as well as in academia. This paper presents the results of interdisciplinary discussions fostered during an annual meeting of the Society for the Study of Psychiatry and Culture to develop recommendations for value-driven innovation in global mental health training. METHODS: Participants (n = 48), who registered for a dedicated workshop on global mental health training advertised in conference proceedings, included both established faculty and current students engaged in learning, practice, and research. They proffered recommendations in five areas of training curriculum: values, competencies, training experiences, resources, and evaluation. RESULTS: Priority values included humility, ethical awareness of power differentials, collaborative action, and "deep accountability" when working in low-resource settings in low- and middle-income countries and high-income countries. Competencies included flexibility and tolerating ambiguity when working across diverse settings, the ability to systematically evaluate personal biases, historical and linguistic proficiency, and evaluation skills across a range of stakeholders. Training experiences included didactics, language training, self-awareness, and supervision in immersive activities related to professional or academic work. Resources included connections with diverse faculty such as social scientists and mentors in addition to medical practitioners, institutional commitment through protected time and funding, and sustainable collaborations with partners in low resource settings. Finally, evaluation skills built upon community-based participatory methods, 360-degree feedback from partners in low-resource settings, and observed structured clinical evaluations (OSCEs) with people of different cultural backgrounds. CONCLUSIONS: Global mental health training, as envisioned in this workshop, exemplifies an ethos of working through power differentials across clinical, professional, and social contexts in order to form longstanding collaborations. If incorporated into the ACGME/ABPN Psychiatry Milestone Project, such recommendations will improve training gained through international experiences as well as the everyday training of mental health professionals, global health practitioners, and social scientists.

Reflections on Aboriginal perinatal mental health, mothers, babies, families and community: A South Australian trainee's experience.

OBJECTIVE: This paper explores novel training opportunities that the Expanded Setting Training Program (ESTP) provides for advanced psychiatry trainees. It is a reflection of a trainee's learning experiences during a year-long posting in Aboriginal Perinatal Mental Health, working alongside the Aboriginal Family Birthing Program, coupled with reflection and supervision. CONCLUSIONS: ESTP provided a fertile area to hone an advanced trainee's skills in the niche areas of Aboriginal mental health, perinatal mental health, culture and psychiatry. In addition, it provided skills in the area of leadership, health advocacy and the establishment and maintenance of successful programs in disadvantaged, culturally and linguistically diverse communities. The ESTP Aboriginal Mental Health rotation provides a unique experience for training, and the learning opportunities are limited only by the creativity of the trainee and supervisor.

Innovative training with virtual patients in transcultural psychiatry: the impact on resident psychiatrists' confidence.

BACKGROUND: Virtual patients are now widely accepted as efficient and safe training tools in medical education, but very little is known about their implementation in psychiatry, especially in transcultural clinical care of traumatized refugee patients. OBJECTIVE: This study aimed at assessing the impact of training with a virtual patient on confidence in providing clinical care for traumatized refugee patients. METHODS: The authors developed an educational tool based on virtual patient methodology portraying the case of "Mrs. K", a traumatized refugee woman with symptoms of PTSD and depression. A group (N=32) of resident psychiatrists tested the system and their confidence in different aspects of providing clinical care for this patient group was evaluated pre- and post-test by using a validated confidence questionnaire. Cronbach's α was calculated for all clusters. Changes between pre- and post-test were compared by using the matched-pair t-test, binomial distribution for exact significance test and a calculation of effect sizes (Cohen's d). RESULTS: A statistically significant improvement was exhibited in overall confidence (mean Δ: 0.34; p<0.0001; d: 0.89) as well as in four more specific domains of clinical care, with the area of identifying and evaluating trauma-related diagnoses and disability showing the most prominent improvement (mean Δ: 0.47; p<0.0001; d: 1.00). CONCLUSIONS: This VP-system can lead to physicians' improvement of confidence in providing transcultural clinical care for traumatized refugee patients. Further research is required to investigate improvement in actual performance and cognitive outcomes with several VPs and in a long-term effect perspective.

Training with virtual patients in transcultural psychiatry: do the learners actually learn?

BACKGROUND: The rapid increase in the number of patients with diverse ethnic backgrounds and previous exposure to severe mental trauma dictates the need for improvement in the quality of transcultural psychiatric health care through the development of relevant and effective training tools. OBJECTIVE: This study aimed to evaluate the impact of training with a virtual patient on the learner's knowledge of posttraumatic stress disorder symptoms, clinical management, and basic communication skills. METHODS: The authors constructed an interactive educational tool based on virtual patient methodology that portrayed a refugee with severe symptoms of posttraumatic stress disorder and depression. A total of 32 resident psychiatrists tested the tool and completed a pre-interaction and post-interaction knowledge test, including skills, at the time and several weeks later. RESULTS: All of the participants (N=32) completed the pre-interaction and post-interaction test, and 26 (81%) of them completed the online follow-up test. The mean pre-interaction score was 7.44 (male: 7.08, female: 7.65, no statistical significance). The mean post-interaction score was 8.47, which was significantly higher (P<.001) than the pre-interaction score (mean score 7.44). The mean score for the follow-up test several weeks later was 8.38, higher than the pre-interaction score by 0.69 points but not statistically significant. CONCLUSIONS: Our results suggest that virtual patients can successfully facilitate the acquisition of core knowledge in the field of psychiatry, in addition to developing skills such as clinical reasoning, decision making, and history taking. Repeated training sessions with virtual patients are proposed in order to achieve sustainable educational effects.

Developing cognitive behaviour therapy training in India: Using the Kolb learning cycle to address challenges in applying transcultural models of mental health and mental health training.

Although mental health workers in India across all major professional groups have identified an unmet need for training in cognitive behaviour therapy (CBT), the uncritical export of models of mental health, therapy provision and training to low- and middle-income countries is a problematic process. This paper describes the context for the first stand-alone CBT training programme in India, based in Chennai. This paper includes an evaluation of the first phase of the training and information from trainees regarding the quality and applicability of the training to their working context. The paper provides an overview of some of the critiques that are pertinent to this process and considers the way that the Kolb learning cycle can be used as a framework within training to go some way to addressing these difficulties.

Psychodynamic cultural psychiatry: a new approach to teaching residents.

This article describes a course, Psychodynamic Cultural Psychiatry, taught to PGY-3 residents at the New York Presbyterian Hospital-Weill Cornell Medical Center that uses psychodynamic theory to help deepen cultural understanding. We (Sandra Park, the instructor for the course, and Elizabeth Auchincloss, the residency training director) developed the class in 2006 in an effort to raise cultural awareness in the residency curriculum. We believe that despite an inherent Western bias, psychodynamic theory can be an effective way to teach cultural psychiatry. Additionally, cultural understanding can enhance understanding of psychodynamic principles. In this article, we argue that our course in psychodynamic cultural psychiatry helps residents to integrate these two points of view.

Multicultural counseling self-efficacy scale-racial diversity form: factor structure and test of a social cognitive model.

This study was conducted to gather evidence on the factor structure and concurrent criterion validity of the multicultural counseling self-efficacy scale-racial diversity form (MCSE-RD; Sheu & Lent, 2007). The MCSE-RD was designed to assess therapists' perceived capabilities in performing culturally relevant in-session behaviors in cross-racial counseling. Participants were 209 students in counseling-related graduate programs in the USA. Confirmatory factor analyses identified a bifactor structure in which responses to MCSE-RD items could be explained by one generic and three multicultural-specific counseling self-efficacy factors. Support was also found for a social cognitive model in which self-efficacy and interests in multicultural counseling mediated the effects of prior cross-racial client contacts and perceptions of multicultural training environments on intent to perform multicultural counseling in the future. Additionally, outcome expectations were predictive of multicultural counseling interests and choice goals. Implications for multicultural training and directions for future research are highlighted.

Introducción. El prejuicio intergrupal desde una perspectiva evolutiva y social / Introduction. Intergroup prejudice from a developmental and social approach

El objetivo de este Tema Monográfico ha sido reunir investigaciones de psicólogos evolutivos y sociales, españoles y extranjeros, en el amplio ámbito del prejuicio y las relaciones intergrupales. Se incluyen trabajos de revisión y estudios empíricos con distintos presupuestos teóricos, procedimientos de investigación y tipo de poblaciones. La mayoría de las contribuciones abordan el estudio de las actitudes de niños, adolescentes y jóvenes hacia la diversidad étnico-racial, el sesgo endogrupal o la identidad étnica, y tres artículos tratan otras formas de prejuicio intergrupal de innegable importancia social en nuestra cultura occidental: los prejuicios hacia la homosexualidad, la discapacidad y la gordura (AU)

The aim of this Special Issue is to gather research from developmental and social psychologists, from Spain and other countries, in the broad area of prejudice and intergroup attitudes. The Monograph includes review papers and empirical studies that present different theoretical assumptions, research procedures, and types of population. Most contributions are related to the study of children’s and youth’s attitudes toward different racial-ethnic groups, in group bias or ethnic identity, and three articles address other forms of prejudice that have an undeniable social significance in our Western societies: biases toward homosexuality, disability, and body size (AU)

Research into witchcraft in psychoanalysis and history.

Witchcraft and witch-hunting have been a topic for numerous historical and psychoanalytical research projects. But until now, most of these projects have remained rather isolated from one from the other, each in their own context. In this article I shall attempt to set up a dialogue between psychoanalysis and history by way of the example of research into witchcraft. However, I make no claim to covering the different psychoanalytical and historical approaches in full. As a historical 'layman', my interest lies in picking out some of the approaches that seem to me particularly well suited to contribute to reciprocal enhancement.