Medical education and creative writing: Poetry and how it can assist trainees in developing psychiatric formulation skills

OBJECTIVE

To reflect on the importance of teaching formulation skills in psychiatry training and explore how creative writing, particularly writing poetry, can help achieve this goal.

CONCLUSIONS

It is vital that formulation skills are embedded throughout psychiatry training. Formulations have an artistic element, and writing poetry can help foster a capacity for curiosity that can assist trainees in developing these skills.

Psychiatry trainee experience of working in a child and adolescent eating disorder program

OBJECTIVES

Eating disorders are serious psychiatric conditions that affect people of all ages. Many psychiatry trainees' first and only experience with eating disorders during training is their Child and Adolescent Psychiatry (CAP) rotation. This study aimed to explore the learning experience of psychiatry trainees working within an Eating Disorder Program (EDP) during their CAP rotation.

METHODS

Fifteen trainees who participated in the EDP were recruited to complete an online survey and focus groups; a thematic analysis design was used to identify themes emerging from their responses.

RESULTS

Themes emerged from the trainee learning experience of working in the EDP around what they found they learnt, what aided that process, what was difficult, and recommendations for future improvement.

CONCLUSIONS

This study provided insight into the trainee experience in an EDP as one example of how trainees can learn about eating disorders and one way that could inform future workforce and training initiatives.

Developments in rehabilitation psychiatry within the RANZCP and the creation of a mental health rehabilitation curriculum

OBJECTIVE

This paper describes the initial development of a mental health rehabilitation curriculum for Australian mental health settings and for psychiatrists and trainees wishing to develop specialist skills in mental health rehabilitation.

METHOD

Members of the Section of Social Cultural and Rehabilitation Psychiatry (SSCRP) established an expert working group under the auspices of the RANZCP. Existing college training resources were reviewed, and a gap analysis was conducted to guide development of new training modules.

RESULTS

A tiered curriculum structure was created that allows a staged development of rehabilitation knowledge, skills and attitudes required to be a specialist in mental health rehabilitation. An introductory module was developed to establish the principles of modern mental health rehabilitation. Most of the curriculum was based on existing resources that are relevant to rehabilitation practice. Finalisation of a draft for review was undertaken with the assistance of the RANZCP education project advisors and curriculum experts.

CONCLUSIONS

As a national body responsible for training psychiatric registrars and maintenance of training for psychiatrists, the RANZCP is well situated to train the specialist medical mental health workforce required to lead rehabilitation services in Australia. The RANZCP mental health rehabilitation curriculum will provide a platform to train the skilled workforce that will enable these services to be fully realised.

The Development of Psychodynamic Psychiatry in Iran

Iran, as one of the oldest civilizations in the world, is positioned at the crossroads of important trade routes linking Asia, Africa, and Europe, resulting in enormous cultural interactions with the East and West. The development of modern psychiatry and psychodynamic psychiatry in Iran occurred in the context of the broader process of modernization through interactions with the West. Mentioning key scholars and influences that helped establish a psychodynamic tradition within centralized government-led systems of mental health care and medical education, the author describes various stages of the development of psychodynamic psychiatry in Iran.

Using a mobile application for psychiatry training in medical students: a quasi-experimental study

OBJECTIVE

Microlearning and gamification through mobile technology can significantly enhance knowledge acquisition and satisfaction. Roozbehyar application, was designed using microlearning and gamification approaches for psychiatry clerkship training.

METHOD

This quasi-experimental study was conducted in Roozbeh Hospital, in 2021. The intervention group was assigned to the Roozbehyar during a 4-week course. Knowledge and satisfaction were assessed after 4 weeks.

RESULTS

We recruited 27 (F/M: 19/8) and 35 students (F/M: 22/13) in the intervention and control groups, respectively. Learning through Roozbehyar was associated with higher scores in the final written exam (p value: 0.031). No difference was seen in the final global assessment scores. The satisfaction scores of the students regarding the content and learners' aspect of the application were above average, yet scores in structural and support aspects were below average.

CONCLUSIONS

We highlighted the effect of a microlearning mobile application in increasing knowledge and satisfaction in psychiatry training in medical students.

South Africa's Psychiatric training capacity in 2008 and in 2018. Has training capacity improved?

Background

There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country.

Aim

To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018.

Setting

South African medical schools with departments of psychiatry.

Methods

A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years.

Results

Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant.

Conclusion

While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training.

Contribution

This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.

A mindfulness-based cognitive therapy informed virtual psychiatry trainee wellbeing programme: Development and preliminary feedback

OBJECTIVE

To report the development and feedback on a newly created mindfulness-based cognitive therapy (MBCT) informed virtual wellbeing programme for psychiatry trainees.

METHODS

Thirteen of the 14 trainees participated in the programme provided feedback via an online questionnaire. Qualitative data was analysed using thematic analysis.

RESULTS

Thematic analysis revealed three main themes: timing of the intervention in relation to the COVID-19 pandemic; trainees were connected to the facilitator, their peers and within oneself; and trainees were going through a transformative experience.

DISCUSSION

Our findings support including an optional MBCT informed wellbeing programme in psychiatry training programmes. Future research could measure efficacy of this online programme by utilising pre- and post-outcome measures of dispositional mindfulness and stress.

Single session family therapy for beginners: what difference does it make to psychiatry registrars to participate in family sessions in front of and behind the screen?

OBJECTIVE

Current competencies required for fellowship of the RANZCP require psychiatry registrars to have experience in working with clients across all age groups, as well as working with families and the client's wider network, however gaining this experience is not always easy for trainees. This paper reports on the experience of participating in Single Session Family Therapy (SSFT) during registrar training as a different modality for learning.

METHOD

An online survey was conducted with fourteen registrars who had participated in SSFT during their child and adolescent rotation. Qualitative and simple quantitative data were collected and analysed.

RESULTS

Participating in SSFT during training was initially daunting, but had a positive effect on trainees, including influencing some towards focussing their future sub-specialisation in the child and youth area. Experience came through learning by doing, and seeing change. Registrars learnt about: understanding the role of the family; teamwork; technical skills; and gained confidence.

CONCLUSIONS

Opportunities for trainees to participate in SSFT enables powerful learning beyond what can be taught in the classroom. Such opportunities may enhance registrars' perceptions of family work, and may positively influence decision about future sub-specialisation.

Psychiatry training for medical students: A global perspective and implications for India's competency-based medical education curriculum

Competency-based medical education curriculum (CBME) has received traction worldwide. However, its adoption and implementation have significantly varied across the globe. The National Medical Commission, India (2019) has adopted CBME to improve the quality and content of training of medical students. However, the ongoing COVID-19 pandemic has spawned several challenges implementing the CBME. Therefore, there is a need to reflect on using novel teaching and assessment methods to enrich medical and psychiatric training. In this paper, we aimed to study global trends and characteristics of competency-based psychiatry training programs and how these experiences can be utilized to overcome challenges and facilitate the implementation of CBME in Psychiatry in the Indian context. A literature search was conducted using PubMed and Google Scholar databases. The findings are presented narratively. Psychiatry training for medical students greatly vary across the globe. High-income countries mainly have implemented CBME and have incorporated psychiatry training during the foundation/pre-clerkship period itself. There is more reliance on skill development and flexible and learning-based training vs. time-based training. Various enrichment activities have been incorporated into the medical curriculum to promote and strengthen psychiatry training for medical students, particularly in developed nations, which have yielded positive results. Although the COVID-19 pandemic has adversely affected the medical student's training, it has reiterated the significance of skill-based education and opened novel avenues for implementing the CBME.Medical educationists need to adapt themselves to provide CBME to the students. Making structural, curricular changes, orienting teachers, and students about the CBME, mentoring teachers, adopting novel training and assessment methods, utilizing enrichment activities, collaborating with educational institutions and technology providers, periodically evaluating the implementation of the CBME, and making appropriate course corrections are essential. In addition, there is a need to address structural barriers, such as lack of workforce, for better realization of the CBME objectives.eriodically evaluating the implementation of the CBME, and making appropriate course corrections are essential. Additionally, there is a need to address structural barriers, such as lack of workforce, for better realization of the CBME objectives.

A Preliminary Italian Cross-Sectional Study on the Level of Digital Psychiatry Training, Knowledge, Beliefs and Experiences among Medical Students, Psychiatry Trainees and Professionals

The COVID-19 pandemic led to the implementation of digital psychiatry (DP), resulting in the need for a new skilled healthcare workforce. The purpose of this study was to investigate the level of training, knowledge, beliefs, and experiences of young mental health professionals and medical students in DP. An ad hoc cross-sectional survey was administered and descriptive analyses, Student’s t and ANOVA tests were conducted, together with an exploratory factor analysis, bivariate correlations and linear regression. Most of the sample (N = 239) declared that DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on the issue. Nevertheless, subjects mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that their training should include this topic (54.4%). Moreover, most subjects declared that digital interventions are less effective than face-to-face ones (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p ≤ 0.05). Strong positive correlations were found between the knowledge score (KS) and perceived significance index (PSI) (r = 0.148, p < 0.001), and KS and Digital Psychiatry Opinion (DPO) index (r = 0.193, p < 0.001). PSI scores statistically significantly predicted KS total scores (F(1, 237) = 5.283, R² = 0.022, p = 0.022). KS scores statistically significantly predicted DPO total scores (F(1, 237) = 9.136, R² = 0.037, p = 0.003). During the current pandemic, DP represented an ideal response to the forced physical distancing by ensuring the advantage of greater access to care. However, this kind of intervention is still uncommon, and mental health professionals still prove to be skeptical. The lack of formal training on DP during the academic years could be a limiting factor.

Training and education in digital psychiatry: A perspective from Asia-Pacific region

BACKGROUND

Digital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a cost-effective solution in those circumstances in which the current mental health services and infrastructure are not able to properly accommodate the patients' needs. However, mental health workforce is often poorly theoretical/practical trained in digital psychiatry and in delivering remote consultations safely and effectively, not being common to own curricula-specific training requirements in digital psychiatry and skills.

METHODS

A web-based international cross-sectional survey was carried out by a working group constituted by one or two national representative(s) of each WHO South-East Asia and Western Pacific Regions (APAC), with the aim to evaluate the level of training, knowledge, experience, and perception regarding the topic of digital psychiatry in a sample constituted by medical students, psychiatry trainees, and early career psychiatrists from APAC.

RESULTS

An overall lack of theoretical and/or practical training on new digital tools and digital health interventions in psychiatry was observed. The level of training influences knowledge background, which, in turns, influences young professionals' perceptions and opinions regarding digital psychiatry and interventions in mental health.

CONCLUSION

Implementing psychiatry training programs may significantly improve the level of knowledge and use of digital tools in mental healthcare. Moreover, mental health services and infrastructures should be properly adapted to the digital era, considering the overall weak and heterogeneous technical support and equipment, issues of internet connectivity, and other administrative-related challenges observed in APAC.

Confidence of psychiatry trainees in meeting the needs of borderline personality disorder in comparison with schizophrenia

OBJECTIVE

Borderline personality disorder (BPD) and schizophrenia are both serious and chronic mental health conditions of similar prevalence. This study was designed to assess trainees' confidence in the assessment, management and treatment of BPD in comparison with schizophrenia.

METHODS

A survey was used to assess psychiatry trainees' confidence and experience of training with regard to managing BPD and schizophrenia.

RESULTS

Eighty-two psychiatry trainees completed the survey. Overall, confidence scores of respondents with respect to BPD were significantly lower in comparison with schizophrenia. Trainees reported a preference for working with patients with schizophrenia compared with BPD. Respondents reported receiving less adequate supervision and training in the assessment, management and treatment of BPD than for schizophrenia.

CONCLUSIONS

The results suggest an urgent need to enhance training and supervision in skills related to the diagnosis, management and treatment of BPD, with a greater focus on psychotherapy to improve trainee psychiatrists' confidence in working with people diagnosed with BPD.

Use of modern technology in psychiatry training in a middle-income country

Recent advances in information technology (IT) provided us with novel teaching solutions, with the potential of a new enhanced learning experience, that is, more adapted to the needs and preferences of the younger generations of psychiatric trainees. These tools include the use of online/virtual whiteboards, live surveys/polls, live quizzes, virtual classrooms, and virtual reality. In the present paper, we describe the implementation of modern technology in psychiatric training in Tunisia, a North-African middle-income country. We discuss the potential benefits arising from this implementation, and we report the challenges and difficulties. Overall, the implementation of these modern technology-based tools in psychiatric training has been successful, with a very few obstacles. It seems that the integration of these novel approaches is possible even in middle and low-income countries without much hassle. These tools can enhance trainees' participation, motivation, and engagement, thereby potentially improving learning outcomes. Most disadvantages are related to potential technical glitches, and are likely to improve as technology progresses. Teaching is the art of tailoring the educational tools to the learning objectives and to the learners' characteristics and preferences. To achieve optimal learning outcomes, it is often needed to use a mixture of different "modern" and "less modern" techniques.

Training and retaining mental health professionals: The Romanian experience in the European Union

BACKGROUND

Romania has been a member of the European Union since 2007. According to the World Health Organization, the national burden of mental disorders is high, with 2743.69 disability-adjusted life years per 100.000 population. Moreover, in a country of 19 million people, Romania's mental health system is currently functioning at capacity, with 5.66 adult psychiatrists/100.000 population and only 0.56 child and adolescent psychiatry (CAP) doctors per 100.000 population.

METHOD

we conducted a simple narrative review of the current literature on the topic of training of psychiatry trainees in Romania.

RESULTS

Undergraduate training consists of only 4 weeks of clinical and theoretical work for adult and CAP. Psychiatry postgraduate training lasts 5 years and is still duration-oriented. Psychiatric trainees mostly spend their clinical work in inpatient units due to the scarcity of other services or the lack of integration of training programs in the existing psychiatric services. Theoretical training is not nationally formalized, and, during training, yearly assessments tend to be neglected. An ongoing challenge in Romania has been retaining young career psychiatrists.

CONCLUSION

Although in a trend toward improvement of health services, "brain drain" has been and continues to be a massive phenomenon among Romanian psychiatrists, mainly driven to Western-European countries due to financial reasons, various shortcomings in overall infrastructure, and because of the lack of continuous professional and personal development opportunities. As the world is currently facing an unprecedented mental health crisis, steps must be taken to improve psychiatric training, retain psychiatrists in Romania, and provide better national mental health services.

Implementing competency-based medical education curriculum in undergraduate psychiatric training in India: Opportunities and challenges

Medical education in India is undergoing a landmark transformation under the National Medical Commission implementing competency-based medical education (CBME). The CBME approach intends to ensure that medical graduates acquire the competencies needed to fulfill the health needs of the patient and society. This outcome-based approach shifts the focus from the traditional knowledge-based training to skill-based training valued on attitude, ethics, and communication (AETCOM) competencies. CBME thus aims to create medical professionals capable of providing holistic care with compassion and excellence embracing the global trends. The opportunity posed by the CBME should be utilized to sensitize and create interest among the learners about the science and scope of psychiatry. However, there are many challenges in the successful implementation of CBME, which have to be identified and addressed on time for serving the purpose. A basic tenet in CBME is to continue training until the desired competencies are achieved; in other words, to de-emphasize time-based learning. Moreover, the current COVID 19 pandemic is posing a significant influence on the execution of CBME implemented in August 2019. Online platforms could have several advantages in assisting the implementation of CBME; they provide an alternative to continue teaching-learning and assessment during these times and allow learners with the flexibility to learn at their own pace. In this article, we discuss the opportunities, including digital platforms and challenges to be overcame as well as the need for training the faculty toward assimilating the curriculum in the undergraduate psychiatric training.

Instructions for Australian and New Zealand trainees in developing skills in formulation: a systematic review of local evidence

OBJECTIVE

To examine the peer-reviewed literature on psychiatric formulation.

METHODS

The term (formula*) was used to systematically search Australasian Psychiatry, Australian and New Zealand Journal of Psychiatry, British Journal of Psychiatry, BJPsych Bulletin, American Journal of Psychiatry and Academic Psychiatry. The resulting papers were reviewed.

RESULTS

Of the 42 papers located, 22 (52%) were published between 2002 and 2019; 90% papers were published in Australasian Psychiatry (15), Academic Psychiatry (12) or BJPsych Bulletin (10), journals that focus on training and clinical practice. The papers varied in their aims and recommendations and not all justified the need for formulation. Formulation was recommended as a necessity for training, a communication tool and a guide to treatment. No article provided evidence for the superiority of any type of formulation, and the role of consumers in formulation was conspicuously lacking.

CONCLUSION

There are many ways to structure formulation. However, the existing literature does not support any particular approach. More consideration needs to be given to the needs of consumers in conceptualising and practicing formulation.

The Networked Computer Metaphor: A Novel Tool for Psychiatric Trainees to Enhance Utility of the Biopsychosocial Model of Health and Illness

The biopsychosocial (BPS) model proposed by George Engel posited that a disease developed through a complex interaction of biological, psychological and social factors. This popular model, despite its limitations, continues to influence the practice and treatment of illness and service delivery worldwide. We propose the networked computer metaphor as a novel and pragmatic tool to help psychiatric trainees appreciate and enhance the utility of the BPS model as it pertains to psychiatric disorders. We also propose that the application of this metaphor would help provide some clues to answer the question of achieving the goal envisioned by Engel of providing holistic and comprehensive patient-centered care. We also discuss the utility of this metaphor from trainee, teacher and patient perspectives and describe various examples of the application of this metaphor so as to deepen our understanding of the BPS model. We discuss the criticisms of this model, summarize the applications of this metaphor and outline future directions for research. 

Understanding the drivers of bottlenecks in RANZCP training: modelling and a calculator to determining sustainable trainee intake

OBJECTIVES

Demand for places in postgraduate psychiatry training programmes has increased over recent years. All systems have capacity limits, and concerns have been raised regarding the sustainability of the current intake. This paper presents a modelling exercise to exploring the presence and strategies to resolve bottleneck in the Queensland training programme.

METHODS

Mathematical modelling based on the RANZCP training regulations and the characteristics of the accredited training programme.

RESULTS

A training bottleneck was identified which has been impacted by increased training intake, demand for Advanced Training certificates, and location factors.

CONCLUSIONS

This investigation raises important questions regarding the future management of postgraduate training in psychiatry in Queensland that may be applicable more widely across Australia and New Zealand. In particular, it highlights the large impact that can result from even small incremental increases in trainees across varying levels of the postgraduate programme and the importance of limiting trainee intake in a manner proportional to the availability of mandatory terms.

Uncovering trends in training progression for a national cohort of psychiatry trainees: discrete-time survival analysis

BACKGROUND

The global rise in mental health issues calls for a strong psychiatry workforce. Yet, psychiatry training worldwide is facing recruitment challenges, causing unfilled consultant posts and possibly threatening the quality of patient care. An in-depth understanding of trainees' progression through training is warranted to explore what happens to recruited trainees during training.

AIMS

To uncover current trends in psychiatry trainees' progression through training in the UK.

METHOD

This national retrospective cohort study with data from the UK Medical Education Database used discrete-time survival analysis to analyse training progression for those trainees who started their core psychiatry post in 2012-2017 (2820 trainees; 59.6% female, 67.6% UK graduates (UKGs)). The impact of sociodemographic characteristics on training progression were also investigated.

RESULTS

The overall probability of completing training in 6 years (minimum years required to complete psychiatry training in the UK) was 17.2% (ranging from 4.8% for non-UKG females to 29% for UKG males). The probability to not progress was highest (57.1%) from core to specialty training. For UKGs, trainees from ethnicities other than White, trainees with a disability, and trainees who had experienced childhood social deprivation (measured as entitlement to free school meals) had a significantly (P ≤ 0.02) lower probability of completing training in 6 years.

CONCLUSIONS

Less than one in five psychiatry trainees are likely to complete training in 6 years and this probability varies across groups of doctors. Completing psychiatry training in 6 years is, therefore, the exception rather than the norm and this has important implications for trainees, those planning psychiatry workforces or responsible for psychiatry training.

The development of patient suicide post-vention guidelines for psychiatry trainees and supervisors

OBJECTIVES

Patient suicide is one of the most stressful events for psychiatrists and psychiatry trainees. However, there is often a lack of consistent guidance and support available to clinicians, including post-vention. The aim of this paper is to describe the development of a resource that could support psychiatry trainees following patient suicide.

METHODS

Following a literature review, we adapted two US patient suicide post-vention guidelines to reflect local processes and support systems available by consulting a number of key stakeholders in the training programme and district health boards.

RESULTS

The first part of the post-vention guidelines included procedural processes such as the serious incident review process and reporting to coroner's office. The second part included a checklist for trainee, supervisor, local training facilitator and director of training according to the following time frame: first 24 hours, first 1-2 weeks and following months.

CONCLUSIONS

Post-vention guidelines and teaching about patient suicide and its effects could improve the training experience of psychiatry trainees and facilitate the development of resilience as they progress through training.

Up-to-date review of psychotherapy via videoconference: implications and recommendations for the RANZCP Psychotherapy Written Case during the COVID-19 pandemic

OBJECTIVE

There has been a surge in videoconferencing technology use in response to the COVID-19 pandemic. RANZCP registrars engaged in the Psychotherapy Written Case are met with new challenges in navigating the psychodynamic processes that can occur when transitioning from in-person to videoconferencing psychotherapy. There is also a myriad of videoconferencing platforms to choose from.

CONCLUSION

It has become necessary to adapt our clinical practice to the current COVID-19 pandemic and physical distancing regulations. The literature recognises videoconferencing psychotherapy as a valid therapeutic medium which can facilitate healthy psychological maturation, but there are theoretical drawbacks. A transition to videoconferencing psychotherapy requires patient agreeability, consistency and reflection upon patient-therapist dynamics; this will aide in the Psychotherapy Written Case submission. Registrars must balance usability, digital security and patient preferences when choosing videoconferencing platforms.

Attitudes of Psychiatry Residents in Canadian Universities toward Neuroscience and Its Implication in Psychiatric Practice

OBJECTIVE

Despite recent advances in neuroscience highlighting its potential applications in the assessment and treatment of psychiatric disorders, the training of psychiatrists in neuroscience is lacking. However, it is not clear to what extent Canadian trainees are interested in further learning and using neuroscience in their daily clinical practice. This study explored the attitudes of Canadian psychiatry trainees with regard to neuroscience education and training by asking them to assess their own understanding of neuroscience and the perceived relevance of neuroscience knowledge to effective psychiatric practice.

METHODS

An online questionnaire was sent to psychiatry residents at Canadian universities. This questionnaire consisted of self-assessments of neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics.

RESULTS

One hundred and eleven psychiatry residents from psychiatry residency programs at Canadian universities responded to this survey. Participants represented trainees from all 5 years of residency. Almost half of all trainees (49.0%) reported their knowledge of neuroscience to be either "inadequate" or "less than adequate," and only 14.7% of trainees reported that they feel "comfortable" or "very comfortable" discussing neuroscience findings with their patients. 63.7% of Canadian trainees rated the quantity of neuroscience education in their residency program as either less than adequate or inadequate, and 46.1% rated the quality of their neuroscience education as "poor" or "very poor." The vast majority of participants (>70%) felt that additional neuroscience education would be moderately-to-hugely helpful in finding personalized treatments, discovering future treatments, destigmatizing patients with psychiatric illness, and understanding mental illness.

CONCLUSIONS

Canadian trainees generally feel that their neuroscience knowledge and the neuroscience education they receive during their psychiatry residencies is inadequate. However, as the first step for any change, the majority of future Canadian psychiatrists are very motivated and have a positive attitude toward neuroscience learning.

Psychiatry Trainees' Attitudes, Knowledge, and Training in Addiction Psychiatry-A European Survey

Background: Although psychoactive substance use disorders (PSUDs) are a domain of mental health, addiction psychiatry is only formally recognized as a subspecialty in a few European countries, and there is no standardized training curriculum. Methods: A 76-item questionnaire was developed and disseminated through an online anonymous data-collecting system and hand-to-hand amongst psychiatric trainees from the 47 European countries of the Council of Europe plus Israel and Belarus. Results: 1,049/1,118 psychiatric trainees from 30 European countries completed the questionnaire. Fifty-nine-point nine percent of trainees stated to have training in addictions. Amongst the trainees who described having training in addictions, 43% documented a not well-structured training and 37% an unsatisfactory training, mainly due to poor acquired knowledge. Overall, 97% of trainees stated that addiction represents a core curriculum for their training. Overall, general adult psychiatric trainees reported a better knowledge in addictions, compared to trainees in child and adolescent psychiatry. Conclusion: Despite a growing spread of PSUDs in European countries, addiction psychiatry is a relatively poorly trained field within psychiatry training programs. Further research should investigate reasons for poor training and timings of the educational activities to optimize experiential education training in addiction psychiatry.

From Learning Psychiatry to Becoming Psychiatrists: A Qualitative Study of Co-constructive Patient Simulation

Objectives: Co-constructive patient simulation (CCPS) is a novel medical education approach that provides a participatory and emotionally supportive alternative to traditional supervision and training. CCPS can adapt iteratively and in real time to emergent vicissitudes and challenges faced by clinicians. We describe the first implementation of CCPS in psychiatry. Methods: We co-developed clinical scripts together with child and adolescent psychiatry senior fellows and professional actors with experience performing as simulated patients (SPs). We conducted the simulation sessions with interviewers blind to the content of case scenarios enacted by the SPs. Each hour-long simulation was followed by an hour-long debriefing session with all participants. We recorded and transcribed case preparation, simulation interactions, and debriefing sessions, and analyzed anonymized transcripts through qualitative analysis within a constructivist framework, aided by NVivo software. Results: Each of six CCPS sessions was attended by a median of 13 participants (range, 11-14). The first three sessions were conducted in person; the last three, which took place during the COVID-19 pandemic, via synchronized videoconferencing. Each of the sessions centered on clinically challenging and affectively charged situations informed by trainees' prior experiences. Through iterative thematic analysis we derived an alliterating "9R" model centered on three types of Reflection: (a) in action/"while doing" (Regulate, Relate, and Reason); (b) on action/"having done" (Realities, Restraints, and Relationships); and (c) for action/"will be doing" (with opportunities for Repair and Reaffirmation). Conclusions: CCPS is an experiential approach that fosters autonomous, meaningful, and individually tailored learning opportunities. CCPS and the 9R model for reflective practice can be effectively applied to psychiatry and have the potential to contribute uniquely to the educational needs of its trainees and practitioners.

Medical students' experiences in learning the Mental State Examination with standardized patients

INTRODUCTION

Standardized patients are widely used in psychiatry teaching and examinations, but their effectiveness in teaching psychopathology and the Mental State Examination in particular has not been established. A mixed-methods study was undertaken amongst fourth year medical students during a psychiatry rotation to explore the usefulness of learning the Mental State Examination with standardized patients compared with real patients.

METHODS

Qualitative semistructured interviews (N = 10) were done to explore learning experiences with standardized patients. The Experience with Standardized Patients Scale was used (N = 200) for the quantitative assessment in relation to examination performance and learning experience.

RESULTS

In qualitative interviews, the common themes were that the experience with standardized patients was not natural and made it difficult to suspend disbelief, but students recognized the usefulness of standardized patients for practicing their skills. While there was no significant relationship between overall student experiences with standardized patients and their examination performance in the end-of-rotation Observed Standardized Clinical Examination (P = .40), the exception was with those who perceived they learnt more communication skills with standardized patients (P = .002). Students' experience with standardized patients role-playing psychotic disorders was poorest compared with standardized patients role-playing depressive and neurotic disorders. There were statistically significant differences in experiences between the three diagnostic groups.

DISCUSSION

Standardized patients are useful in psychiatry for students to practice and improve their skills in eliciting psychopathology. However, attention to the training and selection of these individuals for psychiatric roles are crucial.

Opinion: psychiatry formal education courses have been lost in transition

OBJECTIVE

With reference to relevant literature, this article explores the impact of moving to a competency-based training programme upon psychiatry formal education courses (FECs).

CONCLUSIONS

In the context of major changes in psychiatry training, FECs have lost clarity of role, alignment and governance. Strategic decisions made with key stakeholders are required to continue to train psychiatrists best able to meet future community needs.

Training the Next Generation of Geriatric-Focused Clinical Neuroscientists

It remains challenging to integrate clinical neuroscience into clinical practice. Hindrances at the training level (e.g., lack of qualified faculty and curriculum) contribute to this impasse. To help address this, we present a model of training in clinical neuroscience. We expand on a growing literature on incorporating neuroscience into psychiatry training by emphasizing two points. That is, 1) we propose a training model designed for the geriatric-minded clinician; and 2) that extends across several phases of education and career development. Considering the relevance of dementia to our population of interest, and the potential impact expertise in clinical neuroscience can have in elders with cognitive impairment, we provide relevant curriculum examples at various training stages. Clinical research, both as a practitioner and consumer, figures prominently into our training model. We discuss two mentoring programs, T32 fellowships and Research Career Institute in the Mental Health of Aging, as ways to engage geriatric psychiatrists early in their training and transition them successfully to post-residency clinical investigator positions. Although there is increasing opportunity for geriatric psychiatrists and other clinicians to become leaders in the field of neuroscience, this remains a work in progress; ours and others' training programs continue to evolve based on input from trainers and trainees alike, as well as from the increasing literature on this important topic.

'Having a mentor helped me with difficult times': a trainee-run mentoring project

OBJECTIVE

A mentoring programme was established in South Australia in 2014 by psychiatry trainees, with the goal of reducing stress and burnout amongst first-year trainees. All first-year trainees are offered the opportunity to have a senior trainee as a mentor. This article describes the mentoring programme, presents feedback from participants and identifies areas for further development.

METHOD

The majority (72/76) of first-year trainees entering psychiatry training in South Australia from 2014-2018 were allocated a mentor. Surveys were sent out in 2014, 2015 and 2017. Twenty of 42 (48%) mentors and 17 of 42 (40%) of mentees completed a 10-item questionnaire, with free text responses.

RESULTS

Mentee feedback was mostly positive, reporting that mentors offered them reassurance and support. The most common challenges were advice about training, managing work-life balance and issues with supervision. The main barrier to the mentoring programme was lack of time to meet. Mentors identified that they would have liked more training in mentoring.

CONCLUSION

The trainee mentoring programme has been a useful initiative. As consultant psychiatrists are likely to provide mentoring for more junior colleagues, the authors propose that training in mentoring should be part of the Royal Australian and New Zealand College of Psychiatrists education programme.

The importance of self-awareness: musings of a medical student

OBJECTIVE

Self-awareness is essential for combating burnout, promoting self-care, and wellbeing in health professionals. This article examines modern day roadblocks to developing this skill in medical practice and highlights some simple solutions for consideration.

CONCLUSION

The capacity for self-awareness is essential to the modern-day physician seeking a long and fulfilling career. Mindfulness meditation and reflective writing are two simple, proven methods that can be easily implemented into medical training.

The Integrative Psychiatry Curriculum: Development of an Innovative Model

The Integrative Psychiatry Curriculum (IPC) was developed to train psychiatry residents and fellows to apply an Integrative Medicine (IM) approach for patients presenting with psychiatric disorders. Launched in 2015, IPC includes interactive online courses, in-person experiential sessions, and a clinical component with supervision. Twenty-one residents and fellows have completed the curriculum. The purpose of the IPC is 2-fold: to enhance patient wellness through training residents and fellows in evidence-based whole-person care and to improve physician well-being through enhanced stress management and self-awareness utilizing the practice of mind-body skills within a supportive small group setting. Course participants are trained in a broad range of prevention and treatment options and learn about their evidence base; they then practice incorporating IM into diagnosis and treatment plans through supervised clinical experience. This article describes the development of IPC and its elements. Efforts are underway to further develop and standardize the offerings and increase the portability of the course, making it easier for Psychiatry training programs with limited faculty expertise in IM to provide the curriculum for residents and fellows. To reach the goal of disseminating such a curriculum for integrative psychiatry, further funding and collaboration with multiple residency training programs is needed.

Facilitated Learning Groups: an initiative to enhance psychiatric training in South Australia

OBJECTIVES:

Facilitated Learning Groups (FLGs) were introduced by the South Australian Psychiatry Branch Training Committee in 2016 to provide support for trainees. These incorporated Balint group principles but also had roles that extended beyond a traditional Balint group. This paper reports an evaluation of these groups after their first 12 months.

METHODS:

An evaluation form was sent to all trainee participants, seeking quantitative and qualitative feedback about their experience.

RESULTS:

The majority of trainees found the FLGs to be beneficial. A thematic analysis of the written feedback revealed several key benefits for the participants, including having access to a senior psychiatrist who was outside of training and supervision, mixing with trainees across years and regions, and the capacity to discuss difficult work environments.

CONCLUSIONS:

A forum for trainees to develop reflective practice and discuss challenging issues, which is not involved in their assessment, was experienced positively by the majority of participants and should be considered for wider adoption across Australia and New Zealand.

Supervising trainees in research: what does it take to be a scholarly project supervisor?

OBJECTIVES

Scholarly projects (SPs) are a compulsory component of psychiatry training in Australasia. This article outlines the role of a research supervisor in supporting a trainee to complete an SP.

METHODS

A total of 10 old age and forensic psychiatry SPs were reviewed with regard to aims, methodology, supervisor input, trainee tasks and additional resources.

RESULTS

The main supervisor tasks are described and discussed. They include practical advice on study design, ethics applications, critical appraisal, data analysis, academic writing and publication.

CONCLUSIONS

Supervising SPs can bring significant rewards in awakening a trainee's interest in research. Key competencies for research supervision are discussed and further recommendations for supervisor support and training are provided.

Attitudes toward mental illness among Caribbean medical students

BACKGROUND

There are limited empirical data on all matters pertaining to mental illness in the Caribbean but what little there is suggests significant levels of stigmatization exist. In this context, health professionals reveal at least equal to or only slightly improved attitudes to mental illness as compared to the general population. In addition, while there is evidence of improved attitudes among the population at large over the past decade this trend has not been observed among health professionals. This study, therefore, sought to assess medical students' knowledge about and attitudes toward mental illness as they traversed medical school.

METHODS

Preclinical medical students were surveyed and then retested in their final year of training. Students completed a knowledge scale, and the medical conditions regard scale comparing attitudes to four mental illness and three physical illness.

RESULTS

Knowledge about and attitudes toward mental illness showed significant improvement over the 5-year period. However, both preclinical and clinical students revealed significant levels of stigmatization toward mental illness despite improvements in knowledge. Students recognized the need to prioritize treatment for persons with mental illness but did not want to be personally involved in the treatment process.

DISCUSSION

Results highlight that significant negative attitudes still exist among medical students toward mental illness and these persist up until graduation. There is a need for further research into innovations and interventions to address this matter.

Balint groups: an Australasian perspective for psychiatrists

OBJECTIVE

This paper aims to provide a brief overview of the history and scope of the Balint movement; to outline how Balint groups work; to describe what is entailed in leading a Balint group; and to give a brief overview of the current state of Balint work in Australia and New Zealand.

CONCLUSIONS

Balint groups provide a unique setting in which clinicians can learn how to deal well with challenging doctor-patient relationships and the feelings evoked in clinical practice. Balint work is relatively undeveloped in Australasia. There is scope for involvement by psychiatrists and trainees as both participants and facilitators.

'Teaching' the therapeutic alliance Part 2. Treating patients, supporting trainees: towards a broader view of psychotherapy training

OBJECTIVE

This is the second of two papers focusing on the need for a broader view of contemporary psychotherapy training.

CONCLUSION

Some preliminary suggestions for affective or "right-brain" training, including supervision for psychotherapy with patients with developmental trauma and Balint-style groups are made.

Are psychiatrists trained to be leaders in mental health? A survey of early career psychiatrists

OBJECTIVE

The aim of this study was to investigate how early career psychiatrists in 2014 valued the leadership skill education in their training to become psychiatrists.

METHOD

All psychiatrists who gained Fellowship since 2009 after training in New Zealand or Australia were invited to take part in a survey.

RESULTS

Respondents considered themselves not adequately prepared for the leadership, management and administrative tasks and roles they have as psychiatrists, with preparedness for management tasks scoring the lowest. They valued as most useful to have opportunity to practice with a leadership role, to be able to observe 'leaders at work', to have a supervisor with special interests and skills in leadership and management and to have a formal teaching program on leadership and management. They advised teaching to be given throughout the entire 5 years of the training program by experienced leaders.

CONCLUSIONS

Leadership skills training in the education of psychiatrists should contain both practical experience with leadership and management roles and formal teaching sessions on leadership and management skills development. Suggestions for improvement of the leadership and management skills education in the training of psychiatrists have been formulated.

A novel method of assessing quality of postgraduate psychiatry training: experiences from a large training programme

BACKGROUND

Most assessments of the quality of postgraduate training are based on anonymised questionnaires of trainees. We report a comprehensive assessment of the quality of training at a large postgraduate psychiatry training institute using non-anonymised face-to-face interviews with trainees and their trainers.

METHODS

Two consultant psychiatrists interviewed 99 trainees and 109 trainers. Scoring of interview responses was determined by using a pre-defined criteria. Additional comments were recorded as free text. Interviews covered 13 domains, including: Clinical, teaching, research and management opportunities, clinical environment, clinical supervision, adequacy of job description, absence of bullying and job satisfaction. Multiple interview domain scores were combined, generating a 'Combined' score for each post.

RESULTS

The interview response rate was 97% for trainers 88% for trainees. There was a significant correlation between trainee and trainer scores for the same interview domains (Pearson's r = 0.968, p< 0.001). Overall scores were significantly higher for specialist psychiatry posts as compared to general adult psychiatry posts (Two tailed t-test, p < 0.001, 95% CI: -0.398 to -0.132), and significantly higher for liaison psychiatry as compared to other specialist psychiatry posts (t-test: p = 0.038, 95% CI: -0.3901, -0.0118). Job satisfaction scores of year 1 to year 3 core trainees showed a significant increase with increasing seniority (Linear regression coefficient = 0.273, 95% CI: 0.033 to 0.513, ANOVA p= 0.026).

CONCLUSIONS

This in-depth examination of the quality of training on a large psychiatry training programme successfully elicited strengths and weakness of our programme. Such an interview scheme could be easily implemented in smaller schemes and may well provide important information to allow for targeted improvement of training. Additionally, trends in quality of training and job satisfaction amongst various psychiatric specialities were identified; specifically speciality posts and liaison posts in psychiatry were revealed to be the most popular with trainees.

A new paradigm for teaching behavior change: implications for residency training in family medicine and psychiatry

BACKGROUND

Primary care physicians (PCPs) provide ~50 % of all mental health services in the U.S. Given the widening gap between patient mental health needs and resources available to meet those needs, there is an increasing demand for family medicine and psychiatry trainees to master competencies in both behavioral medicine and primary care counseling during residency-if for no other reason than to accommodate the realities of medical practice given the oft present gap between the need for psychiatric services and the availability, quality, and/or affordability of specialized psychiatric care. To begin to address this gap, a skills-based, interactive curriculum based on motivational interviewing (MI) as a teaching method is presented.

METHODS

The curriculum described in this paper is a four-week block rotation taught in the second year of residency. Motivational interviewing (MI) is used as a teaching approach toward the goal of clinical behavior change. Residents' strengths, personal choice and autonomy are emphasized. Each week of the rotation, there is a clinical topic and a set of specific skills for mastery. Residents are offered a "menu" of skills, role modeling, role/real play, practice with standardized patients (SP), and direct supervision in clinic.

RESULTS

Thirty-nine residents have completed the curriculum. Based on residents' subjective reporting using pre-post scales (i.e., importance and confidence), all participants to date have reported substantial increases in confidence/self-efficacy using primary care counseling skills in their continuity clinic.

CONCLUSIONS

This paper presents an innovative, empirically based model for teaching the essential skills necessary for physicians providing care for patients with mental/emotional health needs as well as health-behavior change concerns. Implications for training in the broader context, particularly as it relates to multi-disciplinary and collaborative models of teaching/training are discussed.