Anxiety disorders, as the most common psychiatric condition (Kessler et al., Arch Gen Psychiatry 62:593–602, 2005), pose a significant public health problem. Through our current disease model approach, while we have been studying... more
Anxiety disorders, as the most common psychiatric condition (Kessler et al., Arch Gen Psychiatry 62:593–602, 2005), pose a significant public health problem. Through our current disease model approach, while we have been studying weaknesses and problems causing anxiety disorders, we do not fully understand the biopsychosocial strengths that shield people from or help them overcome anxiety disorders. While clinicians are trained to elicit the predisposing, precipitating, and perpetuating factors at length, we still need to explore protective factors in more depth.
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Negative thought patterns or thought processes have been shown to be the core cognitive theories of depression. Seligman and his colleague’s positive psychology exercises (PPEs) have been instrumental in treating patients with mental... more
Negative thought patterns or thought processes have been shown to be the core cognitive theories of depression. Seligman and his colleague’s positive psychology exercises (PPEs) have been instrumental in treating patients with mental illness. Decades ago our focus was diagnosing and treating youth mental illness. We have also identified risk factors and some prevention models that are fundamental for promoting positivity and resiliency in our youth today. There is a paucity of research on positive psychiatry and psychology in children and adolescents. There is an increasing need for studies on youth positivity, wellness, and resilience. This chapter will expound on how youth mental health experts and trainees can be more familiar with and use positivity in their patient’s treatment formulation to enhance resiliency in youth.
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In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee’s goals was to understand the AADPRT membership’s composition and... more
In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee’s goals was to understand the AADPRT membership’s composition and their perceptions of D&I. This study’s objective was to identify the demographic characteristics of the AADPRT membership. Program directors were invited by email to participate in an anonymous survey. The survey collected participants’ demographic information including gender, race/ethnicity, training background, age, disability/differently abled status, job role, geographic region where their program is located, type of program, and their program’s community setting. Two hundred fifty six of 657 AADPRT members (39%) completed the survey. Respondents were mostly White (64.5%) followed by Asian/Southeast Asian (17.6%), Hispanic/Latinx (4.3%), and Black (1.6%). Only 13.3% of the participants were international medical graduates. Women were more prevalent (61.7%) than men (37.5%), and 9.4% self-identified as members of the LGBTQ+ Community. This study represents the first systematic investigation into the diversity among psychiatry program directors throughout the USA and Canada. Future qualitative studies are needed to better understand the reasons behind this initial study’s findings. Potential concerns requiring exploration include the possibility of the program director role serving as a “glass ceiling” for some women and a “leaky pipeline” in academia for groups underrepresented in medicine.
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Since the turn of the millennium, suicide among Southeast Asian diverse youth has increased. It has become one of the leading causes of mortality in young people globally. Therefore, it has become a public health concern in developing... more
Since the turn of the millennium, suicide among Southeast Asian diverse youth has increased. It has become one of the leading causes of mortality in young people globally. Therefore, it has become a public health concern in developing countries such as those in Southeast Asia (SEA). Suicide was identified to be one of the five leading causes of death in people aged 15–29 years (Patton et al. Lancet. 2009;374(9693):881–92). There appears to be specific predisposing and risk factors, psychiatric diagnoses, and access to means of self-harm among youth who either thought of suicide, attempt suicide, or complete suicide in the majority of these countries. Fortunately, some countries have taken steps to prevention and intervention. In other countries, the stigma of mental illness is still profound. This stigma can translate into their adopted countries such as the USA, where there are profound difference in Asian-American mental healthcare utilization (Abe-Kim et al. Am J Public Health. 2007;97(1):91–98). We performed a literature search of the most recent publications with the most recent statistics and epidemiology of suicide among youth from Southeast Asian ethnicity and found that there are very limited studies or literature. But, there are studies studying mental health among Asian-Americans. The countries we will focus on in this chapter are Brunei, Cambodia, Malaysia, the Philippines, Thailand, and Vietnam.
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Research Interests: Psychology, Mental Health, Traditional Medicine, Cultural Competency, Cultural Diversity, and 11 moreAdolescent, Traditional Chinese Medicine, Humans, Substance Abuse, Substance Use, United States, Mental health services, Clinical Sciences, Prevalence, Substance-Related Disorders, and Paediatrics and reproductive medicine
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Since the turn of the millennium, suicide among Southeast Asian diverse youth has increased. It has become one of the leading causes of mortality in young people globally. Therefore, it has become a public health concern in developing... more
Since the turn of the millennium, suicide among Southeast Asian diverse youth has increased. It has become one of the leading causes of mortality in young people globally. Therefore, it has become a public health concern in developing countries such as those in Southeast Asia (SEA). Suicide was identified to be one of the five leading causes of death in people aged 15–29 years (Patton et al. Lancet. 2009;374(9693):881–92). There appears to be specific predisposing and risk factors, psychiatric diagnoses, and access to means of self-harm among youth who either thought of suicide, attempt suicide, or complete suicide in the majority of these countries. Fortunately, some countries have taken steps to prevention and intervention. In other countries, the stigma of mental illness is still profound. This stigma can translate into their adopted countries such as the USA, where there are profound difference in Asian-American mental healthcare utilization (Abe-Kim et al. Am J Public Health. 2007;97(1):91–98). We performed a literature search of the most recent publications with the most recent statistics and epidemiology of suicide among youth from Southeast Asian ethnicity and found that there are very limited studies or literature. But, there are studies studying mental health among Asian-Americans. The countries we will focus on in this chapter are Brunei, Cambodia, Malaysia, the Philippines, Thailand, and Vietnam.
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Negative thought patterns or thought processes have been shown to be the core cognitive theories of depression. Seligman and his colleague’s positive psychology exercises (PPEs) have been instrumental in treating patients with mental... more
Negative thought patterns or thought processes have been shown to be the core cognitive theories of depression. Seligman and his colleague’s positive psychology exercises (PPEs) have been instrumental in treating patients with mental illness. Decades ago our focus was diagnosing and treating youth mental illness. We have also identified risk factors and some prevention models that are fundamental for promoting positivity and resiliency in our youth today. There is a paucity of research on positive psychiatry and psychology in children and adolescents. There is an increasing need for studies on youth positivity, wellness, and resilience. This chapter will expound on how youth mental health experts and trainees can be more familiar with and use positivity in their patient’s treatment formulation to enhance resiliency in youth.
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Anxiety disorders, as the most common psychiatric condition (Kessler et al., Arch Gen Psychiatry 62:593–602, 2005), pose a significant public health problem. Through our current disease model approach, while we have been studying... more
Anxiety disorders, as the most common psychiatric condition (Kessler et al., Arch Gen Psychiatry 62:593–602, 2005), pose a significant public health problem. Through our current disease model approach, while we have been studying weaknesses and problems causing anxiety disorders, we do not fully understand the biopsychosocial strengths that shield people from or help them overcome anxiety disorders. While clinicians are trained to elicit the predisposing, precipitating, and perpetuating factors at length, we still need to explore protective factors in more depth.
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In May 2020, the Coalition for Physician Accountability's Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training (WG) released their final report and recommendations. These... more
In May 2020, the Coalition for Physician Accountability's Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training (WG) released their final report and recommendations. These recommendations pertain to away rotations, virtual interviews, Electronic Residency Application Service opening for programs and the overall residency timeline, and general communications and attempt to provide clarity and level the playing field during the 2020-2021 residency application cycle. The WG's aims include promoting professional accountability by improving the quality, efficiency, and continuity of the education, training, and assessment of physicians. The authors argue the first 3 WG recommendations may disproportionately impact candidates from historically excluded and underrepresented groups in medicine (HEURGMs) and may affect an institution's ability to ensure equity in the selection of residency applicants, and, thus, warrant further consideration. The authors examine these recommendations from a diversity, equity, and inclusion (DEI) perspective. For each of the first 3 WG recommendations, the authors highlight new opportunities created by the recommendations and detail challenges which programs must carefully navigate to ensure equity for all candidates. The authors also recommend solutions to guide programs as they address these challenges, meet new common program requirements, and attempt to promote equity for HEURGMs. Finally, the authors recommend that after the 2020-2021 recruitment cycle, the medical education community evaluate DEI-related outcomes of both the WG's and the authors' recommendations and incorporate the findings into future application cycles.
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In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee’s goals was to understand the AADPRT membership’s composition and... more
In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee’s goals was to understand the AADPRT membership’s composition and their perceptions of D&I. This study’s objective was to identify the demographic characteristics of the AADPRT membership. Program directors were invited by email to participate in an anonymous survey. The survey collected participants’ demographic information including gender, race/ethnicity, training background, age, disability/differently abled status, job role, geographic region where their program is located, type of program, and their program’s community setting. Two hundred fifty six of 657 AADPRT members (39%) completed the survey. Respondents were mostly White (64.5%) followed by Asian/Southeast Asian (17.6%), Hispanic/Latinx (4.3%), and Black (1.6%). Only 13.3% of the participants were international medical graduates. Women were more prevalent (61.7%) than men (37.5%), and 9.4% self-identified as members of the LGBTQ+ Community. This study represents the first systematic investigation into the diversity among psychiatry program directors throughout the USA and Canada. Future qualitative studies are needed to better understand the reasons behind this initial study’s findings. Potential concerns requiring exploration include the possibility of the program director role serving as a “glass ceiling” for some women and a “leaky pipeline” in academia for groups underrepresented in medicine.
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To the editor: Morbidity and mortality (M&M) conferences are considered powerful opportunities for learning and reflection. Traditionally, the goal is to provide a safe forum for faculty and trainees to explore the management details... more
To the editor: Morbidity and mortality (M&M) conferences are considered powerful opportunities for learning and reflection. Traditionally, the goal is to provide a safe forum for faculty and trainees to explore the management details of particular cases wherein M&M occurred [1]. Unlike the disciplines of internal medicine and surgery, psychiatry does not have a tradition of holding M&M conferences [2]. However, the Accreditation Council for Graduate Medical Educat ion (ACGME) Clinical Learning Environment Review (CLER) requires all residents to participate in patient safety and quality improvement programs as part of their core competencies [3]. In 2009, a study found only 9 reports in the literature over the past 40 years of psychiatric M&M endeavors [4]. While still scarce, recent literature indicate transformation of systems of care through resident-led M&M conferences to improve residency education in the areas of patient safety and quality improvement while meeting ACGME requirements [5]. To our knowledge, we are the second example of a resident-led initiative to implement a psychiatry M&M conference to engage both trainees and faculty. Thus, we follow the first resident-led initiative [5] and have replicated aspects of implementing an interdisciplinary case review. The conference followed an approach published by the Association of American Medical Colleges, “Conference Agenda and Logistics for Quality Improvement Morbidity and Mortality Conference” which include root cause analysis (RCA) framework [3]. It was held during formal grand rounds, entitled “Psychiatry Morbidity and Mortality Case Conference” (PMMCC). This was organized and led by 2 senior psychiatry residents and chief resident, with support from the residency training program director and the department chair. In collaboration with the university hospital risk management administration and legal team, cases that were cited or analyzed for a specific adverse event or near miss were selected and reviewed for consideration. Three cases were ultimately identified and presented: a case of completed suicide, a case of violence and assault, and a case of morbid drug overdose. The cases were then de-identified by removing any patient-identifying data and provider-identifying data, and dates were estimated by season. Due to prior department aversions to change, unrelated to case conferences, we assumed possible reluctant participation and felt the necessity to display a completed problem-cause-and-effect diagram. Thus, prior to the scheduled case conference, the cases were presented to faculty who were not involved in the case and asked to assist in identifying errors and completing a root cause analysis. Once the study was judged to be exempt by the Institutional Review Board (IRB), over a span of 6 months, notice was given to the psychiatry department of 3 separate scheduled M&M case conferences during psychiatry grand rounds. While the speaking resident presented the case, a second resident in the PMMCC team was reclusive with computer and electronic medical record (EMR) access to help clarify any questions that were not apparent during the presentation. Efforts were made to conceal the screen to protect patientidentifying information. The conference agenda followed a similar structure as suggested by a study published through the Association of American Medical Colleges (AAMC) [3]. Throughout the conference, attendees were encouraged to actively participate, i.e., ask questions, engage in academic debate, and suggest resolution initiatives. All pertinent discussion and suggestions for change were submitted formally to the risk management department as liability protected work product. At the conclusion of the PMMCC, all attendees were asked to complete an anonymous post-conference satisfaction survey. Using a Likert scale, the survey assessed participants’ * Daniel Bigman [email protected]
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A Faculty Development Task Force surveyed the American Association of Directors of Psychiatric Residency Training membership to assess faculty development for graduate medical education faculty in psychiatry departments and barriers to... more
A Faculty Development Task Force surveyed the American Association of Directors of Psychiatric Residency Training membership to assess faculty development for graduate medical education faculty in psychiatry departments and barriers to seeking graduate medical education careers. An anonymous Survey Monkey survey was emailed to 722 American Association of Directors of Psychiatric Residency Training members. The survey included questions about demographics, the current state of faculty development offerings within the respondent's psychiatry department and institution, and potential American Association of Directors of Psychiatric Residency Training faculty development programming. Two open-response questions targeted unmet faculty development needs and barriers to seeking a career in graduate medical education. Results were analyzed as frequencies and open-ended questions were coded by two independent coders. We limited our analysis to general psychiatry program director response...
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Background Research suggests pediatrics practitioners lack confidence and skills in the end-of-life (EOL) care. Objective This pilot study explored the impact of a curriculum designed to prepare future pediatricians to manage pain and... more
Background Research suggests pediatrics practitioners lack confidence and skills in the end-of-life (EOL) care. Objective This pilot study explored the impact of a curriculum designed to prepare future pediatricians to manage pain and provide comfort for children and infants with life-threatening conditions and to be more confident and competent in their EOL discussions with families. Methods Participants included 8 postgraduate year (PGY)-2 residents in the study group and 9 PGY-3 residents in a control group. The EOL curriculum included 4, 1-hour sessions consisting of didactic lectures, videos, and small-group, interactive discussions. Topics included discussing EOL with families, withdrawal of care, and pain assessment and management. Curriculum evaluation used an objective structured clinical examination (OSCE), self-assessment confidence and competency questionnaire, and a follow-up survey 18 months after the intervention. Results The OSCE showed no statistically significant d...
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We sought to derive preliminary estimates of the prevalence of bipolar disorder among a sample of emergency department (ED) patients. For 1 week in November 2003, consecutive patients aged ≥ 18 years presenting to an urban ED between 8:00... more
We sought to derive preliminary estimates of the prevalence of bipolar disorder among a sample of emergency department (ED) patients. For 1 week in November 2003, consecutive patients aged ≥ 18 years presenting to an urban ED between 8:00 a.m. and midnight were screened for bipolar disorder. We used the National Depression Screening Day protocol, which includes the Mood Disorder Questionnaire. Patients who were severely ill or who had altered mental status were excluded. Demographic factors, past mental health history, and medical history also were assessed. Of the 212 patients that were approached and eligible, 182 (86%) were enrolled. Our sample's point prevalence for positive screen for bipolar disorder was 6.6% (95% CI = 3.5% to 11.2%). Nearly 7% of ED patients screened positive for bipolar disorder, which is considerably higher than community estimates of 1.3%. Further prospective research on bipolar disorders among ED patients is needed to further define the scope of the problem and to inform the development of appropriate screening, assessment, and intervention programs.
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Objective: We sought to derive preliminary estimates of the prevalence of bipolar disorder among a sample of emergency department (ED) patients. Method: For 1 week in November 2003, consecutive patients aged ≥ 18 years presenting to an... more
Objective: We sought to derive preliminary estimates of the prevalence of bipolar disorder among a sample of emergency department (ED) patients. Method: For 1 week in November 2003, consecutive patients aged ≥ 18 years presenting to an urban ED between 8:00 a.m. and midnight were screened for bipolar disorder. We used the National Depression Screening Day protocol, which includes the Mood Disorder Questionnaire. Patients who were severely ill or who had altered mental status were excluded. Demographic factors, past mental health history, and medical history also were assessed. Results: Of the 212 patients that were ap- proached and eligible, 182 (86%) were enrolled. Our sample's point prevalence for positive screen for bipolar disorder was 6.6% (95% CI = 3.5% to 11.2%). Conclusion: Nearly 7% of ED patients screened positive for bipolar disorder, which is considerably higher than community estimates of 1.3%. Further prospective research on bipolar disorders among ED patients is ...