Developing a Rural Psychiatry Training Program on The Texas-Mexico Border: A Chance for Innovation.

Creating residencies that produce psychiatrists who are skilled and interested in working in under resourced areas, especially in community and rural settings is challenging. State and private agency collaboration can be an effective approach to enhancing such training. These resources for education have the goals of improving access and services, addressing workforce shortages and improving physician retention. They can provide flexibility to implement innovations that enhance training and address community needs. This article describes the implementation of a psychiatry residency at the University of Texas Rio Grande Valley School of Medicine. Funding was obtained from state and private initiatives. This paper describes the implementation. Feedback was positive at all levels. This program illustrates some of the advantages of utilizing alternate funding in creating high quality residencies that are integral to the community, produce skilled collaborative physicians, provide necessary care that addresses specific community needs and potentially address workforce issues in underserved areas.

Using the Psychiatry Resident-In-Training Examination (PRITE) to Assess the Psychiatry Medical Knowledge Milestones in Psychiatry.

OBJECTIVE: The introduction of the Milestone Project underscored the need for objective assessments of resident progress across the competencies. Therefore, the authors examined the Psychiatry Resident-In-Training Examination (PRITE) utility for measuring improvements in medical knowledge (MK). METHODS: The authors compared the mean performance for each MK subcompetency by resident year for all residents taking the PRITE from 2015 to 2017 (18,175 examination administrations). In addition, they surveyed psychiatry residency program directors regarding how well they thought they teach these subcompetencies. RESULTS: Increases in MK subcompetencies by resident year were significant for Psychopathology (p < 0.003), Psychotherapy (p < 0.002), and Somatic Therapies (p < 0.000). Development, Clinical Neuroscience, and Practice of Psychiatry did not show statistically significant differences between postgraduate years. Eighty psychiatry program directors responded to the survey and felt optimistic about their ability to teach the Psychopathology, Psychotherapy, Somatic Therapies, and Practice of Psychiatry subcompetencies. CONCLUSIONS: The PRITE measured significant improvements in medical knowledge for several of the core subcompetencies. The program director's responses would suggest that the lack of statistically significant differences found for Development and Clinical Neuroscience reflects areas in need of curricular development. The disparity between PRITE performance and program director perception of the Practice of Psychiatry subcompetency may reflect difficulties in defining the scope of this subcompetency. Overall, this suggests that structured examinations help measure improvements in certain subcompetencies and may also help identify curricular needs. However, there may be potential problems with the definition of some subcompetencies.

Development of Learning Objectives to Guide Enhancement of Chronic Disease Prevention and Management Curricula in Undergraduate Medical Education.

Phenomenon: Chronic disease is a leading cause of death and disability in the United States. With an increase in the demand for healthcare and rising costs related to chronic care, physicians need to be better trained to address chronic disease at various stages of illness in a collaborative and cost-effective manner. Specific and measurable learning objectives are key to the design and evaluation of effective training, but there has been no consensus on chronic disease learning objectives appropriate to medical student education. Approach: Wagner's Chronic Care Model (CCM) was selected as a theoretical framework to guide development of an enhanced chronic disease prevention and management (CDPM) curriculum. Findings of a literature review of CDPM competencies, objectives, and topical statements were mapped to each of the six domains of the CCM to understand the breadth of existing learning topics within each domain. At an in-person meeting, medical educators prepared a survey for the modified Delphi approach. Attendees identified 51 possible learning objectives from the literature review mapping, rephrased the CCM domains as competencies, constructed possible CDPM learning objectives for each competency with the goal of reaching multi-institutional consensus on a limited number of CDPM learning objectives that would be feasible for institutions to use to guide enhancement of medical student curricula related to CDPM. After the meeting, the group developed a survey which included 39 learning objectives. In the study phase of the modified Delphi approach, 32 physician CDPM experts and educators completed an online survey to prioritize the top 20 objectives. The next step occurred at a CDPM interest group in-person meeting with the goal of identifying the top 10 objectives. Findings: The CCM domains were reframed as the following competencies for medical student education: patient self-care management, decision support, clinical information systems, community resources, delivery systems and teams, and health system practice and improvement. Eleven CDPM learning objectives were identified within the six competencies that were most important in developing curriculum for medical students. Insights: These learning objectives cut across education on the prevention and management of individual chronic diseases and frame chronic disease care as requiring the health system science competencies identified in the CCM. They are intended to be used in combination with traditional disease-specific pathophysiology and treatment objectives. Additional efforts are needed to identify specific curricular strategies and assessment tools for each learning objective.

Ethics in Child and Adolescent Psychiatry Training: What and How Are We Teaching?

OBJECTIVE: This article describes survey results describing ethics/professionalism curricula of US child and adolescent psychiatry (CAP) residency programs. This project repeated and expanded upon an earlier survey. METHODS: CAP program directors were sent an e-mail with a link to an anonymous electronic survey. RESULTS: Ninety-nine programs responded with 92 completing the majority of the survey. All had instruction during both training years; reading seminars and lectures were the most common teaching formats. The median number of teaching hours was 10. Teaching was considered inadequate by 22%. Confidentiality, child advocacy, and informed consent were the most frequent ethics topics. Communication, patient care during working hours, and conduct at work were the most common professionalism topics. Faculty and resident opinion differed on certain topics. CAPs were preferred educators in 56.5%. External program resources were available to 87% but over 30% used them rarely or never. Faculty evaluations, 360-degree evaluations, and faculty observations were the most common assessment methods; 38% thought trainee assessments need improvement. Programs were classified into more confident and less confident. More confident programs used available ethics resources more frequently (25% vs 8%, p = 0.30) and had more than the median teaching hours (58% vs 35%, p = 0.035). CONCLUSIONS: Compared to the previous study, CAP programs had increased use of interactive methods with more programs reporting having adequate hours. These results are consistent with existing literature confirming the importance of this curriculum but significant issues with adequately educating and evaluating trainees remain.

Correction to: Mind, Brain, and Behavior: an Integrative Approach to Teaching Neuroscience to Medical Students.

This article was updated to correct Ignacio Martinez Escobedo's name.

Practical Applications for Maintenance of Certification Products in Child and Adolescent Residency Training.

OBJECTIVE: The authors evaluated whether Maintenance of Certification (MOC) Performance-in-Practice products in training increases trainee knowledge of MOC processes and is viewed by trainees as a useful activity. METHODS: Six child and adolescent psychiatry fellowships used MOC products in continuity clinics to assess their usefulness as training tools. Two surveys assessed initial knowledge of MOC and usefulness of the activity. RESULTS: Forty-one fellows completed the initial survey. A majority of first-year fellows indicated lack of awareness of MOC in contrast to a majority of second-year fellows who indicated some awareness. Thirty-five fellows completed the second survey. A majority of first- and second-year fellows found the activity easy to execute and would change something about their practice as a result. CONCLUSIONS: Using MOC products in training appears to be a useful activity that may assist training programs in teaching the principles of self- and peer-learning.

The DSM-5: an opportunity to affirm "the whole child" concept in child and adolescent psychiatric residency training.

This article summarizes a 2013 American Psychiatric Association annual meeting presentation on the incorporation of the DSM-5 into child and adolescent psychiatric residency training with focus on the potential benefits of the DSM-5 for medical education.

Child psychiatry: what are we teaching medical students?

OBJECTIVE: The author describes child and adolescent psychiatry (CAP) undergraduate teaching in American and Canadian medical schools. METHODS: A survey asking for information on CAP teaching, student interest in CAP, and opinions about the CAP importance was sent to the medical student psychiatry director at 142 accredited medical schools in the United States and Canada. The results were summarized and various factors considered relevant to CAP student interest were analyzed statistically. RESULTS: Approximately 81% of the schools returned surveys. Most teach required CAP didactics in the preclinical and clinical years. Almost 63% of the schools have CAP clinical rotations; most are not required. Twenty-three percent of all medical students have a clinical CAP experience during their psychiatry clerkship. The majority of schools have CAP electives, and approximately 4.8% of students participate. Child and adolescent psychiatry leadership, early exposure to CAP, and CAP clinical experiences were related to student CAP interest, but these relationships were not statistically significant. CONCLUSION: The time allotted to teaching CAP in the undergraduate medical curriculum is minimal, consistent with previous survey results. Most schools require didactic instruction averaging about 12 hours and offer elective clinical opportunities. The survey findings should help direct future planning to improve CAP medical student education.

Ethics education.

This article briefly describes the background and status of medical education in the areas of ethics and professionalism. Methods of teaching and assessment are described for medical students, residents, and practitioners within the core competency framework of medical education. Key areas of content for child and adolescent psychiatrists are described.

Competencies.

This article briefly describes the background and development of the core competencies in medicine and their relevance to various levels of medical education: undergraduate, graduate, and post-graduate. The current status and issues of the competencies for each state of training--medical schools, residencies, and continuing medical education--are reviewed. Strategies for developing and implementing the core competencies into child and adolescent psychiatry training are discussed.

Phantom urinary incontinence in children with bladder-bowel dysfunction.

OBJECTIVE: To report a previously undescribed condition in which children present with the sensation of wetness because of presumed urinary incontinence when they are actually completely dry. We have termed this entity "phantom" urinary incontinence (PUI). MATERIALS AND METHODS: Twenty children referred to our pediatric urology clinic were diagnosed with PUI between 2009 and 2013. Patient demographics, associated bladder and bowel symptoms, concomitant diagnoses, imaging, management, and treatment outcomes were evaluated. RESULTS: Twenty children (18 females and 2 males) were diagnosed with PUI over a 5-year interval. Mean age at diagnosis was 6.9 ± 2.5 years (range, 4-12 years). Nineteen patients (95%) had concomitant lower urinary tract symptoms, and all were also diagnosed with constipation. Urgency (75%) and frequency (50%) were the most common associated bladder symptoms. Of the 18 girls, 13 (72%) had associated vaginitis. Fourteen children (70%) carried a parent-reported diagnosis of obsessive-compulsive disorder or obsessive-compulsive disorder personality traits. Patients were managed with timed voiding, dietary modifications, and a bowel regimen. Ninety percent children experienced improvement of bladder-bowel dysfunction and resolution of PUI at a mean follow-up of 14.4 months. CONCLUSION: Children with PUI have a high incidence of obsessive-compulsive traits. Phantom incontinence as well as associated lower urinary tract symptoms resolve with adherence to a strict bladder-bowel regimen.

Relationship between performance on child and adolescent psychiatry in-training and certification examinations.

BACKGROUND: Studies across a range of specialties have consistently yielded positive associations between performance on in-training examinations and board certification examinations, supporting the use of the in-training examination as a valuable formative feedback tool for residents and residency programs. That association to date, however, has not been tested in child and adolescent psychiatry residents. OBJECTIVE: This is the first study to explore the relationship between performance on the American College of Psychiatrists' Child Psychiatry Resident In-Training Examination (CHILD PRITE) and subsequent performance on the American Board of Psychiatry and Neurology's (ABPN) subspecialty multiple-choice examination (Part I) in child and adolescent psychiatry (CAP). METHODS: Pearson correlation coefficients were used to examine the relationship between performance on the CHILD PRITE and the CAP Part I examination for 342 fellows. RESULTS: Second-year CAP fellows performed significantly better on the CHILD PRITE than did the first-year fellows. The correlation between the CHILD PRITE total score and the CAP Part I examination total score was .41 (P  =  .01) for first-year CAP fellows; it was .52 (P  =  .01) for second-year CAP fellows. CONCLUSIONS: The significant correlations between scores on the 2 tests show they assess the same achievement domain. This supports the use of the CHILD PRITE as a valid measure of medical knowledge and formative feedback tool in child and adolescent psychiatry.

A 2-year progress report of the AACAP-Harvard Macy Teaching Scholars Program.

OBJECTIVE: The American Academy of Child and Adolescent Psychiatry (AACAP) has partnered with the Harvard Macy Program for Healthcare Educators so that selected child and adolescent psychiatry academic faculty might enhance their teaching expertise in order to possibly enhance recruitment of medical students into child and adolescent psychiatry. METHODS: Thirteen child psychiatry faculty have graduated from the AACAP-Harvard Macy Teaching Scholars Program (HMTSP). There are 10 additional child and adolescent psychiatry faculty members in the process of completing the program. A survey was created to broadly assess the effect of the AACAP-HMTSP training on the first 13 graduates of the program as a pilot to guide future study of the program. Three teaching scholars who are the first authors of this article (JH, DS, MH) conducted this survey and the data interpretation for this study. RESULTS: Thirteen of the scholars submitted responses to the survey. All participants indicated a high degree of satisfaction with the HMTSP and with the overall usefulness of the concepts learned. All but one of the scholars reported that the program enhanced their teaching effectiveness. The scholars reported increased teaching of medical students (9 of 13) and psychiatry residents (6 of 13) after the HMTSP. CONCLUSION: The AACAP-Harvard Macy Teaching Scholars reported high levels of satisfaction with the overall program. Whether the reported increase in medical student and psychiatry resident mentoring and teaching will eventually lead to increased medical student recruitment into child and adolescent psychiatry remains to be determined.