Stigma and Mental Health: A Proposal for Next Steps

Reducing stigma and increasing competence working with mental illness: Adaptation of a contact-based program for osteopathic medical students to a virtual, active learning format

PURPOSE

Contact-based education, offering meaningful contact with individuals living in recovery with mental illness, reduces stigma. This study evaluated the effectiveness of the National Alliance on Mental Illness Provider Education Program (NAMI PEP) when implemented as a curricular requirement across two cohorts of third-year osteopathic medical students, comparing traditional, passive learning and active, online delivery formats.

MATERIALS AND METHODS

Participants were two cohorts of third-year medical students (Cohort 1 n = 186; Cohort 2 n = 139; overall N = 325) who completed questionnaires measuring affect, beliefs, and behaviors toward patients with mental illness at pre-program, 1-week follow-up, and 6-month follow-up. For Cohort 1, the existing community-based NAMI PEP was implemented. For Cohort 2, the program was adapted to an online, active learning format tailored to medical students, and an additional 3-month follow-up assessment was added to better identify intermediate-term effects.

RESULTS

The NAMI PEP was associated with longitudinal improvements in target outcomes, with enhanced effects with the adapted curriculum in Cohort 2. At 6-month follow-up, students reported less stigma, fewer stereotyping negative attitudes, and lower anxiety treating patients with mental illness. They also reported increased confidence integrating psychiatry into routine care and increased competence in principles of collaborative mental health treatment.

CONCLUSIONS

This study demonstrates the longitudinal effectiveness of the NAMI PEP across two cohorts of medical students, with strengthened effects observed when the program is tailored to contemporary medical education.

Inpatient Child and Adolescent Psychiatry as an Extracurricular Venue for Medical Student and Resident Education and Professional Development: Story Time and Teen Talk

OBJECTIVE

Comparatively little systematic data exists concerning medical student education from the inpatient child and adolescent psychiatry venue. Training in this venue is vulnerable to pressures including increasingly reduced lengths of stay and greater emphasis on clinical productivity. An extracurricular psychosocial opportunity during evening hours may be a productive means through which to provide meaningful patient exposure, training, and mentorship to trainees. We sought to evaluate the impact upon student beliefs and attitudes through participation in an initiative titled "Story Time and Teen Talk."

METHODS

Under the direct supervision of postgraduate resident physicians in psychiatry, students read fairy tales and children's literature to children and conducted group discussions with adolescents during weekly held evening hours. Students were invited to complete a 15-item questionnaire that surveyed the impact of their participation on their beliefs and attitudes concerning general medical education and patient care, the field of psychiatry, and training in child and adolescent psychiatry. A subset of students underwent a semi-structured interview which was evaluated via grounded theory analysis to determine qualitative themes related to impact of program participation.

RESULTS

Thirty students (N = 30) completed the survey and five students (N = 5) completed the interview. The majority of students reported strongly agreeing or agreeing that participation impacted their attitudes and beliefs about general medical education and patient care in twelve of the thirteen assayed items. Themes from qualitative analysis supported these findings.

CONCLUSIONS

Extracurricular opportunities may be a productive venue for graduate medical education and, specifically, child and adolescent psychiatry.

Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview

The Institute of Medicine estimated that by 2030, from 10.1 to 14.4 million Americans aged 65 years or older will have mental health or substance use disorders. This article reviews the history and current status of training, certification, and practice in geriatric psychiatry against the backdrop of this "silver tsunami." The American Board of Psychiatry and Neurology (ABPN) administered the first subspecialty examination in geriatric psychiatry in 1991, and through 2015 3,329 certificates were awarded. The Accreditation Council for Graduate Medical Education approved the training requirements in 1993. After a surge in programs and fellows, the numbers appear to have stabilized at about 57 programs and 60-65 trainees per year with fewer than half of the positions filled each year. The majority of graduates seeks and obtains ABPN certification, and the majority of those who were fellowship trained have maintained certification. Despite the unprecedented demand for mental health services for older adults, it must be acknowledged that not enough geriatric psychiatrists can be prepared to meet the needs of an aging U.S.

POPULATION

Strategies for addressing the shortage are discussed, including undertaking subspecialty training in the fourth year of psychiatry training, increasing the time devoted to the care of older adults in undergraduate and graduate medical education, and developing alternative training pathways such as mini-fellowships. It is not clear whether more favorable Medicare reimbursement rates for those certified in geriatric psychiatry would increase the numbers seeking fellowship training.