Introduction: Background: The Centers for Disease Control (CDC) notes a 154 percent increase in t... more Introduction: Background: The Centers for Disease Control (CDC) notes a 154 percent increase in telemedicine use amongst healthcare providers between March 2019 and March 2020. While not formally incorporated into the Liaison Committee on Medical Education (LCME) accreditation standards, the Association of American Medical Colleges (AAMC) has made the provision of telemedicine services as an entrustable professional activity (EPA). Given the growth of telemedicine use, medical student comfort with the formalized EPAs was explored in this study.Methods: An IRB-approved 17-question, anonymous survey was created based on the AAMC’s EPAs and administered to students at Northeast Ohio Medical University (NEOMED) over four weeks. The primary outcome of this study is to assess medical students’ self-reported telemedicine comfort levels.Results: The response rate was 141 students (22%). 57% of students describe that they were able to create equally as effective a therapeutic alliance using ...
Summary: Careful observers have long recognized the signs, symptoms, and behaviors of bipolar dis... more Summary: Careful observers have long recognized the signs, symptoms, and behaviors of bipolar disorder. Depressive episodes in bipolar disorder are diagnostically identical with major depressive disorder and consist of at least 2 weeks of depressed mood accompanied by a combination of anhedonia, altered sleep, altered appetite, decreased energy, impaired concentration, psychomotor retardation or agitation, feelings of worthless or guilt, impaired cognitive functioning, or thoughts of death. Psychoeducation should be included in all medical treatment as patients have a right to know their diagnosis, the risks of the treatment, alternative treatments, and why the treatment is likely to be helpful. Starting effective medications is of the utmost importance in controlling the devastating symptoms of mania. Bipolar disorder is highly recurrent by nature, so patients must recognize the need to continue on their treatment indefinitely in order to prevent relapses
<jats:p>Psychotherapy continues to be an integral part of psychiatric practice. The rich, i... more <jats:p>Psychotherapy continues to be an integral part of psychiatric practice. The rich, interesting history of psychotherapy in medicine and psychiatry set the background to current practice. Psychoeducation provides patients with necessary information and forms the basic building block for all other psychotherapies. Supportive therapy, cognitive-behavioral therapy, and psychoanalytic/psychodynamic psychotherapies constitute the core of the therapeutic styles, but dialectical behavioral therapy, eye movement desensitization and reprocessing, interpersonal psychotherapy, motivational interviewing, hypnosis, and group psychotherapy are also practiced in current psychiatry. Key therapeutic tenets from each of these disciplines are incorporated into the medical practice of psychiatry. This review contains 5 figures, 4 tables, and 63 references. Key words: cognitive-behavioral therapy, current psychiatric practices, dialectical behavioral therapy, psychiatrist as therapist, psychoanalytic psychotherapy, psychodynamic psychotherapy, psychoeducation, psychotherapy, supportive psychotherapy </jats:p>
This article was migrated. The article was marked as recommended. Objective: The Best Practice Co... more This article was migrated. The article was marked as recommended. Objective: The Best Practice Conference (BPC) was designed to use active techniques to enhance measurable learning from a continuing medical education program. Design: The BPC incorporated flipped-classroom techniques, guided discussion, and peer based components to enhance learning. The impact of the BPC was measured by comparing pre-conference, post-conference, and 3-month follow-up data. Setting: The BPC started with emails to likely attendees. The conference occurred during a regularly scheduled Grand Rounds time slot. There were subsequent follow up e-mails to those who had attended. Methods: The Best Practice Conference involved e-mail contact with residents and faculty members who were likely to attend the conference. These e-mails included clinical scenarios, questions about treatment options, and journal articles. The BPC lasted for 1.5 hours and included a variety of active learning techniques. These confere...
Morbidity and Mortality Conferences (MMCs) have been used in medical training for over 100 years ... more Morbidity and Mortality Conferences (MMCs) have been used in medical training for over 100 years [1]. In-depth discussions of practice and outcomes create an opportunity to acknowledge errors and suggest improvements [2, 3]. With graduate medical education’s growing focus on patient safety, MMCs represent a means of creating a culture of safety by identifying systembased problems. Proponents of system-basedMMCs recognize that idiosyncratic methods for identifying, discussing, and following cases have hampered their impact [4, 5]. Although structured MMCs lead to increased numbers of quality improvement projects and awareness of systems issues, documenting a consistent positive effect on patient care and outcomes remains elusive [6–8]. Specific medical errors typically occur at a low frequency, and statistically significant decreases in rare events may be difficult to demonstrate [9]. Some MMCs do not impact the rates of medical errors because they do not focus onmedical errors [5, 7]. These cases are chosen for other reasons, e.g., an interesting or rare case. While these may be educational, they exacerbate the challenge of propagating clinically relevant lessons from MMCs [10]. Despite these limitations, participants tend to believe that MMCs are beneficial even when they do not totally agree with suggested changes [9]. Increasing the structure of MMCs further increases provider satisfaction [7, 9, 11]. Unfortunately, resident physicians may perceive fewer benefits from MMCs than other participants [9]. Data regarding the impact of MMCs in psychiatry and psychiatry training is extremely limited. In a review of nearly monthly psychiatry MMCs over a 2-year period, 80% of cases uncovered opportunities for possible improvement in patient care, and attendees praised the usefulness of the presentations and discussions [12]. A survey following three resident-driven psychiatric MMCs found that 87.3% of attendees strongly agreed that the presentation increased their knowledge, and 88.6% agreed or strongly agreed that it provided more practical educational insight than a traditional lecture [13].We created aMMC as a pilot project to measure its impact in a psychiatry residency program. The format of theMMC, the lessons to be learned from theMMC, and the details of the case arose from discussions with the resident authors. The MMC focused on obtaining fasting blood sugars (FBS) when starting second-generation antipsychotic medications (SGAs). Participants were initially asked seven questions about laboratory monitoring and health promotion related to starting a SGA. The key question for this study was, “Over the last month when you have started a secondgeneration antipsychotic medication how frequently did you obtain a baseline and follow up: Fasting Blood Sugar”. The possible answers ranged from Never = 1 to Always = 5. The MMC discussion followed a hypothetical patient who had been prescribed an SGA while on an inpatient unit and subsequently presented to the Emergency Department in diabetic ketoacidosis. The authors played the roles of residents who had provided care for the patient and their attending physician. Theywalked the participants through the case describing clinical and laboratory findings. Audience members discussed the diagnoses and management of the patient through the different stages of presentation, assessment, and treatment. After presenting the complete case history and revealing the final diagnoses and outcomes, summaries of several pertinent articles were presented. The presenters reviewed “Lessons Learned” regarding the risk of elevated blood sugar and diabetic ketoacidosis in patients prescribed SGAs. The importance of baseline and follow-up FBS was emphasized repeatedly. Upon the conclusion of the MMC, attendees were asked how often they planned on obtaining FBS when starting second-generation antipsychotic medications. Attendees were asked how much they learned from the MMC and if they would participate in the next phase of the study. The responses of the participants were given a meaningless alpha-numeric * Randon S. Welton rwelton@neomed.edu
Although benzodiazepines (BZDs) are commonly used in the treatment of posttraumatic stress disord... more Although benzodiazepines (BZDs) are commonly used in the treatment of posttraumatic stress disorder (PTSD), no systematic review or meta-analysis has specifically examined this treatment. The goal of this study was to analyze and summarize evidence concerning the efficacy of BZDs in treating PTSD. The review protocol was undertaken according to the principles recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and is registered with the PROSPERO international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO, registration number CRD42014009318). Two authors independently conducted a search of all relevant articles using multiple electronic databases and independently abstracted information from studies measuring PTSD outcomes in patients using BZDs. Eighteen clinical trials and observational studies were identified, with a total of 5236 participants. Outcomes were assessed using qualitative and quantit...
For over 100 years psychoanalytically-oriented psychotherapists have recognized and worked with t... more For over 100 years psychoanalytically-oriented psychotherapists have recognized and worked with transference and countertransference. At first seen as obstacles to treatment, they are now understood to be valuable tools. Transference is an inappropriate or exaggerated response to the therapist, often outside of the patient’s awareness. Common types of transference include idealized, negative, and sexualized transferences. Countertransference consists of the therapist’s emotional response to the patients and can often mirror the patient’s experience (concordant countertransference) or produce the opposite feeling in the therapist (complementary countertransference). When properly understood and managed, transference and countertransference provide invaluable insight into the patient’s inner world.
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, Jan 14, 2015
Air Force psychiatry faces the task of training competent military psychiatrists in an era of con... more Air Force psychiatry faces the task of training competent military psychiatrists in an era of continuing reductions. Beginning in the 1980s, the Air Force started collaborating with University partners to create hybrid training programs, civilian-military psychiatry residencies. These mergers provide stability for Air Force psychiatry training in the face of increased operational missions and uncertain military recruiting. As a result of these combined programs, Air Force psychiatry residents gain access to a broader range of civilian clinical experience and expertise while maintaining a focus on distinctive military requirements. The combining of programs opens up options for academic activities which may not have otherwise existed. Both military and civilian residents benefit from the occupational psychiatry experiences available within military clinical sites. These programs give civilian residents a chance to assist active duty members and their families and provide insight into...
Transference has been proposed as a critical concept in psychotherapy. The transference may be po... more Transference has been proposed as a critical concept in psychotherapy. The transference may be positive, negative, or sexualized. When the transference becomes sexualized, there are potentially damaging outcomes depending on the management of the transference. This paper addresses the significance of early experiences in residency training with sexualized transference and focuses on the therapeutic relationship in which the transference has become eroticized. The author will explore the potential benefits and challenges of properly managing such transference.
Introduction: Background: The Centers for Disease Control (CDC) notes a 154 percent increase in t... more Introduction: Background: The Centers for Disease Control (CDC) notes a 154 percent increase in telemedicine use amongst healthcare providers between March 2019 and March 2020. While not formally incorporated into the Liaison Committee on Medical Education (LCME) accreditation standards, the Association of American Medical Colleges (AAMC) has made the provision of telemedicine services as an entrustable professional activity (EPA). Given the growth of telemedicine use, medical student comfort with the formalized EPAs was explored in this study.Methods: An IRB-approved 17-question, anonymous survey was created based on the AAMC’s EPAs and administered to students at Northeast Ohio Medical University (NEOMED) over four weeks. The primary outcome of this study is to assess medical students’ self-reported telemedicine comfort levels.Results: The response rate was 141 students (22%). 57% of students describe that they were able to create equally as effective a therapeutic alliance using ...
Summary: Careful observers have long recognized the signs, symptoms, and behaviors of bipolar dis... more Summary: Careful observers have long recognized the signs, symptoms, and behaviors of bipolar disorder. Depressive episodes in bipolar disorder are diagnostically identical with major depressive disorder and consist of at least 2 weeks of depressed mood accompanied by a combination of anhedonia, altered sleep, altered appetite, decreased energy, impaired concentration, psychomotor retardation or agitation, feelings of worthless or guilt, impaired cognitive functioning, or thoughts of death. Psychoeducation should be included in all medical treatment as patients have a right to know their diagnosis, the risks of the treatment, alternative treatments, and why the treatment is likely to be helpful. Starting effective medications is of the utmost importance in controlling the devastating symptoms of mania. Bipolar disorder is highly recurrent by nature, so patients must recognize the need to continue on their treatment indefinitely in order to prevent relapses
<jats:p>Psychotherapy continues to be an integral part of psychiatric practice. The rich, i... more <jats:p>Psychotherapy continues to be an integral part of psychiatric practice. The rich, interesting history of psychotherapy in medicine and psychiatry set the background to current practice. Psychoeducation provides patients with necessary information and forms the basic building block for all other psychotherapies. Supportive therapy, cognitive-behavioral therapy, and psychoanalytic/psychodynamic psychotherapies constitute the core of the therapeutic styles, but dialectical behavioral therapy, eye movement desensitization and reprocessing, interpersonal psychotherapy, motivational interviewing, hypnosis, and group psychotherapy are also practiced in current psychiatry. Key therapeutic tenets from each of these disciplines are incorporated into the medical practice of psychiatry. This review contains 5 figures, 4 tables, and 63 references. Key words: cognitive-behavioral therapy, current psychiatric practices, dialectical behavioral therapy, psychiatrist as therapist, psychoanalytic psychotherapy, psychodynamic psychotherapy, psychoeducation, psychotherapy, supportive psychotherapy </jats:p>
This article was migrated. The article was marked as recommended. Objective: The Best Practice Co... more This article was migrated. The article was marked as recommended. Objective: The Best Practice Conference (BPC) was designed to use active techniques to enhance measurable learning from a continuing medical education program. Design: The BPC incorporated flipped-classroom techniques, guided discussion, and peer based components to enhance learning. The impact of the BPC was measured by comparing pre-conference, post-conference, and 3-month follow-up data. Setting: The BPC started with emails to likely attendees. The conference occurred during a regularly scheduled Grand Rounds time slot. There were subsequent follow up e-mails to those who had attended. Methods: The Best Practice Conference involved e-mail contact with residents and faculty members who were likely to attend the conference. These e-mails included clinical scenarios, questions about treatment options, and journal articles. The BPC lasted for 1.5 hours and included a variety of active learning techniques. These confere...
Morbidity and Mortality Conferences (MMCs) have been used in medical training for over 100 years ... more Morbidity and Mortality Conferences (MMCs) have been used in medical training for over 100 years [1]. In-depth discussions of practice and outcomes create an opportunity to acknowledge errors and suggest improvements [2, 3]. With graduate medical education’s growing focus on patient safety, MMCs represent a means of creating a culture of safety by identifying systembased problems. Proponents of system-basedMMCs recognize that idiosyncratic methods for identifying, discussing, and following cases have hampered their impact [4, 5]. Although structured MMCs lead to increased numbers of quality improvement projects and awareness of systems issues, documenting a consistent positive effect on patient care and outcomes remains elusive [6–8]. Specific medical errors typically occur at a low frequency, and statistically significant decreases in rare events may be difficult to demonstrate [9]. Some MMCs do not impact the rates of medical errors because they do not focus onmedical errors [5, 7]. These cases are chosen for other reasons, e.g., an interesting or rare case. While these may be educational, they exacerbate the challenge of propagating clinically relevant lessons from MMCs [10]. Despite these limitations, participants tend to believe that MMCs are beneficial even when they do not totally agree with suggested changes [9]. Increasing the structure of MMCs further increases provider satisfaction [7, 9, 11]. Unfortunately, resident physicians may perceive fewer benefits from MMCs than other participants [9]. Data regarding the impact of MMCs in psychiatry and psychiatry training is extremely limited. In a review of nearly monthly psychiatry MMCs over a 2-year period, 80% of cases uncovered opportunities for possible improvement in patient care, and attendees praised the usefulness of the presentations and discussions [12]. A survey following three resident-driven psychiatric MMCs found that 87.3% of attendees strongly agreed that the presentation increased their knowledge, and 88.6% agreed or strongly agreed that it provided more practical educational insight than a traditional lecture [13].We created aMMC as a pilot project to measure its impact in a psychiatry residency program. The format of theMMC, the lessons to be learned from theMMC, and the details of the case arose from discussions with the resident authors. The MMC focused on obtaining fasting blood sugars (FBS) when starting second-generation antipsychotic medications (SGAs). Participants were initially asked seven questions about laboratory monitoring and health promotion related to starting a SGA. The key question for this study was, “Over the last month when you have started a secondgeneration antipsychotic medication how frequently did you obtain a baseline and follow up: Fasting Blood Sugar”. The possible answers ranged from Never = 1 to Always = 5. The MMC discussion followed a hypothetical patient who had been prescribed an SGA while on an inpatient unit and subsequently presented to the Emergency Department in diabetic ketoacidosis. The authors played the roles of residents who had provided care for the patient and their attending physician. Theywalked the participants through the case describing clinical and laboratory findings. Audience members discussed the diagnoses and management of the patient through the different stages of presentation, assessment, and treatment. After presenting the complete case history and revealing the final diagnoses and outcomes, summaries of several pertinent articles were presented. The presenters reviewed “Lessons Learned” regarding the risk of elevated blood sugar and diabetic ketoacidosis in patients prescribed SGAs. The importance of baseline and follow-up FBS was emphasized repeatedly. Upon the conclusion of the MMC, attendees were asked how often they planned on obtaining FBS when starting second-generation antipsychotic medications. Attendees were asked how much they learned from the MMC and if they would participate in the next phase of the study. The responses of the participants were given a meaningless alpha-numeric * Randon S. Welton rwelton@neomed.edu
Although benzodiazepines (BZDs) are commonly used in the treatment of posttraumatic stress disord... more Although benzodiazepines (BZDs) are commonly used in the treatment of posttraumatic stress disorder (PTSD), no systematic review or meta-analysis has specifically examined this treatment. The goal of this study was to analyze and summarize evidence concerning the efficacy of BZDs in treating PTSD. The review protocol was undertaken according to the principles recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and is registered with the PROSPERO international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO, registration number CRD42014009318). Two authors independently conducted a search of all relevant articles using multiple electronic databases and independently abstracted information from studies measuring PTSD outcomes in patients using BZDs. Eighteen clinical trials and observational studies were identified, with a total of 5236 participants. Outcomes were assessed using qualitative and quantit...
For over 100 years psychoanalytically-oriented psychotherapists have recognized and worked with t... more For over 100 years psychoanalytically-oriented psychotherapists have recognized and worked with transference and countertransference. At first seen as obstacles to treatment, they are now understood to be valuable tools. Transference is an inappropriate or exaggerated response to the therapist, often outside of the patient’s awareness. Common types of transference include idealized, negative, and sexualized transferences. Countertransference consists of the therapist’s emotional response to the patients and can often mirror the patient’s experience (concordant countertransference) or produce the opposite feeling in the therapist (complementary countertransference). When properly understood and managed, transference and countertransference provide invaluable insight into the patient’s inner world.
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, Jan 14, 2015
Air Force psychiatry faces the task of training competent military psychiatrists in an era of con... more Air Force psychiatry faces the task of training competent military psychiatrists in an era of continuing reductions. Beginning in the 1980s, the Air Force started collaborating with University partners to create hybrid training programs, civilian-military psychiatry residencies. These mergers provide stability for Air Force psychiatry training in the face of increased operational missions and uncertain military recruiting. As a result of these combined programs, Air Force psychiatry residents gain access to a broader range of civilian clinical experience and expertise while maintaining a focus on distinctive military requirements. The combining of programs opens up options for academic activities which may not have otherwise existed. Both military and civilian residents benefit from the occupational psychiatry experiences available within military clinical sites. These programs give civilian residents a chance to assist active duty members and their families and provide insight into...
Transference has been proposed as a critical concept in psychotherapy. The transference may be po... more Transference has been proposed as a critical concept in psychotherapy. The transference may be positive, negative, or sexualized. When the transference becomes sexualized, there are potentially damaging outcomes depending on the management of the transference. This paper addresses the significance of early experiences in residency training with sexualized transference and focuses on the therapeutic relationship in which the transference has become eroticized. The author will explore the potential benefits and challenges of properly managing such transference.
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