1
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Rohrbaugh RM, DeJong SM. The Role of the Program Director in Supporting Diversity, Equity, and Inclusion. Acad Psychiatry 2022; 46:264-268. [PMID: 34272722 DOI: 10.1007/s40596-021-01474-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Sandra M DeJong
- Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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2
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Hou J, Peluso MJ, Samaan JS, Kellett AT, Rohrbaugh RM. Global health education in China's medical schools: A national cross-sectional study. Med Teach 2021; 43:1317-1322. [PMID: 34260862 DOI: 10.1080/0142159x.2021.1947478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Despite China's large and growing global presence, data about global health (GH) education (GHE) in China's medical schools are limited. We aimed to describe GHE in these schools and determine whether some may teach GH concepts without labeling them as such. METHODS In 2019, 161 Chinese medical schools eligible for accreditation by the Ministry of Education were invited to complete a questionnaire as part of a national survey. Data were analyzed using descriptive analyses, Chi-square tests, Fisher exact tests, and logit models. RESULTS Approximately 57% of schools completed the survey (n = 93). 33 (35.5%) indicated that GHE was included in the curriculum. Although the majority of responding schools reported the absence of GH in the curriculum, GH topics were identified at many institutions. Schools affiliated with the central government or an aspiring world-class university were more likely to report the inclusion of GHE and offered more opportunities at international away sites. CONCLUSIONS Chinese medical schools are frequently teaching GH topics, but may not label the instruction as such. Policy-makers and educators should be equipped with a global perspective to facilitate GHE at China's medical schools and take measures to address differences between schools.
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Affiliation(s)
- Jianlin Hou
- Institute of Medical Education & National Center for Health Professions Education Development, Peking University, Beijing, China
| | | | - Janette S Samaan
- Visiting Student Learning Opportunities, Association of American Medical Colleges, Washington, D.C, USA
| | - Anne T Kellett
- Office of Global Health Education, Yale School of Medicine, New Haven, CT, USA
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3
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Krystal JH, Alvarado J, Ball SA, Fortunati FG, Hu M, Ivy ME, Kapo J, Olson KD, Rohrbaugh RM, Sinha R, Tebes JK, Vender RJ, Yonkers KA, Mayes LC. Mobilizing an institutional supportive response for healthcare workers and other staff in the context of COVID-19: The Yale experience. Gen Hosp Psychiatry 2021; 68:12-18. [PMID: 33254081 PMCID: PMC7680059 DOI: 10.1016/j.genhosppsych.2020.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
The burden of the COVID-19 pandemic upon healthcare workers necessitates a systematic effort to support their resilience. This article describes the Yale University and Yale New Haven Health System effort to unite several independent initiatives into a coherent integrated model for institutional support for healthcare workers. Here, we highlight both opportunities and challenges faced in attempting to support healthcare workers during this pandemic.
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Affiliation(s)
- John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States of America,Department of Psychology, Yale University, New Haven, CT, United States of America,Department of Psychiatry and Behavioral Health, Yale-New Haven Hospital, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Corresponding author at: Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States of America
| | - Javier Alvarado
- Department of Social Work, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Samuel A. Ball
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America,Silver Hill Hospital, New Canaan, CT, United States of America
| | - Frank G. Fortunati
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Psychiatry and Behavioral Health, Yale-New Haven Hospital, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America
| | - Mary Hu
- Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael E. Ivy
- Office of the Chief Medical Officer, Yale New Haven Health, New Haven, CT, United States of America
| | - Jennifer Kapo
- Yale Medicine, New Haven, CT, United States of America,Palliative Medicine, Yale School of Medicine and Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Kristine D. Olson
- Office of the Chief Wellness Officer, Yale-New Haven Hospital, New Haven, CT, United States of America,Department of Internal Medicine, Yale School of Medicine, United States of America
| | - Robert M. Rohrbaugh
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Neuroscience, Yale School of Medicine, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Child Study Center, Yale School of Medicine, New Haven, CT, United States of America
| | - Jacob K. Tebes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Department of Internal Medicine, Yale School of Medicine, United States of America,Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT, United States of America
| | - Ronald J. Vender
- Yale Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America,Department of Internal Medicine, Yale School of Medicine, United States of America
| | - Kimberly A. Yonkers
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT, United States of America,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Linda C. Mayes
- Department of Psychology, Yale University, New Haven, CT, United States of America,Yale Medicine, New Haven, CT, United States of America,Office of the Dean, Yale School of Medicine, New Haven, CT, United States of America,Child Study Center, Yale School of Medicine, New Haven, CT, United States of America,Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
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Abstract
This article highlights the history of the psychiatric training practices that have contributed to inequity in mental health service delivery, particularly to underserved populations. It discusses current training practices that may be effective at reducing such disparities, suggests policy recommendations to increase the number of underrepresented minorities in health services, and makes recommendations for the further development and implementation of training practices that address health inequity. The article reviews issues in both general psychiatry and child/adolescent training in addition to lifelong learning needs.
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Affiliation(s)
- Donna M Sudak
- Drexel-Tower Health Psychiatry, Drexel University, 219 Broad Street, Fifth Floor #506, Philadelphia, PA 19107, USA.
| | - Sandra M DeJong
- Harvard Medical School, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA
| | - Brigitte Bailey
- Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive MC 7792, San Antonio, TX 78229, USA
| | - Robert M Rohrbaugh
- Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06437, USA
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5
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Abstract
By describing an instance of racial violence by a patient against a resident physician, the authors hope to stimulate further discussion by addressing three specific questions about managing racist patients: (1) How should the resident (or any level of trainee) respond to the immediate situation? (2) How should the unit respond to the event as a community? and (3) How should the institution (hospital and/or academic institution) respond to the event? The authors argue that responses to such incidents should acknowledge the history of structural racism in U.S. society and in medicine. The authors recommend an approach that names the racism directly while addressing the safety of the patient and the providers in the moment, supports those affected in the aftermath, and considers appropriate consequences for the perpetrators of violence.
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Affiliation(s)
- J Corey Williams
- J.C. Williams is child and adolescent psychiatry fellow, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. R.M. Rohrbaugh is deputy chair for education and career development and residency program director, Department of Psychiatry, Yale University, New Haven, Connecticut
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6
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Gold JA, Hu X, Huang G, Li WZ, Wu YF, Gao S, Liu ZN, Trockel M, Li WZ, Wu YF, Gao S, Liu ZN, Rohrbaugh RM, Wilkins KM. Medical student depression and its correlates across three international medical schools. World J Psychiatry 2019; 9:65-77. [PMID: 31799151 PMCID: PMC6885454 DOI: 10.5498/wjp.v9.i4.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/26/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Medical students have high rates of depression, anxiety, and burnout that have been found to affect their empathy, professional behaviors, and performance as a physician. While studies have examined predictors for burnout and depression in the United States (US), no study, to our knowledge, has compared depression in medical students cross-culturally, or has attempted to examine the effect of factors influencing rates including burnout, exercise, stress, unmet mental health needs, and region.
AIM To examine rates of depression in three international cohorts of medical students, and determine variables that may explain these differences.
METHODS Convenience samples of medical students from three countries (US, China, and a Middle Eastern country whose name remains anonymous per request from the school) were surveyed in this observational study. Using the Patient Health Questionnaire-2 (PHQ-2) and a modified Maslach Burnout Inventory, depression and burnout were examined among medical students from the three cohorts (n = 473). Chi-square test and analysis of variance were used to examine differences in demographics, behavioral, and psychological variables across these three schools to identify potentially confounding descriptive characteristics. Analysis of covariance compared depression and the emotional exhaustion component of burnout identified through Principal Component Analysis across countries. Multiple linear regression was used to analyze the impact of demographic, behavioral, and psychological variables on screening positive for depression.
RESULTS Medical students from the Middle Eastern country had the highest rates of positive depression screens (41.1%), defined as a PHQ-2 score of ≥ 3, followed by China (14.1 %), and then the US (3.8%). More students in the Middle Eastern school had unmet mental health needs (50.8%) than at the medical school in China (34.8%) or the school in the US (32.8%) (Pearson chi-square significance < 0.05). Thus, PHQ-2 scores were adjusted for unmet mental health needs; however, the Middle Eastern country continued to have the highest depression. Adjusting for PHQ-2 score, medical students from the US scored the highest on emotional exhaustion (a measure of burnout). Demographic variables did not significantly predict medical student depression; however, lack of exercise, unmet mental health needs, stress, and emotional exhaustion predicted nearly half of depression in these cohorts. In comparison to the US, coming from the Middle Eastern country and China predicted higher levels of depression.
CONCLUSION Depression rates differ in three international cohorts of medical students. Measured factors contributed to some observed differences. Identifying site-specific prevention and intervention strategies in medical student mental health is warranted.
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO 63110, United States
| | - Xinran Hu
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Gan Huang
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Wan-Zhen Li
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Yi-Fan Wu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Shan Gao
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Zhe-Ning Liu
- Central South University Xiangya School of Medicine, Changsha 410013, Hunan Province, China
| | - Mickey Trockel
- Department of Psychiatry, Stanford University, Stanford, CA 94305, United States
| | | | | | | | | | - Robert M Rohrbaugh
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
| | - Kirsten M Wilkins
- Department of Psychiatry, Yale University, New Haven, CT 06511, United States
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7
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Londono Tobon A, Budde KS, Rohrbaugh RM. A Novel Approach to Fostering Diversity in Graduate Medical Education: Chief Residents for Diversity and Inclusion. Acad Psychiatry 2019; 43:344-345. [PMID: 31041660 DOI: 10.1007/s40596-019-01055-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
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8
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Bromage B, Encandela JA, Cranford M, Diaz E, Williamson B, Spell VT, Rohrbaugh RM. Understanding Health Disparities Through the Eyes of Community Members: a Structural Competency Education Intervention. Acad Psychiatry 2019; 43:244-247. [PMID: 29761285 DOI: 10.1007/s40596-018-0937-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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9
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Hansen H, Braslow J, Rohrbaugh RM. From Cultural to Structural Competency-Training Psychiatry Residents to Act on Social Determinants of Health and Institutional Racism. JAMA Psychiatry 2018; 75:117-118. [PMID: 29261827 DOI: 10.1001/jamapsychiatry.2017.3894] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Helena Hansen
- Department of Psychiatry, New York University, New York.,Department of Anthropology, New York University, New York.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Joel Braslow
- Department of Psychiatry, UCLA (University of California, Los Angeles).,Department of History, UCLA.,Department of Biobehavioral Sciences, UCLA
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10
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Wilkins KM, Fenick AM, Goldenberg MN, Ellis PJ, Barkil-Oteo A, Rohrbaugh RM. Integration of Primary Care and Psychiatry: A New Paradigm for Medical Student Clerkships. J Gen Intern Med 2018; 33:120-124. [PMID: 28849354 PMCID: PMC5756162 DOI: 10.1007/s11606-017-4169-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/16/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems. AIM To implement an integrated primary care-psychiatry clerkship for third-year medical students. SETTING Undergraduate medical education, amid institutional curriculum reform. PARTICIPANTS Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017. PROGRAM DESCRIPTION Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines. PROGRAM EVALUATION Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting. CONCLUSIONS While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century.
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Affiliation(s)
- Kirsten M Wilkins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Ada M Fenick
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew N Goldenberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Peter J Ellis
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andres Barkil-Oteo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert M Rohrbaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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11
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Peluso MJ, Rodman A, Mata DA, Kellett AT, van Schalkwyk S, Rohrbaugh RM. A Comparison of the Expectations and Experiences of Medical Students From High-, Middle-, and Low-Income Countries Participating in Global Health Clinical Electives. Teach Learn Med 2018; 30:45-56. [PMID: 29240454 DOI: 10.1080/10401334.2017.1347510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED Phenomenon: Global health education (GHE) is expanding to include socioculturally and resource-different settings, with the goal of developing a workforce with members who can promote health equity locally and globally. GHE is also no longer limited to students from high-income countries (HICs). However, it is unknown whether the motivations and experiences of medical students from HICs and from low- and middle-income countries (LMICs) participating in GHE clinical electives through institutional partnerships are similar or different. Such an understanding is needed to design programs that meet the needs of participants and effectively train them in the principles and practice of global health. APPROACH This was a cross-sectional, mixed-methods survey of LMIC students from partner sites rotating at one U.S. medical school, and U.S. students from one medical school rotating at partner sites, between 2010 and 2015. Variables included demographic characteristics of participants, components of the curriculum at the home institution, and components of the away rotation, including perceptions of its content and impact. Content analysis was used to identify themes in the responses provided to open-ended questions. FINDINGS In all, 63 of 84 (75%) LMIC and 61 of 152 (40%) U.S. students participated. Recall of predeparture training was low for both LMIC and U.S. students (44% and 55%, respectively). Opportunities to experience different healthcare systems, resource-different settings, and cultural exposure emerged as motivators for both groups. Both groups noted differences in doctor-patient relationships, interactions between colleagues, and use of diagnostic testing. U.S. respondents were more likely to perceive differences in the impact of social determinants of health and ethical issues. Both groups felt that their experience affected their interactions with patients and perspectives on education, but U.S. students were more likely to mention perspectives on healthcare delivery and social determinants of health, whereas LMIC respondents noted impacts on career goals. Insights: These results argue that GHE is not restricted to resource-constrained settings and that students from LMICs have similar reasons for participation as those from HICs. LMIC students also identified a lack of emphasis on GHE topics like social determinants of health during GH electives, which could diminish the effectiveness of these experiences. Both U.S. and LMIC students emphasized the cultural component of their GHE experience but had different perceptions regarding core tenets of GHE, such as the social determinants of health and health equity, during these experiences.
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Affiliation(s)
- Michael J Peluso
- a Department of Medicine and Division of Global Health Equity , Brigham and Women's Hospital , Boston , Massachusetts , USA
- b Harvard Medical School , Boston , Massachusetts , USA
| | - Adam Rodman
- b Harvard Medical School , Boston , Massachusetts , USA
- c Department of Medicine , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
| | - Douglas A Mata
- b Harvard Medical School , Boston , Massachusetts , USA
- d Department of Pathology , Brigham and Women's Hospital , Boston , Massachusetts , USA
- e Brigham Education Institute , Boston , Massachusetts , USA
| | - Anne T Kellett
- f Office of International Medical Student Education , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Susan van Schalkwyk
- g Centre for Health Professions Education, Faculty of Medicine and Health Sciences , Stellenbosch University , Stellenbosch , South Africa
| | - Robert M Rohrbaugh
- f Office of International Medical Student Education , Yale University School of Medicine , New Haven , Connecticut , USA
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Long Y, Ouyang X, Liu Z, Chen X, Hu X, Lee E, Chen EYH, Pu W, Shan B, Rohrbaugh RM. Associations Among Suicidal Ideation, White Matter Integrity and Cognitive Deficit in First-Episode Schizophrenia. Front Psychiatry 2018; 9:391. [PMID: 30210372 PMCID: PMC6121174 DOI: 10.3389/fpsyt.2018.00391] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/03/2018] [Indexed: 11/26/2022] Open
Abstract
Objective: The study was aimed to investigate the possible associations among suicidal ideation, brain white matter (WM) integrity and cognitive deficit in first-episode schizophrenia (FES) using diffusion tensor imaging. Methods: The sample contained 18 FES patients with suicidal ideation (SI+), 45 FES patients without suicidal ideation (SI-) and 44 healthy controls. The Calgary Depression Scale for Schizophrenia was used to measure the suicidal ideation and depression symptoms. The whole brain WM integrity and three domains of cognitive function: working memory, verbal comprehension as well as processing speed were compared between the three groups. Results: Compared with SI-, SI+ showed preserved WM integrity as indicated by significantly higher factional anisotropy (FA) or lower mean diffusivity (MD) in multiple WM tracts, and higher FA coupled with lower MD in bilateral posterior corona radiata. Compared with SI-, SI+ were more depressed and had less cognitive deficit in working memory and verbal comprehension. The fiber tracts in bilateral posterior corona radiata connect to the precuneus as shown by probabilistic tractography, and their WM integrity disruptions were found to be positively associated with the cognitive deficits in the FES patients. Discussion: Preserved WM integrity may be a risk factor for suicidal ideation in FES patients. One possible explanation is that it contributes to preserved cognitive function, especially in working memory and verbal comprehension, which may be associated with greater insight and could lead to increased depression and suicidal ideation. The posterior corona radiata and the precuneus may be linked to the related biological processes.
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Affiliation(s)
- Yicheng Long
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Chinese National Clinical Research Center on Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China.,Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, Chinese National Clinical Research Center on Mental Health Disorders, National Technology Institute of Psychiatry, Changsha, China
| | - Xudong Chen
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xinran Hu
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China
| | - Edwin Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, Hong Kong
| | - Weidan Pu
- Medical Psychological Center, Second Xiangya Hospital, Central South University, Changsha, China
| | - Baoci Shan
- Key Laboratory of Nuclear Analysis, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Robert M Rohrbaugh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Margolis CZ, Rohrbaugh RM, Tsang L, Fleischer J, Graham MJ, Kellett A, Hafler JP. Student Reflection Papers on a Global Clinical Experience: A Qualitative
Study. Ann Glob Health 2017; 83:333-338. [DOI: 10.1016/j.aogh.2017.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Wilkins KM, Moore D, Rohrbaugh RM, Briscoe GW. Integration of Basic and Clinical Science in the Psychiatry Clerkship. Acad Psychiatry 2017; 41:369-372. [PMID: 27882519 DOI: 10.1007/s40596-016-0640-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/31/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Integration of basic and clinical science is a key component of medical education reform, yet best practices have not been identified. The authors compared two methods of basic and clinical science integration in the psychiatry clerkship. METHODS Two interventions aimed at integrating basic and clinical science were implemented and compared in a dementia conference: flipped curriculum and coteaching by clinician and physician-scientist. The authors surveyed students following each intervention. Likert-scale responses were compared. RESULTS Participants in both groups responded favorably to the integration format and would recommend integration be implemented elsewhere in the curriculum. Survey response rates differed significantly between the groups and student engagement with the flipped curriculum video was limited. CONCLUSIONS Flipped curriculum and co-teaching by clinician and physician-scientist are two methods of integrating basic and clinical science in the psychiatry clerkship. Student learning preferences may influence engagement with a particular teaching format.
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Affiliation(s)
| | - David Moore
- Yale University School of Medicine, New Haven, CT, USA
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15
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van Schalkwyk GI, Katz RB, Resignato J, van Schalkwyk SC, Rohrbaugh RM. Effective Research Mentorship for Residents: Meeting the Needs of Early Career Physicians. Acad Psychiatry 2017; 41:326-332. [PMID: 27766554 DOI: 10.1007/s40596-016-0625-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Challenges in pursuing research during residency may contribute to the shortage of clinician-scientists. Although the importance of mentorship in facilitating academic research careers has been described, little is understood about early career research mentorship for residents. The aim of this study was to better understand the mentorship process in the context of psychiatry residency. METHOD Semi-structured interviews were conducted with experienced faculty mentors in a psychiatry department at a large academic medical center. Interviews were analyzed using inductive thematic analysis. Results from faculty interviews identified several key themes that were explored with an additional sample of resident mentees. RESULTS Five themes emerged in our study: (1) being compatible: shared interests, methods, and working styles; (2) understanding level of development and research career goals in the context of residency training; (3) establishing a shared sense of expectations about time commitment, research skills, and autonomy; (4) residents' identity as a researcher; and (5) the diverse needs of a resident mentee. There was considerable congruence between mentor and mentee responses. CONCLUSIONS There is an opportunity to improve research mentoring practice by providing guidance to both mentors and mentees that facilitates a more structured approach to the mentorship relationship.
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Peluso MJ, van Schalkwyk S, Kellett A, Brewer TF, Clarfield AM, Davies D, Garg B, Greensweig T, Hafler J, Hou J, Maley M, Mayanja-Kizza H, Pemba S, Jenny Samaan J, Schoenbaum S, Sethia B, Uribe JP, Margolis CZ, Rohrbaugh RM. Reframing undergraduate medical education in global health: Rationale and key principles from the Bellagio Global Health Education Initiative. Med Teach 2017; 39:639-645. [PMID: 28362131 DOI: 10.1080/0142159x.2017.1301654] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Global health education (GHE) continues to be a growing initiative in many medical schools across the world. This focus is no longer limited to participants from high-income countries and has expanded to institutions and students from low- and middle-income settings. With this shift has come a need to develop meaningful curricula through engagement between educators and learners who represent the sending institutions and the diverse settings in which GHE takes place. The Bellagio Global Health Education Initiative (BGHEI) was founded to create a space for such debate and discussion and to generate guidelines towards a universal curriculum for global health. In this article, we describe the development and process of our work and outline six overarching principles that ought to be considered when adopting an inclusive approach to GHE curriculum development.
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Affiliation(s)
- Michael J Peluso
- a Harvard Medical School , Brigham and Women's Hospital , Boston , MA , USA
| | - Susan van Schalkwyk
- b Stellenbosch University, Centre for Health Professions Education , Tygerberg , South Africa
| | - Anne Kellett
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
| | | | - A Mark Clarfield
- e Medical School for International Health, Ben Gurion University of the Negev , Beer-Sheva , Israel
| | - David Davies
- f Warwick Medical School, University of Warwick , Coventry , United Kingdom
| | - Bishan Garg
- g Dr Sushila Nayar School of Public Health , Sewagram , India
| | | | - Janet Hafler
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
| | | | - Moira Maley
- j The University of Western Australia, The Rural Clinical School of Western Australia , Crawley , Australia
| | | | - Senga Pemba
- l St Francis University College of Health , Ifakara , Tanzania
| | - Janette Jenny Samaan
- m Global Health Learning Opportunities , Association of American Medical Colleges , Washington , DC , USA
| | | | | | | | - Carmi Z Margolis
- e Medical School for International Health, Ben Gurion University of the Negev , Beer-Sheva , Israel
- q Prywes Center for Medical Education, Ben Gurion University Faculty of Health Sciences , Beer-Sheva , Israel
| | - Robert M Rohrbaugh
- c Yale University School of Medicine, Office of International Medical Student Education , New Haven , CT , USA
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Steiner JL, Anez-Nava L, Baranoski M, Cole R, Davidson L, Delphin-Rittmon M, Dike C, DiLeo PJ, Duman RS, Kirk T, Krystal J, Malison RT, Rohrbaugh RM, Sernyak MJ, Srihari V, Styron T, Tebes JK, Woods S, Zonana H, Jacobs SC. The Connecticut Mental Health Center: Celebrating 50 Years of a Successful Partnership Between the State and Yale University. Psychiatr Serv 2016; 67:1286-1289. [PMID: 27691379 DOI: 10.1176/appi.ps.201600373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-owned and state-operated joint venture between the state and Yale University built and sustained with federal, state, and university funds. Collaboration across these entities has produced a wide array of clinical, educational, and research initiatives, a few of which are described in this column. The missions of clinical care, research, and education remain the foundation for an organization that serves 5,000 individuals each year who are poor and who experience serious mental illnesses and substance use disorders.
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Affiliation(s)
- Jeanne L Steiner
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Luis Anez-Nava
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Madelon Baranoski
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Robert Cole
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Larry Davidson
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Miriam Delphin-Rittmon
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Charles Dike
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Paul J DiLeo
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Ronald S Duman
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Thomas Kirk
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - John Krystal
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Robert T Malison
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Robert M Rohrbaugh
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Michael J Sernyak
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Vinod Srihari
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Thomas Styron
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Jacob K Tebes
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Scott Woods
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Howard Zonana
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
| | - Selby C Jacobs
- The authors are with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: ). Dr. Davidson, Dr. Delphin-Rittmon, Dr. Dike, and Mr. DiLeo are also with the Connecticut Department of Mental Health and Addiction Services, Hartford. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column
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Ross DA, van Schalkwyk GI, Rohrbaugh RM. Developing a Novel Approach for Teaching Biopsychosocial Formulation. Acad Psychiatry 2016; 40:540-542. [PMID: 26283526 DOI: 10.1007/s40596-015-0396-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 07/14/2015] [Indexed: 06/04/2023]
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Annamalai A, Rohrbaugh RM, Sernyak MJ. General Medicine Training in Psychiatry Residency. Acad Psychiatry 2015; 39:437-441. [PMID: 26048458 DOI: 10.1007/s40596-015-0344-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/07/2015] [Indexed: 06/04/2023]
Abstract
With growing awareness of the need for integrated health care settings, psychiatrists may be required to provide clinical care at the primary care and behavioral health interface. This article discusses the curricular changes that could enhance the development of psychiatrists as leaders in integrated primary and behavioral health care. Psychiatrists may be called upon to provide enhanced collaborative care services at primary care or behavioral health settings. This article focuses on the provision of integrated care in behavioral health settings, especially in the public sector. The authors review the additional training in general medicine that would facilitate these skills. They outline the principles and goals to be considered in building such a curriculum. They examine the curricular building blocks of such training and also discuss challenges in implementing these curricular changes. Finally, they discuss the implications of incorporating integrated health care training on the future of psychiatric practice.
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Gold JA, Johnson B, Leydon G, Rohrbaugh RM, Wilkins KM. Mental health self-care in medical students: a comprehensive look at help-seeking. Acad Psychiatry 2015; 39:37-46. [PMID: 25082721 DOI: 10.1007/s40596-014-0202-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/04/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The authors characterize medical student help-seeking behaviors and examine the relationship with stress, burnout, stigma, depression, and personal health behaviors. METHODS In 2013, the authors administered an electronic survey of all enrolled students at Yale School of Medicine (183 responders, response rate=35 %), inquiring about students' primary medical and mental health care, personal health behaviors, support systems, and help-seeking behaviors. Students completed the Attitudes to Mental Health Questionnaire, the Patient Health Questionnaire-2, and a modified Maslach Burnout Inventory. The authors analyzed the results with logistic regression, the Wilcoxon rank-sum test, the Kruskal-Wallis test, or a test for significance of Kendall rank correlation. RESULTS Most students reported having a primary care provider (PCP), yet few reported seeking care when sick (33 %). Nineteen percent of students reported having a mental health provider, fewer than reported having a PCP (p<0.0001). Twenty-five percent of students reported increased mental health needs since beginning medical school, and these students were more likely to agree that their needs were untreated. The majority of students endorsed stress, which correlated with increased and unmet mental health needs (p<0.001). Burnout peaked in second- and third-year students and correlated with stress and increased and untreated needs. Most students reported comfort with asking for academic help; those uncomfortable were more likely to have mental health needs for which they did not seek treatment (p=0.004). Mental health stigma was low. CONCLUSIONS Medical students had a significant unmet need for health care, influenced by barriers to accessing care, stress, burnout, and depression. Academic help seeking and supportive faculty relationships appear related to mental health treatment seeking. Targeted interventions for stress and burnout reduction, as well as incorporation of reflective practice, may have an impact on overall care seeking among medical students. Future studies should expand to other medical and professional schools.
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Affiliation(s)
- Jessica A Gold
- Stanford University School of Medicine, Stanford, CA, USA,
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21
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Affiliation(s)
- Andres Barkil-Oteo
- Yale Psychiatry Department, Yale School of Medicine, New Haven, CT 06511, USA.
| | - Michelle A Silva
- Yale Psychiatry Department, Yale School of Medicine, New Haven, CT 06511, USA
| | - Marco A Ramos
- Yale Psychiatry Department, Yale School of Medicine, New Haven, CT 06511, USA
| | - Robert M Rohrbaugh
- Yale Psychiatry Department, Yale School of Medicine, New Haven, CT 06511, USA
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Annamalai A, Rohrbaugh RM, Sernyak MJ. Status of general medicine training and education in psychiatry residency. Acad Psychiatry 2014; 38:473-475. [PMID: 24664597 DOI: 10.1007/s40596-014-0106-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/11/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE With the current emphasis on integrated care, the role of psychiatrists is expanding to either directly provide medical care or coordinate its delivery. The purpose of this study was to survey general psychiatry programs on the extent of general medicine training provided during residency. METHODS A short web-based survey was sent to 173 residency program directors to recruit participants for a larger survey. Thirty-seven participants were recruited and surveyed, and of these, 12 (32.4%) responded. The survey assessed the extent of general medicine training and didactics during and after the first postgraduate year and attitudes towards enhancing this training in residency. This study was approved by the local institutional review board. RESULTS Seventy-five percent of programs require only the minimum 4 months of primary care in the first postgraduate year, and didactics during these months is often not relevant to psychiatry residents. Some programs offer elective didactics on chronic medical conditions in the fourth postgraduate year. Respondents are in favor of enhancing general medicine training in psychiatry but indicate some resistance from their institutions. CONCLUSIONS These results suggest that very few programs require additional clinical training in relevant medical illnesses after the first postgraduate year. Respondents indicated favorable institutional support for enhancing training, but also expected resistance. The reasons for resistance should be an area of future research. Also important is to determine if enhancing medical didactics improves patient care and outcomes. The changing role of psychiatrists entails a closer look at resident curricula.
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Affiliation(s)
- Carla Marienfeld
- Dept. of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Peluso MJ, Forrestel AK, Hafler JP, Rohrbaugh RM. Structured global health programs in U.S. medical schools: a web-based review of certificates, tracks, and concentrations. Acad Med 2013; 88:124-30. [PMID: 23165271 DOI: 10.1097/acm.0b013e3182765768] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE To determine the prevalence and requirements of structured, longitudinal, nondegree global health (GH) programs (e.g., certificates, tracks, concentrations) in U.S. MD-granting medical schools. METHOD In March 2011, two reviewers independently searched the Web sites of all 133 U.S. MD-granting medical schools and reviewed Google search results seeking evidence of, information about, and the requirements of structured GH programs. The authors excluded programs that were not open to medical students, granted a degree, and/or required medical students to extend training time. RESULTS Of 133 institutions analyzed, 32 (24%) had evidence of a structured GH program. Of the 30 (94%) programs for which the authors could find further information online, 16/30 (53%) were administered by the medical school, whereas 13/30 (43%) were administered by a different entity within the university; 1/30 (3%) was jointly administered. All 30 of the programs required additional didactic course work. The median number of courses was 4 (range: 1-12). Of the 30 schools with GH programs, 22 (73%) required an international experiential component, but only 12/30 (40%) specifically required an international clinical experience. Only 1 school (3%) directly addressed language or cultural proficiency. CONCLUSIONS Although structured GH programs were offered at one-quarter of U.S. medical schools, little standardization across programs existed in terms of requirements for didactic, clinical, scholarly, and cultural components. Online GH program information is not easily accessible, but it may be valuable in the development of new structured programs, the refinement of programs that already exist, and students' selection of medical schools.
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Affiliation(s)
- Michael J Peluso
- Global Health, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
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Affiliation(s)
- Neil K Aggarwal
- Dept. of Psychiatry, Yale University School of Medicine, New Haven CT, USA.
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Rohrbaugh RM, Felker B, Kosten T. The VA psychiatry-primary care education initiative. Acad Psychiatry 2009; 33:31-36. [PMID: 19349441 DOI: 10.1176/appi.ap.33.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Robert M Rohrbaugh
- Yale School of Medicine, Department of Psychiatry, 300 George St., Suite 901, Room 24, New Haven, CT 06511, USA.
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Landefeld CS, Bowers BJ, Feld AD, Hartmann KE, Hoffman E, Ingber MJ, King JT, McDougal WS, Nelson H, Orav EJ, Pignone M, Richardson LH, Rohrbaugh RM, Siebens HC, Trock BJ. National Institutes of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med 2008; 148:449-58. [PMID: 18268289 DOI: 10.7326/0003-4819-148-6-200803180-00210] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Seth Landefeld
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California 94143-1265, USA
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Abstract
CONTEXT Traditional methods of setting curricular guidelines using experts or consensus panels may miss important areas of knowledge, skills, and attitudes that need to be addressed in the training of medical students and residents. OBJECTIVE To seek input from medical students and internal medicine residents ("trainees") on their perception of their needs for training in Geriatrics. DESIGN Two assessment methods were used (1) focus groups with students and residents were conducted by professional facilitators and the transcripts analyzed for areas of agreement and divergence and (2) geriatric medicine experts and ward attendings were surveyed to examine training gaps raised by trainees during Geriatric Guest Attending Rounds. RESULTS Trainees perceived training gaps in caring for elderly patients in the areas of (1) recognizing and addressing the complex, multifactorial nature of illness; (2) setting priorities and goals for work-up and intervention; (3) communication with families and with patients with cognitive disorders; (4) assessment of a patient for discharge from the hospital and the services at different sites in which patients may receive care. They recounted feeling overwhelmed by complex patients and social situations while acknowledging the special aspects of connecting with older patients. The gaps identified by trainees differ from and complement the curriculum guidelines set by expert recommendations. CONCLUSION Trainees identified gaps in skills and knowledge leading to trainee frustration and potentially adverse outcomes in caring for elderly patients. Development of curriculum guidelines should include assessment of trainees' perceived learning needs.
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Affiliation(s)
- Margaret A Drickamer
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06504, USA.
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Srihari VH, Lee TSW, Rohrbaugh RM, D'Souza DC. Revisiting cycloid psychosis: a case of an acute, transient and recurring psychotic disorder. Schizophr Res 2006; 82:261-4. [PMID: 16442782 DOI: 10.1016/j.schres.2005.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 11/22/2005] [Accepted: 11/30/2005] [Indexed: 11/26/2022]
Abstract
We report a case of recurrent psychosis, spanning decades, with full inter-episode recovery and minimal functional impairment. While it is difficult to classify this disorder using DSM IV-TR criteria, Leonhard and others have described a 'cycloid psychosis' that correlates well with the phenomenology and course of this case. We believe this may represent a subset within the ICD-10 category of 'acute and transient psychotic disorders'. While this disorder, of unknown incidence, is not well reported in the U.S., it is worthy of further investigation and clinical attention given its generally favorable prognosis and potentially distinct pathophysiology and treatment.
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Affiliation(s)
- Vinod H Srihari
- Department of Psychiatry, Yale University School of Medicine, CMHC, 34 Park Street, New Haven, CT 06508, USA.
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Randall ML, Rosenbaum JR, Rohrbaugh RM, Rosenheck RA. Attitudes and behaviors of psychiatry residents toward pharmaceutical representatives before and after an educational intervention. Acad Psychiatry 2005; 29:33-39. [PMID: 15772402 DOI: 10.1176/appi.ap.29.1.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The authors sought to determine the effect of an educational seminar on interactions with pharmaceutical representatives on residents' attitudes and behavior. METHOD A controlled trial of an educational intervention was conducted. Residents at a university-affiliated residency program (N=32) were divided into two groups: one group (N=18) received a 1-hour educational intervention, while the other group (N=14) served as a control. Both groups completed a 33-item survey before the intervention and 2 months after the intervention. RESULTS Residents interacted substantially with pharmaceutical representatives. The majority of residents found the interactions and gifts useful and believed their prescribing practices were not influenced. Compared to the comparison group, the intervention group significantly decreased the reported number of office supplies and noneducational gifts, but showed no change in attitude toward pharmaceutical representatives and their gifts. CONCLUSION One-time educational interventions may have significant impact on psychiatric residents' targeted gift-accepting behavior but little effect on attitudes.
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Affiliation(s)
- Melinda L Randall
- Department of Psychiatry, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA.
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Abstract
Mental health studies frequently involve multifaceted psychosocial interventions. It may be difficult to isolate the active ingredients that make these interventions successful. This study examined the use of qualitative methods to better understand the content of one of these interventions and to help elucidate the links between the care process and health outcomes. A series of five focus groups were convened at a site remote from a model primary care clinic for veterans. Transcripts of the focus groups were analyzed to identify themes and categorize results for patients with serious mental disorders. Three themes emerged from the groups: the difficulty patients had previously faced in obtaining medical care, the flexibility and availability of resources that defined the clinic culture, and organizational restructuring that allowed enhanced communication. Qualitative methods can be a useful means of "unpacking" multifaceted mental health services interventions. These methods may make it possible to refine and disseminate these models more widely.
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Affiliation(s)
- Carolyn Levinson Miller
- Department of Psychiatry, Yale University, 950 Campbell Avenue/182, West Haven, CT 06516, USA.
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Druss BG, Rohrbaugh RM, Levinson CM, Rosenheck RA. Integrated medical care for patients with serious psychiatric illness: a randomized trial. Arch Gen Psychiatry 2001; 58:861-8. [PMID: 11545670 DOI: 10.1001/archpsyc.58.9.861] [Citation(s) in RCA: 301] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This randomized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders. METHODS A total of 120 individuals enrolled in a Veterans Affairs (VA) mental health clinic were randomized to receive primary medical care through an integrated care initiative located in the mental health clinic (n = 59) or through the VA general medicine clinic (n = 61). Veterans who obtained care in the integrated care clinic received on-site primary care and case management that emphasized preventive medical care, patient education, and close collaboration with mental health providers to improve access to and continuity of care. Analyses compared health process (use of medical services, quality of care, and satisfaction) and outcomes (health and mental health status and costs) between the groups in the year after randomization. RESULTS Patients treated in the integrated care clinic were significantly more likely to have made a primary care visit and had a greater mean number of primary care visits than those in the usual care group. They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines. Patients assigned to the integrated care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic (4.7 points vs -0.3 points, P<.001). There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs. CONCLUSION On-site, integrated primary care was associated with improved quality and outcomes of medical care.
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Affiliation(s)
- B G Druss
- Department of Psychiatry, Yale University, West Haven, CT, USA.
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Abstract
OBJECTIVE The authors assessed the association between depressive symptoms and health costs for a national Veterans Administration (VA) sample. METHOD The Rand Depression Index was administered to 1,316 medical or surgical inpatients over the age of 60 at nine VA hospitals. Scores were merged with utilization, demographic, and hospital data from national VA inpatient and outpatient files. RESULTS Medical costs for respondents with the highest quartile of symptoms were approximately $3,200-or 50%-greater than medical costs for those in the least symptomatic quartile. Depressive symptoms were not associated with any statistically significant mental health expenditures. CONCLUSIONS The study extends previous reports of the high medical costs associated with depressive disorders to an older, public sector population. The mechanisms underlying increased medical costs associated with depressive symptoms, while the subject of much speculation in the literature, still remain largely unknown.
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Affiliation(s)
- B G Druss
- Northeast Program Evaluation Center, VA Healthcare System, and the Department of Psychiatry and Public Health, Yale University, West Haven, Conn., USA.
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McDougle CJ, Southwick SM, Rohrbaugh RM. Tourette's disorder and associated complex behaviors: a case report. Yale J Biol Med 1990; 63:209-14. [PMID: 2238716 PMCID: PMC2589286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A case of a man with Tourette's disorder associated with obsessive-compulsive disorder, multiple sexual paraphilias, and aggressive behavior is described. Treatment with haloperidol led to improvement in the characteristic tics of Tourette's disorder as well as to improvement in these three complex-associated behaviors. After haloperidol was discontinued, an exacerbation of tics and the associated behaviors occurred.
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Affiliation(s)
- C J McDougle
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Abstract
The lifetime course of illness in older outpatient men who remained symptomatic despite adequate pharmacologic treatment for depression was examined. A bimodal distribution of age of onset of first major depression was found, with 75% having onset before age 35 years and 25% having onset after age 50 years. At all ages, episodes of chronic depression developed after episodes of major depression and appeared to be partially resolved major depression. In 88% of patients, anxiety disorders developed before age 35 years, preceded onset of other disorders, and continued throughout the patient's lifetime. Seventy percent developed alcoholism and 25% had a medical illness that impaired function to a significant degree. The importance of obtaining a lifetime course of illness in older patients is discussed.
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Affiliation(s)
- R M Rohrbaugh
- Department of Psychiatry, Yale University, New Haven, CT
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Abstract
Weight loss and malnutrition despite adequate dietary intake has been reported to be part of the clinical course in advanced dementia of the Alzheimer type. We present a case of reversible weight loss associated with neuroleptic use in a patient with Alzheimer's disease and discuss a possible pathophysiological basis for the weight loss.
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Affiliation(s)
- R M Rohrbaugh
- Department of Psychiatry, Yale University, New Haven, Connecticut
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Affiliation(s)
- R M Rohrbaugh
- Department of Psychiatry, Yale University, New Haven, Connecticut
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