Assessing Adverse Outcomes and Learning Needs in Canadian Psychiatric Independent Medical Examinations.

Despite the importance of independent medical examinations (IMEs), there is virtually no literature on the risks to the IME assessor nor the learning needs of psychiatrists in this area. To address this deficit, a retrospective chart review of nearly 38,000 cases from the Canadian Medical Protective Association (CMPA) identified 108 files involving complaints or legal actions against psychiatrists performing IMEs. Most complaints identified by the CMPA were to regulatory bodies, including biased opinion, inadequate assessment, inappropriately relying on a requester's information without independent evaluation, nonadherence to regulatory body policies, cursory documentation lacking relevant details, and communication breakdowns. A survey by the Canadian Academy of Psychiatry and the Law (CAPL) and the Canadian Psychiatric Association (CPA) had 306 Canadian psychiatrist respondents. About 37 percent of psychiatrists completing IMEs reported medico-legal consequences, including complaints to regulatory authorities. Only 40 percent of those doing IMEs and 20 percent of all psychiatrists had formal training in doing IMEs. The studies confirm that despite a low but important risk of medico-legal consequences, many psychiatrists performing IMEs do not have formalized training. Using the new CAPL Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing is a step to reduce the risk of such evaluations.

Coping strategies of psychiatrists and psychiatry trainees following patient suicide and suicide attempt: A national cross-sectional study in Saudi Arabia.

A patient's suicide or suicide attempt is a challenging experience for psychiatrists. This study aimed to explore the common coping strategies and habits developed by psychiatrists/trainees following such incidents. A self-administered questionnaire was distributed among participants in Saudi Arabia. The study enrolled 178 participants, of whom 38.8% experienced a patient's suicide, 12.9% experienced a patient's severe suicide attempt, and 48.3% did not encounter any suicidal events. The most frequently utilized sources of support were colleagues (48.9%), team discussions (41.3%), and supervisors (29.3%). Only 21.4% received formal education in coping with a patient's suicide. Approximately 94.9% reported a lack of support systems within their institution. The study highlighted the coping strategies most commonly employed by psychiatrists/trainees and revealed that the majority of participants reported no changes in their daily habits. The findings underscore the need for a structured support system and formal educational resources to address the existing deficit. Mental health organizations must take action to ensure adequate resources for healthcare providers.

Depression among psychiatrists and psychiatry trainees and its associated factors regarding work, social support, and loneliness.

BACKGROUND: This study aimed to survey the prevalence of depression and its associated factors among psychiatrists and psychiatry trainees (physicians in psychiatric residency training). METHODS: This cross-sectional study surveyed Thai psychiatrists and psychiatry trainees from January to February 2023 using an online questionnaire. The questionnaires consisted of (1) the demographic and work-related information; (2) perceptions towards social support and work; (3) the Patient Health Questionnaire-9 (PHQ-9) Thai version; and (4) the 6-item Revised UCLA Loneliness Scale Thai version. All data were analyzed using descriptive statistics, and the associated factors concerning depression were analyzed via multiple linear regression analyses. RESULTS: Of the 225 total participants, 52(23.1%) and 173 (76.9%) were psychiatry trainees and psychiatrists, respectively. Most of them were female (64.9%) with overall median age (interquatile) was 34 (30, 42) years. Regarding the PHQ-9 findings, the prevalence of depression among all participants was 12.4% (psychiatrists 13.9% and psychiatry trainees 7.7%). From regression analyses, depression was associated with loneliness and perceived levels of work satisfaction and work stress in psychiatrists, while in psychiatry trainees, depression was associated with loneliness and perceived level of ability to control work schedule. CONCLUSIONS: One-tenth of psychiatrists and psychiatry trainees had depression. Although the prevalence of depression in this study was not extremely high, key contributing factors related to depression, such as loneliness, work satisfaction, work stress, and ability to control the work schedule should be required to action to reduce the depression rate among mental health personnel.

Palliative Care Psychiatry: Building Synergy Across the Spectrum.

PURPOSE OF REVIEW: Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS: PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.

Distributed Medical Education (DME) in psychiatry: perspectives on facilitators, obstacles, and factors affecting psychiatrists' willingness to engage in teaching activities.

BACKGROUND: Distributed Medical Education (DME), a decentralized model focused on smaller cities and communities, has been implemented worldwide to bridge the gap in psychiatric education. Faculty engagement in teaching activities such as clinical teaching, supervision, and examinations is a crucial aspect of DME sites. Implementing or expanding DME sites requires careful consideration to identify enablers that contribute to success and barriers that need to be addressed. This study aims to examine enablers, barriers, and factors influencing psychiatrists' willingness to start or continue participating in teaching activities within Dalhousie University's Faculty of Medicine DME sites in two provinces in Atlantic Canada. METHODOLOGY: This cross-sectional study was conducted as part of an environmental scan of Dalhousie Faculty of Medicine's DME programs in Nova Scotia (NS) and New Brunswick (NB), Canada. In February 2023, psychiatrists from seven administrative health zones in these provinces anonymously participated in an online survey. The survey, created with OPINIO, collected data on sociodemographic factors, practice-related characteristics, medical education, and barriers to teaching activities. Five key outcomes were assessed, which included psychiatrists' willingness to engage in (i) clinical training and supervision, (ii) lectures or skills-based teaching, (iii) skills-based examinations, (iv) training and supervision of Canadian-trained psychiatrists, and (v) training and supervision of internationally trained psychiatrists. The study employed various statistical analyses, including descriptive analysis, chi-square tests, and logistic regression, to identify potential predictors associated with each outcome variable. RESULTS: The study involved 60 psychiatrists, primarily male (69%), practicing in NS (53.3%), with international medical education (69%), mainly working in outpatient services (41%). Notably, 60.3% lacked formal medical education training, yet they did not perceive the lack of training as a significant barrier, but lack of protected time as the main one. Despite this, there was a strong willingness to engage in teaching activities, with an average positive response rate of 81.98%. The lack of protected time for teaching/training was a major barrier reported by study participants. Availability to take the Royal College of Physicians and Surgeons of Canada Competency by Design training was the main factor associated with psychiatrists' willingness to participate in the five teaching activities investigated in this study: willingness to participate in clinical training and supervision of psychiatry residents (p = .01); provision of lectures or skills-based teaching for psychiatry residents (p < .01); skills-based examinations of psychiatry residents (p < .001); training/supervision of Canadian-trained psychiatrists (p < .01); and training and supervision of internationally trained psychiatrists (p < .01). CONCLUSION: The study reveals a nuanced picture regarding psychiatrists' engagement in teaching activities at DME sites. Despite a significant association between interest in formal medical education training and willingness to participate in teaching activities, clinicians do not consider the lack of formal training as a barrier. Addressing this complexity requires thoughtful strategies, potentially involving resource allocation, policy modifications, and adjustments to incentive structures by relevant institutions.

A Comparative Study on Mental Disorder Conceptualization: A Cross-Disciplinary Analysis.

The conceptualization of mental disorders varies among professionals, impacting diagnosis, treatment, and research. This cross-disciplinary study aimed to understand how various professionals, including psychiatrists, psychologists, medical students, philosophers, and social sciences experts, perceive mental disorders, their attitudes towards the disease status of certain mental states, and their emphasis on biological versus social explanatory attributions. A survey of 371 participants assessed their agreement on a variety of conceptual statements and the relative influence of biological or social explanatory attribution for different mental states. Our findings revealed a consensus on the need for multiple explanatory perspectives in understanding psychiatric conditions and the influence of social, cultural, moral, and political values on diagnosis and classification. Psychiatrists demonstrated balanced bio-social explanatory attributions for various mental conditions, indicating a potential shift from the biological attribution predominantly observed among medical students and residents in psychiatry. Further research into factors influencing these differing perspectives is necessary.

Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study.

OBJECTIVES: To describe the practical experience of delivering a proactive and integrated consultation-liaison (C-L) psychiatry service model (PICLP). PICLP is designed for older medical inpatients and is explicitly biopsychosocial and discharge-focused. In this paper we report: (a) observations on the training of 15 clinicians (seven senior C-L psychiatrists and eight assisting clinicians) to deliver PICLP; (b) the care they provided to 1359 patients; (c) their experiences of working in this new way. METHOD: A mixed methods observational study using quantitative and qualitative data, collected prospectively over two years as part of The HOME Study (a randomized trial comparing PICLP with usual care). RESULTS: The clinicians were successfully trained to deliver PICLP according to the service manual. They proactively assessed all patients and found that most had multiple biopsychosocial problems impeding their timely discharge from hospital. They integrated with ward teams to provide a range of interventions aimed at addressing these problems. Delivering PICLP took a modest amount of clinical time, and the clinicians experienced it as both clinically valuable and professionally rewarding. CONCLUSION: The experience of delivering PICLP highlights the special role that C-L psychiatry clinicians, working in a proactive and integrated way, can play in medical care.

Psychiatry Vice Chairs of Education: Expected and Actual Responsibilities, Satisfaction, and Work Barriers.

OBJECTIVES: The current study investigated the gap between actual and expected work responsibilities of psychiatry vice chairs of education (VCEs), their work satisfaction, and perceived work barriers. METHODS: Psychiatry VCEs were identified through professional memberships and school websites within the USA. In 2021, identified VCEs were emailed an anonymous survey that was based on past research on roles and responsibilities of VCEs. Through qualitative and quantitative questions, the survey assessed demographic characteristics, actual and expected work responsibilities, work satisfaction, and work barriers during time spent in the VCE role. RESULTS: Of 57 identified psychiatry VCEs, 32 (56.1%) completed the survey. Most respondents (59.4%) said their department/institution did not have a written VCE job description. There were gaps between actual and expected VCE responsibilities, especially with the performance review of education leaders (Δ - 11; actual n = 20 vs. expected n = 31). The greatest satisfaction came from mentoring trainees/faculty (respectively 4.88 ± 0.33 and 4.85 ± 0.37 on a 5-point scale) and overseeing/supporting educational programs (4.66 ± 0.48). Comments on work barriers included limited protected time (n = 11), education budget constraints (n = 6), and having multiple leadership roles (n = 5). The actual full-time equivalent in the VCE role was significantly lower than expected (p < .001). CONCLUSION: Considering the role of psychiatry VCEs remains relatively new and is evolving, adequate allocation of resources and improved job descriptions may help close the gap between expected and actual responsibilities. The current findings can assist in developing such job descriptions to attract and define the work of a VCE based on specific responsibilities and associated work satisfaction.

Effectiveness of Entrustable Professional Activity-Based Clinical Psychiatry Training for Indian Medical Interns: A Preliminary Study.

ObjectiveEntrustable Professional Activities (EPA) are discretely measurable specific professional tasks that integrate multiple competencies to define and provide varying levels of faculty support per trainee needs. Methods: We developed an EPA-based psychiatry curriculum for medical interns. Fifty-four interns completed the OSCE stations, Multiple Choice Questions, and Attitude questionnaires to assess EPAs, knowledge and attitudes towards the relevance and utility of clinical psychiatry in general practice. Results: Two weeks of EPA-based psychiatry training resulted in improvement in median scores on attitude questions (p < 0.05), clinical skills measured using EPA levels. Conclusions: EPA-based curriculum can improve clinical skills, knowledge, and attitudes towards clinical psychiatry in interns.

Impact of a Medical Student-Run Bingo Group on Psychiatry Inpatients and Students.

Medical students have few opportunities to lead patient groups during their clinical year. During the psychiatry clerkship, they are group observers and do not have the skills to lead psychotherapy or treatment groups. This report describes a bingo group led by medical students on an inpatient psychiatry unit. The group provides leadership opportunities for students lacking advanced group training, enables student integration into the ward, and reduces stigma. Patients find it easier to engage and benefit from socialization and improved cognitive and ego functioning. The group also provides continuity of care when staffing changes. Clerkship directors are encouraged to consider such a program.Prim Care Companion CNS Disord 2024;26(1):23m03576. Author affiliations are listed at the end of this article.

Pediatric Consultation-Liaison (C-L) Psychiatry Training Pathways.

This perspective piece reviews the current training pathways for pediatric consultation-liaison psychiatry. Significant workforce shortages of child and adolescent psychiatry over the past 3 decades have led to the creation of new training pathways between pediatrics and child and adolescent psychiatry training programs to care for children whose medical and psychiatric management has become increasingly complex. There are now several options available to receive excellent training in pediatric consultation-liaison. Efforts to foster continued interactions and shared education between adult and pediatric consultation-liaison providers are likely to be beneficial to both disciplines given the astonishing advances in technology over the years that have allowed many patients with complex childhood medical disorders to survive into adulthood today.

The Virtual Couch: a Curriculum on the Question of the Fundamentals of Remote Psychotherapy-Pilot Study.

OBJECTIVE: With a rise in remote clinical practice related to the COVID-19 pandemic, a novel remote psychotherapy curriculum was presented to psychiatry residents and fellows to address the urgent need to teach trainees how to adapt traditional psychotherapy skills to telepsychiatry settings. METHODS: Trainees completed a survey before and after receiving the curriculum to assess remote psychotherapy skills and areas for growth. RESULTS: Eighteen trainees (24% fellows, 77% residents) completed the pre-curriculum survey, and 28 trainees (26% fellows, 74% residents) completed the post-curriculum survey. Thirty-five percent of pre-curriculum participants indicated no experience with remote psychotherapy. Technology (24%) and patient engagement (29%) were identified as the greatest challenges in providing teletherapy pre-curriculum. Content related to patient care (69%) and technology (31%) was of most interest to pre-curriculum participants and identified as most helpful post-curriculum (53% and 26%, respectively). After receiving the curriculum, most trainees planned to make internal, provider-related changes to their remote teletherapy practice. CONCLUSIONS: The remote psychotherapy curriculum was well received by psychiatry trainees who had limited experience with remote clinical practice prior to the pandemic.