Improving child and adolescent psychiatry education for medical students: an inter-organizational collaborative action plan.

OBJECTIVE: A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students. METHOD: The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP's CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies. RESULTS/CONCLUSION: The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

Developing, Losing, and Regaining Trust in the Doctor-Patient Relationship.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Treatment of depression in children and adolescents.

Depression occurs in children and adolescents, although it may appear differently in younger patients. Research suggests juvenile depression may respond to psychotherapy and to pharmacologic agents, and that antidepressants remain a valuable treatment for juveniles with depression. Diagnostic considerations in juveniles with mood symptoms are discussed. A brief overview is provided of the evidence supporting psychotherapy for juveniles with depression. Controlled antidepressant trials in juveniles with depression provide some support for the use of some selective serotonin reuptake inhibitors and little support for atypical antidepressants, tricyclic antidepressants, or monoamine oxidase inhibitors. Evidence from suicide rates over time, autopsy findings among juvenile suicides, and impacts of antidepressant prescribing trends are related to the current controversy over suicidality and antidepressant use in juvenile patients. Based on this evidence, practical guidelines for treatment of juvenile depression are provided.

The functional assessment of media in child and adolescent psychiatric treatment.

Clinicians and parents share a responsibility to educate themselves in how young people communicate with each other and how it impacts on communication with the adults in their lives. The greater fluency that clinicians have with the world of youth, the easier it is to begin a meaningful dialogue with young people. Such a dialogue always has been the purview of clinicians interested in the developmental trajectory of their young patients. The enormity of media exposure and the changes that characterize current media formats make such a dialogue important and challenging. From watching video clips to listening to music, this assessment affords clinicians a snapshot into the milieu of the modern young world. The dialogue is "virtually" always well worth the effort.

An approach to the psychosocial treatment of the medically ill patient.

This article discusses some of the practices of psychosocial treatment. Broadly speaking, these practices include an emphasis on the doctor-patient relationship, the creation of a sound and lasting alliance, and the experience of trust and partnership that the physician fosters in helping the patient to negotiate the complex and uniquely individual experience of being ill. An argument is proposed that unless practitioners of medicine are mindful of the threats to the way they would like and are expected by their patients to practice medicine, they are unlikely to endorse changes actively or to pass the need for these changes onto the next generation of physicians. In this sense, keeping these concerns alive and the subject of ongoing discussion is crucial to the ongoing conceptualization of what it means to be a doctor.

Using a Socratic dialogue to tackle thorny issues of psychiatry.

Medical students often experience significant cognitive dissonance as they attempt to understand psychiatry. After the security of lab values and medical tests that characterize much of medical practice, the ambiguity of seemingly subjectively obtained information characteristic of psychiatry often leaves students somewhat uncomfortable with how psychiatric diagnoses are made and understood. This is, at its root, an issue of epistemology: How do we know what we say we know? Psychiatry can seem "fuzzy" to medical students, and it behooves psychiatry educators to explicitly address this discomfort but, at the same time, not apologize for the differences between psychiatry and "the rest of medicine." In this article, the author strives to emphasize that this kind of epistemological challenge is ancient and esteemed, represented to some extent in the writings of Plato (who believed that we measure the world by comparing our experience with our innate sense of what we know is true) and Aristotle (who insisted that what we know is based largely on what we can measurably experience). Using humor, an imagined conversation among these ancient philosophers and a modern psychiatrist-medical educator might help to dispel some of the discomfort that psychiatry education sometimes engenders among future physicians. The author presents an example of such a conversation. After a brief discussion of the epistemological differences characteristic of Platonic and Aristotelian views, students could be shown a script similar to the example script and then asked to discuss and debate the arguments elucidated. Perhaps even better, students could be asked to write their own debates based on how Plato or Aristotle would be expected to behave.

Training pediatric residents and pediatricians about adolescent mental health problems: a proof-of-concept pilot for a proposed national curriculum.

OBJECTIVE: This article presents a DVD-based educational program intended to help pediatric residents and practicing pediatricians recognize and respond to adolescent depression in busy primary care settings. METHODS: Representatives from pediatrics and adolescent medicine, child and adolescent psychiatry and psychology, and experts in the creation of educational mental health programs met to design a multimedia approach to improving the mental health diagnostic skills among pediatric residents. The authors chose depression as the initial topic because of its relatively high prevalence among children and adolescents, and evidence suggesting that pediatricians may have difficulty diagnosing this disorder in the primary care setting. The authors created a 30-minute DVD program featuring depressed adolescents and experts in child psychiatry and adolescent medicine. After viewing the DVD, residents in the training program, as well as practicing pediatricians, completed a standardized survey to assess the usefulness and attractiveness of this approach to pediatric education. RESULTS: The survey results support the potential value of this type of material and the feasibility of similar programs in addressing an array of mental health concerns in pediatric residencies. Participants found the program useful and indicated interest in receiving more educational programs in this format. CONCLUSION: The authors suggest that the relative ease with which initiatives such as this media-based approach can be implemented make this educational technique appropriate and feasible on a large scale for programs throughout the nation and for a variety of mental health concerns.