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Kirwin P, Conroy M, Lyketsos C, Greenwald B, Forester B, deVries C, Ahmed II, Wiechers I, Zdanys K, Steffens D, Reynolds CF. A Call to Restructure Psychiatry General and Subspecialty Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:145-8. [PMID: 24809688 DOI: 10.1007/s40596-014-0144-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/21/2014] [Indexed: 05/20/2023]
Abstract
Dire shortages of psychiatrists with special expertise in geriatrics, substance abuse, forensics, and psychosomatics create barriers to care for populations with complex mental disorders and pose a significant public health concern. To address these disparities in access to care, we propose streamlining graduate medical education to increase efficiency and enhance cost-effectiveness while simultaneously increasing the number of psychiatric subspecialists in these key areas. We propose that trainees interested in subspecialties complete their general training in 3 years, while meeting ACGME required milestones, and then utilize their 4th year to complete subspecialty fellowship training. Eligible trainees would then qualify for psychiatry subspecialty certification and general psychiatry ABPN certification at the end of 4 years.
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Affiliation(s)
- Paul Kirwin
- Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Michelle Conroy
- Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Blaine Greenwald
- Long Island Jewish Medical Center/North Shore University Hospital, Glen Oaks, NY, USA
| | - Brent Forester
- McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | | | | | - Ilse Wiechers
- Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kristina Zdanys
- University of Connecticut Health Center, Farmington, CT, USA
| | - David Steffens
- University of Connecticut School of Medicine, Farmington, CT, USA
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Hayes RB, Geller AC, Crawford SL, Jolicoeur DG, Churchill LC, Okuyemi KS, David SP, Adams M, Waugh J, Allen SS, Leone FT, Fauver R, Leung K, Liu Q, Ockene JK. Medical school curriculum characteristics associated with intentions and frequency of tobacco dependence treatment among 3rd year U.S. medical students. Prev Med 2015; 72:56-63. [PMID: 25572623 PMCID: PMC4562320 DOI: 10.1016/j.ypmed.2014.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/20/2014] [Accepted: 12/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Physicians play a critical role in addressing tobacco dependence, yet report limited training. Tobacco dependence treatment curricula for medical students could improve performance in this area. This study identified student and medical school tobacco treatment curricula characteristics associated with intentions and use of the 5As for tobacco treatment among 3rd year U.S. medical students. METHODS Third year medical students (N=1065, 49.3% male) from 10 U.S. medical schools completed a survey in 2009-2010 assessing student characteristics, including demographics, tobacco treatment knowledge, and self-efficacy. Tobacco curricula characteristics assessed included amount and type of classroom instruction, frequency of tobacco treatment observation, instruction, and perception of preceptors as role models. RESULTS Greater tobacco treatment knowledge, self-efficacy, and curriculum-specific variables were associated with 5A intentions, while younger age, tobacco treatment self-efficacy, intentions, and each curriculum-specific variable were associated with greater 5A behaviors. When controlling for important student variables, greater frequency of receiving 5A instruction (OR=1.07; 95%CI 1.01-1.12) and perception of preceptors as excellent role models in tobacco treatment (OR=1.35; 95%CI 1.04-1.75) were significant curriculum predictors of 5A intentions. Greater 5A instruction (B=.06 (.03); p<.05) and observation of tobacco treatment (B=.35 (.02); p<.001) were significant curriculum predictors of greater 5A behaviors. CONCLUSIONS Greater exposure to tobacco treatment teaching during medical school is associated with both greater intentions to use and practice tobacco 5As. Clerkship preceptors, or those physicians who provide training to medical students, may be particularly influential when they personally model and instruct students in tobacco dependence treatment.
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Affiliation(s)
- Rashelle B Hayes
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States
| | - Sybil L Crawford
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Denise G Jolicoeur
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Linda C Churchill
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kolawole S Okuyemi
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Sean P David
- Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Michael Adams
- Division of General Internal Medicine, Department of Medicine, Georgetown University Hospital, United States
| | - Jonathan Waugh
- Department of Clinical and Diagnostics Sciences/UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sharon S Allen
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Frank T Leone
- Division of Pulmonary, Allergy and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Randy Fauver
- Center for Education & Research in Family and Community Medicine, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Katherine Leung
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Qin Liu
- Wistar Institute, Philadelphia, PA, United States
| | - Judith K Ockene
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Ten Cate O. What is a 21st-century doctor? Rethinking the significance of the medical degree. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:966-9. [PMID: 24979164 DOI: 10.1097/acm.0000000000000280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The undergraduate medical degree, leading to a license to practice, has traditionally been the defining professional milestone of the physician. Developments in health care and medical education and training, however, have changed the significance of the medical degree in the continuum of education toward clinical practice. The author discusses six questions that should lead us to rethink the current status and significance of the medical degree and, consequently, that of the physician. These questions include the quest for core knowledge and competence of the doctor, the place of the degree in the education continuum, the increasing length of training, the sharing of health care tasks with other professionals, and the nature of professional identity in a multitasking world. The author concludes by examining ways to redefine what it means to be a "medical doctor."
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Affiliation(s)
- Olle Ten Cate
- Dr. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Goulston KJ, Oates K. Training doctors — too long in the cellar? Med J Aust 2012; 197:329. [DOI: 10.5694/mja12.11169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Kim Oates
- Sydney Medical School, University of Sydney, Sydney, NSW
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