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The purpose of this paper is to increase awareness of shared decision making, the initial aim of the study was to understand how psychiatrists-in-training defined themselves as unique among physicians with an eye on how professional identity might shape approach to care. The second aim was to use those definitions and descriptions related to professional identity and tailor a brief training module to promote awareness of the shared decision making model.

The authors do this by first conducting focus groups to ascertain how psychiatric residents characterize their professional identity and unique disciplinary characteristics. The authors then designed a brief training session that exploits the relationship between how they define themselves as physicians and how they approach clinical decision making with patients.

Three major themes that emerged from the focus group data: the central role of societal and treatment contexts in shaping their professional identity and approaches to care, a professional identity characterized by a great sense of pride, and a strong commitment to systematic decision-making processes in practice. While the assessment of the training module is preliminary and lacks rigor for any generalizability or statements of causality, responses likely affirm the training tailored around professional identity as a possible vehicle for effective exposure to the concept of shared decision making and served as a useful avenue for self-reflection about needed changes to more fully embrace the practice.

More inquiry may be needed into the association between trust, relationship longevity and power and paternalism, as a way to bring greater insight into the adoption of shared decision making. Future research will have to investigate whether or not including identity-related content is empirically connected to successful training on shared decision making. Likewise, future research should also look at the reciprocal impact of effectively using shared decision making on the affirmation of professional identity among psychiatrists, and indeed all who embrace patient-centered care.

This is the one of the first papers to investigate issues of professional identity among psychiatry residents, and also among the first papers to consider the relationship between professional identity and use of shared decision making.

The Lemuel Shattuck Hospital Youth Service Program adopted a public health approach to address the mental health needs of incarcerated juvenile offenders in Massachusetts. The program, which operated for 6 years, provided psychiatric care and neuropsychological assessment to delinquent youth as well as training for psychiatry residents, neuropsychology fellows and Massachusetts Department of Youth Services’ staff. The program recognized and attempted to address the health care disparity of limited access to quality mental health services for incarcerated youth, particularly those from disadvantaged and minority backgrounds. The program was a collaborative venture among the Massachusetts Departments of Public Health and Youth Services, and Tufts-New England Medical Center. The scope of the problem of mental health care for incarcerated youth will be first outlined, followed by a history and evaluation of the program from a public health and system integration perspective.

The purpose of this paper is to review the impact of a new, brief forensic rotation for general psychiatry residents on the variety of residents’ forensic exposures.

The authors surveyed residents who trained before and after the implementation of the new rotation to assess the impact of the rotation on the residents’ forensic experiences during training across a variety of domains.

Even in a highly clinical forensic setting, residents participating in the required rotation reported significantly greater variety of forensic experiences than those who had not completed the required rotation, including types of settings and assessments, Rotation completers reported greater exposure to various types of settings and assessments, and courtroom-related experiences, as well as the overall number of forensic exposures. The two groups did not differ in their forensic exposures in general psychiatry settings, civil-forensic evaluations or diverse forensic populations. Secondary analyses showed that increased exposure to court-based experiences and multiple forensic settings was associated with forensic fellowship interest.

This study demonstrates that a brief, mandatory forensic clinical rotation may increase residents’ exposure to forensic settings, assessments and courtroom-related experiences and that increased exposure to courtroom-based experiences in particular may increase interest in forensic fellowship. While not surprising, the results demonstrate that residents were not otherwise having these forensic experiences and that even time-limited forensic rotations can enhance the breadth of residents’ forensic exposures. Further, the rotation achieved these outcomes without using typical forensic sites but instead highly clinical sites, which may be particularly encouraging to residency programs without ready access to classic forensic rotation sites. This study contributes to the small but expanding body of the literature describing the value of increasing psychiatry residents’ training in clinical forensic psychiatry.

Feedback is a tool that informs students about their learning process and facilitates necessary changes. It looks for the students’ own perceptions of their performance and how to improve it, developing permanent learning skills vital for autonomous practice. It is useful for improving one’s performance, clinical skills, communication and treatment of patients. If carried out improperly, it causes a lack of motivation and a collapse in the teacher–student relationship. The purpose of this paper is to analyze the perceptions and experiences of the residents and graduates of the psychiatry specialty at the Universidad of Concepción with respect to the feedback received on their performance during their training.

The study was conducted using a qualitative approach of an exploratory, descriptive and interpretative nature that was also based on Grounded Theory. Ten in-depth voluntary interviews were conducted with residents-in-training and graduates from within the last two years of the Adult Psychiatry specialty at the Universidad of Concepción. Subsequently, the data were codified to create a theoretical model.

The interpersonal teacher–resident relationship, when based on collaboration and an openness to dialogue, is fundamental in producing effective feedback.

The limitations of this study were based mainly on the qualitative methodology used, so it is not possible to generalize the results. Although the above limitation, this study seems to reaffirm the importance of feedback for residents in training, so it would be advisable to reproduce it in various training contexts and extend it to the perception of the teachers involved. On the other hand, to follow this research line, it is essential to create instruments that facilitate the use of quantitative research methodology, which allows the generalization and comparison of results in different areas.

This research opens a first line of research regarding subjective experience when receiving feedback, which will allow the creation of instruments to objectify how it is being developed in different educational contexts and to propose strategies to standardize its realization.

There are no other studies of this type published. The originality of this research was that beyond the mention made about the known characteristics that a feedback must have to be effective, the participants gave special emphasis to the fact that it is a social relationship, which should be based on a horizontal interaction between two actors, in addition to promoting dialogue and mutual involvement in the task that brings them together. Thus it is an effective teaching strategy, fulfilling the objective of motivating the learning and autonomy of the resident.

The purpose of this paper is to identify the training needs of the next generation of psychiatrists, and barriers in prescribing first-generation antipsychotics (FGAs), long-acting injectable (LAIs) antipsychotics and clozapine.

An electronic survey was sent to psychiatry residents (N= 75/288, 26 percent) at four Canadian residency programs in late December 2017. The survey was based on an instrument originally developed at the University of Cambridge and consisted of 31 questions in 10 content domains.

Nearly 80 percent of residents were aware that FGAs and second-generation antipsychotics (SGAs) have similar efficacy. However, extra-pyramidal symptoms and lack of training experience were the leading concerns associated with the prescribing of FGAs. Although over 90 percent of residents felt confident about initiating an oral SGA as a regular medication, only 40 percent did so with FGAs. Confidence with initiating LAIs and clozapine was 60 and 61 percent, respectively.

The survey highlights the need for better training in the use of FGAs, clozapine and LAIs. These medications can be effectively used in providing patients with the most appropriate evidence-based treatment options to improve treatment outcomes, while ensuring that these resources are not lost to the future generations of psychiatrists.

The survey may be the first of its kind to assess antipsychotic prescribing attitudes in Canadian psychiatry residents in multiple sites.

Mental health providers will be increasingly called on to lead psychiatric efforts to improve care and care redesign. The Accreditation Council for Graduate Medical Education (ACGME) in the USA requires residency programs to teach quality improvement (QI) and systems-based practice (SBP) to all trainees as part of training requirements. However, teaching QI and SBP concepts without a clinical context can be challenging with low trainee engagement. The paper aims to discuss these issues.

The authors describe curricular redesign with a specialized educator faculty task force that aimed to create a longitudinal curriculum that integrated abstract QI concepts into clinical practice settings, and helped trainees apply SBP concepts throughout residency. In addition, the authors describe the utilization of resident prescriber profiles to contextualize clinical practice habits, and the implementation of an educational case conference series with emphasis on QI-specific educational tools such as root cause analysis (RCA).

Formal resident feedback from 2016 to 2018 has demonstrated improved trainee satisfaction. The resulting curricular change has also led to a new chief resident role and sustained engagement in QI and SBP education by trainees.

The faculty task force and curricular design changes described in this paper were implemented at one large academic institution. Thus, additional assessment and research is necessary to address the generalizability of the interventions described.

Since QI and SBP are becoming more prominent requirements for medical education accrediting bodies such as the ACGME, the innovative curricular design can benefit other residency and medical student education programs that attempt to integrate clinical practice with education incorporating QI and SBP concepts.

Several studies have shown benefits of peer mentoring on wellness among medical students and health care professionals. Peer mentorship has also been pointed as having interesting potential for International Medical Graduates. However, the literature on peer mentoring at the residency level is very limited. The purpose of this paper is to assess the benefits of a resident-led pilot peer-mentoring initiative at McGill University.

Over 2 years, 17 residents from various residency programs were put in contact with a volunteer peer mentor by e-mail. The structure of the mentorship was flexible. A survey using Likert scale and free text responses was sent to all the participants.

There were response rates of 65 percent for mentees and 59 percent for mentors. The majority of mentees thought the service was either moderately helpful (18 percent) or helpful (36 percent). Several residents noted that communication by e-mails and lack of in-person contacts were a limitation in the mentorship experience. The most frequent challenge that led to consult the service was immigration or arrival from another province.

The results show that the program can be helpful to medical residents, is cost-effective, flexible and could be adapted and replicated elsewhere. In the future, the program will adjust to tend toward a more structured frame, highlighting the importance of in-person contacts. The small sample size of participants and the recall bias are some limitations of our study.

The paper provides a Canadian perspective on the use of psychotropic medication in the management of problem behaviours in adults with intellectual disabilities in Canada. Psychotropic medication and intellectual disabilities were explored in the context of Canadian health and social services, clinical practices, medical training and factors that have shaped these over the past few decades. Informal physician intellectual disabilities networks and the newly formed Canadian Network of the National Coalition on Dual Diagnosis provided the opportunity to survey the use of psychotropic medication for problem behaviours across the country. Geographic, political, cultural and other influences on the development of health and social services are described, as well as training requirements for physicians. Survey responses were received from all provinces and represented clinicians in mental health multidisciplinary teams, health and social services ministry representatives, agency staff (up to executive director level) and family members of individuals with intellectual disabilities. Psychiatry and family medicine perspectives of the authors from working in Canada and the UK with people with intellectual disabilities presenting with problem behaviours are described. In Canada there are no national, provincial or territorial policies or guidelines on use of psychotropic medication for the management of such behaviours. There are no requirements for physicians prescribing these medications to have training in the care of people with intellectual disabilities. Services for people with intellectual disabilities and behaviour problems in Canada appear to be more crisis‐reactive than those in the UK.

The purpose of this paper is to systematically appraise the effect of use of interpreters for mental health problems in old age. The primary objective of the review is to assess the impact of a language barrier for assessment and management in relation to mental health problems in the old age. The secondary objectives are to assess the effect of the use of interpreters on patient satisfaction and quality of care, identify good practice and make recommendations for research and practice in the old age mental health.

The following data sources were searched for publications between 1966 and 2011: PubMed, PsycINFO, CINAHL and Cochrane Library. The authors found in previous reviews that a substantial number of papers from developing and non-English speaking countries are published in journals not indexed in mainstream databases, and devised a search strategy using Google which identified a number of papers, which could not be found when the search was limited to scientific data bases only (Farooq et al., 2009). The strategy was considered especially important for this review which focuses on communication across many different languages. Thus, the authors conducted a search of the World Wide Web using Google Scholar, employing the search term Medical Interpreters and Mental Health. The search included literature in all languages. The authors also searched the reference lists of included and excluded studies for additional relevant papers. Bibliographies of systematic review articles published in the last five years were also examined to identify pertinent studies.

Only four publications related specifically to “old age” and 33 addressed “interpreting” and “psychiatry” generally. Four articles presented original research (Parnes and Westfall, 2003; Hasset and George, 2002; Sadavoy et al., 2004; Van de Mieroop et al., 2012). One article (Shah, 1997) reports an “anecdotal descriptive account” of interviewing elderly people from ethnic backgrounds in a psychogeriatric service in Melbourne and does not report any data. Therefore, only four papers met the inclusion and exclusion criteria and present original research in the field of “old age”, “psychiatry” and “interpreting”. None of these papers present UK-based research. One is a quantitative study from Australia (Hasset and George, 2002), the second is a qualitative study from Canada (Sadavoy et al., 2004), in the third paper Van de Mieroop et al. (2012) describe community interpreting in a Belgian old home and the final paper is an American case study (Parnes and Westfall, 2003).

Interviewing older patients for constructs like cognitive function and decision-making capacity through interpreters can pose significant clinical and legal problems. There is urgent need for training mental health professionals for developing skills to overcome the language barrier and for interpreters to be trained for work in psychogeriatrics.

The literature on working through interpreters is limited to a few empirical studies. This has serious consequences for service users such as lack of trust in services, clinical errors and neglect of human rights. Further studies are needed to understand the extent of problem and how effective interpreting and translating services can be provided in the routine clinical practice. It is also essential to develop a standard of translation services in mental health that can be measured for their quality and also efficiency. At present such a quality standard is not available in the UK, unlike Sweden (see www.regeringen.se/sb/d/3288/a/19564). This omission is disturbing – especially when decisions on human rights are being considered as part of the Mental Health Act. Such a standard can best be achieved by collaboration between medical profession and linguists’ professional associations (Cambridge et al., 2012).

Whilst translation/interpretation has been addressed more generally in mental health: specific considerations related to old age psychiatry are almost absent. This needs urgent rectification given that a large proportion of older people from BME communities will require translation and interpretation services.

To galvanize practical discussion about how to modify psychiatry residency programs to instill the recovery paradigm into students who will become psychiatrists.

A review of relevant literature is undertaken.

Eight suggestions are offered to help residency programs initiate conversations about recovery.

There has been little, if any, discussion about how psychiatry residency programs must change in terms of curriculum and pedagogy.