Psychiatric Education

It is widely accepted that quality improvement (QI) education should be experiential. Many training programs believe that making QI learning "hands-on" through project-based learning will translate into successful learning about QI. However, this pervasive and overly simplistic interpretation of experiential QI learning, and the general lack of empirical exploration of the factors that influence experiential learning processes, may limit the overall impact of project-based learning on educational outcomes...

BACKGROUND: Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. METHODS: In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of 'bricolage' which means our approach was inductive...

BACKGROUND: Eating disorders affect 1%-4% of the population and they are associated with an increased rate of mortality and multimorbidity. Following the avoidable deaths of three people the parliamentary ombudsman called for a review of training for all junior doctors to improve patient safety. OBJECTIVE: To review the teaching and assessment relating to eating disorders at all levels of medical training in the UK. METHOD: We surveyed all the UK medical schools about their curricula, teaching and examinations related to eating disorders in 2017...

Educational assessment for the health professions has seen a major attempt to introduce competency based frameworks. As high level policy developments, the changes were intended to improve outcomes by supporting learning and skills development. However, we argue that previous experiences with major innovations in assessment offer an important road map for developing and refining assessment innovations, including careful piloting and analyses of their measurement qualities and impacts. Based on the literature, numerous assessment workshops, personal interactions with potential users, and our 40 years of experience in implementing assessment change, we lament the lack of a coordinated approach to clarify and improve measurement qualities and functionality of competency based assessment (CBA)...

In this essay, I reflect on some of the ways racial privilege influenced my experience as a white physician in training. While white Americans often think of "racism" as a social construct primarily affecting people of color, "racism" is a system of both racial disadvantage as well as reciprocal racial advantage. Medical professionals are increasingly aware of how social determinants of health lead to important health disparities, however white physicians seldom ask how their own racial privilege reinforces a white supremacist culture and what effects this may have on our patients' health...

As American psychiatrists moved from the asylum to the private clinic during the early twentieth century, psychiatry acquired a growing presence within medical school curricula. This shift in disciplinary status took place at a time when medical education itself was experiencing a period of reform. By examining medical school registers at Harvard University, records from the Dean's office of Harvard's medical school, and oral histories, this paper examines the rise in prominence of psychiatry in medical education...

There is an increasing focus on factors that influence the variability of rater-based judgments. First impressions are one such factor. First impressions are judgments about people that are made quickly and are based on little information. Under some circumstances, these judgments can be predictive of subsequent decisions. A concern for both examinees and test administrators is whether the relationship remains stable when the performance of the examinee changes. That is, once a first impression is formed, to what degree will an examiner be willing to modify it? The purpose of this study is to determine the degree that first impressions influence final ratings when the performance of examinees changes within the context of an objective structured clinical examination (OSCE)...

BACKGROUND: Dementia diagnosis rates are increasing. Guidelines recommend that people with dementia should be told their diagnosis clearly and honestly to facilitate future planning. Aims To analyse how doctors deliver a dementia diagnosis in practice. METHOD: Conversation analysis was conducted on 81 video-recorded diagnosis feedback meetings with 20 doctors from nine UK memory clinics. RESULTS: All doctors named dementia; 59% (n = 48) approached the diagnosis indirectly but delicately ('this is dementia') and 41% (n = 33) approached this directly but bluntly ('you have Alzheimer's disease')...

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OBJECTIVE: This analysis quantified and assessed the projected workforce of psychiatrists in the United States through 2050 on the basis of population data. METHODS: With use of data from the Association of American Medical Colleges (2000-2015), American Board of Psychiatry and Neurology (2000-2015), and U.S. Census Bureau (2000-2050), the psychiatrist workforce was projected through 2050. Two established psychiatrist-to-population ratios were used to determine the estimated demand for psychiatrists and potential shortages...

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CONTEXT: In university programmes preparing students to work with patients with mental illness, clerkship is proposed as a component that may contribute to the battle against stigma, through bringing students into contact with the patients' reality. Yet, the precise contribution of clerkship remains unclear, perhaps because of the variety of university programmes, clerkship characteristics or types of stigma explored. This is the first systematic meta-analysis of available evidence determining the precise effect size of the influence of clerkship on stigma and the potential moderators...

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This Open Forum explores the role of implicit bias along the mental health care continuum, which may contribute to mental health disparities among vulnerable populations. Emerging research shows that implicit bias is prevalent among service providers. These negative or stigmatizing attitudes toward population groups are held at a subconscious level and are automatically activated during practitioner-client encounters. The authors provide examples of how implicit bias may impede access to care, clinical screening and diagnosis, treatment processes, and crisis response...

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The introduction of competency-based medical education has shifted thinking from a fixed-time model to one stressing attained competencies, independent of the time needed to arrive at those competencies. In this article, the authors explore theoretical and conceptual issues related to time variability in medical training, starting with the Carroll model from the 1960s that put time in the equation of learning. They discuss mastery learning, deliberate practice, and learning curves.While such behaviorist theories apply well to structured courses and highly structured training settings, learning in the clinical workplace is not well captured in such theories or in the model that Carroll proposed...