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4.
JAMA ; 324(24): 2557-2558, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33351034
8.
Psychodyn Psychiatry ; 48(3): 259-270, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996847

RESUMO

Coronavirus disease 2019 (COVID-19) is currently ravaging health systems across the world. Psychiatric trainees are at risk of exposure to patients with COVID-19 given their clinical roles in emergency and inpatient psychiatric settings. This article represents a case study of group dynamics in which we reflect on our own experience as psychiatric residents at a Boston-area hospital system in the era of COVID-19 and apply Wilfred Bion's concepts of the "work group" and the "basic assumption group" processes of group operation. We assess dynamics between trainees and administrative leadership both at baseline and in the current pandemic. Since navigation through crises is more effective if group leadership recognizes and responds to basic assumption behaviors, we propose suggestions to enable health system administration to successfully lead health care organizations through periods of societal turmoil. We posit that these principles apply across settings, specialties, and provider types. In addition, we use our observations to indicate future directions for expanding Bion's theories in the contemporary context.


Assuntos
Infecções por Coronavirus , Internato e Residência , Liderança , Pandemias , Pneumonia Viral , Psiquiatria/educação , Betacoronavirus , Processos Grupais , Humanos
15.
Adv Exp Med Biol ; 1195: 117-126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468466

RESUMO

Medical training in Australia has been clouded in recent times by media reporting on the tragic suicides of multiple trainees. This has brought attention to the stressful demands of the medical profession and the often-poor wellbeing of trainees, who must balance both study and work demands. Psychiatry trainees in particular face unique stressors in the workplace, being in a profession that carries a high emotional burden. Psychiatry trainees encounter suicides by patients and colleagues at an alarmingly high rate and commonly experience isolation, unrealistic workloads and stigma towards their chosen specialty. This literature review will highlight the extent to which these factors impact on psychiatry trainees. We will also explore the factors that contribute to their wellbeing, including the role of supervision, as well as leisurely and social activities. This review will look at the availability of these supports to psychiatry trainees and whether their lifestyles allow them time to spend on these activities. Though it is impossible to remove all stressors from psychiatry, interventions to improve trainee wellbeing must consider factors that improve resilience and support as well as target change to the culture in medicine that currently promotes stress and overwork. It must be recognised that trainees who feel supported and mentally well will perform better in the workplace in the long run, and, in this review, we will speculate about how workplace changes that are occurring for psychiatry trainees in Victoria, Australia, may affect their wellbeing.


Assuntos
Psiquiatria/educação , Estudantes de Medicina/psicologia , Suicídio/estatística & dados numéricos , Local de Trabalho/psicologia , Adaptação Psicológica , Humanos , Saúde do Trabalhador , Estresse Psicológico , Estudantes de Medicina/estatística & dados numéricos , Suicídio/psicologia , Vitória/epidemiologia , Carga de Trabalho/estatística & dados numéricos
17.
Postgrad Med ; 132(7): 590-594, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32442058

RESUMO

OBJECTIVES: Psychotic disorders can exact a toll on both patients and caregivers. Whilst the desired teaching goals include gaining an understanding of the manifestations, neurobiology and treatment of these conditions, such concepts may appear abstract to medical undergraduates new to psychiatry before their clinical rotation. This study aimed to examine the use of patient narratives in teaching. Based on self-determination and Kolb's learning theories, it was hypothesized that intermediate processes (such as engagement, motivation, reflection) mediate narratives' effectiveness as a pedagogical tool. METHODS: Narratives in the form of stories of prominent individuals with psychotic disorders (such as John Nash) were incorporated in undergraduate teaching. Overall, 1014 out of 1500 (67.6%) medical undergraduates provided feedback over 2014-2018 through an anonymized questionnaire after the teaching session. Relationships between the use of narratives, intermediate processes, and overall effectiveness of session were assessed using correlation, regression, and structural equation modeling analyses. RESULTS: Most learners (97.2%) found that use of narratives helped them better appreciate the topic. Use of narratives correlated with better engagement, motivation, feeling equipped, reflection about the topic, and effectiveness as a pedagogical medium. The use of narratives was significantly predictive of ratings on these intermediate processes (all p < 0.001), which in turn mediated the relationship between narratives and overall session ratings. CONCLUSION: Consistent with adult learning theories, the use of narratives can improve appreciation of psychotic spectrum disorders via better engagement, motivation, and reflection within learners. Appropriate narratives can be incorporated into other topics to enhance undergraduate psychiatry education.


Assuntos
Anedotas como Assunto , Educação de Graduação em Medicina/métodos , Psiquiatria/educação , Autoeficácia , Estudantes de Ciências da Saúde/psicologia , Adulto , Currículo , Feminino , Humanos , Masculino
18.
Postgrad Med J ; 96(1137): 384-386, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404498

RESUMO

The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year's end.


Assuntos
Competência Clínica/normas , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Educação Médica Continuada/tendências , Medicina , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Medicina de Emergência/educação , Pesquisa sobre Serviços de Saúde , Humanos , Infectologia/educação , Inovação Organizacional , Pneumonia Viral/epidemiologia , Medicina Preventiva/educação , Psiquiatria/educação , Pneumologia/educação
19.
Acad Med ; 95(10): 1546-1549, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32271227

RESUMO

PROBLEM: Entrustable professional activities (EPAs) can be used to operationalize competency-based medical education. Mobile apps can efficiently capture feedback based on direct observation. To leverage the benefits of both, the authors developed an assessment tool that combines EPAs with mobile technology. APPROACH: The authors designed an app to collect EPA data based on direct observation using human-technology interface guidelines. Data collected in the app included: name of resident, the 13 end-of-training EPAs for psychiatry, entrustment ratings, and corrective narrative feedback. The app was implemented in an outpatient continuity clinic for second-year psychiatry residents over a 10-month period between September 2017 and June 2018. Ten faculty-resident dyads piloted the app. To assess the feasibility, utility, and validity of this intervention, the authors examined 3 outcomes: (1) utilization (mean time to complete each assessment; percentage of dyads who completed 10 assessments), (2) quality of the comments (proportion of comments that were behaviorally specific and actionable), and (3) correlation between entrustment level and resident experience (defined as days elapsed since the beginning of the experience). OUTCOMES: A total of 99 assessments were completed during the pilot. Mean time to complete an assessment was 76 seconds (standard deviation = 50 seconds, median = 67 seconds). Only 6 of the 10 dyads completed at least 10 assessments. Of all comments, 95% (94) were behaviorally specific and actionable and 91% (90) were corrective. Entrustment scores correlated moderately with resident experience (r = 0.43, P < .001). NEXT STEPS: The authors' EPA mobile app was efficient, generated high-quality feedback, and produced entrustment scores that improved as the residents gained experience. Challenges included uneven adoption. Looking forward, the authors plan to examine the enablers and barriers to adoption from an implementation science perspective.


Assuntos
Educação Baseada em Competências/métodos , Avaliação Educacional/métodos , Internato e Residência/métodos , Aplicativos Móveis , Psiquiatria/educação , Adulto , Competência Clínica , Feminino , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde
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