Academic Psychiatry最新文献

Objective: Novel mission-aligned assessments can be an option to incorporate into the supplementary application to enhance the holistic review process within graduate medical education (GME). This article describes an exploratory proof-of-concept study to design, implement, and incorporate a pilot anti-racism and structural competency assessment into the supplementary application for a child and adolescent psychiatry (CAP) fellowship program. The program team also sought to understand whether responses to the pilot assessment would yield useful information for integration into a holistic review admissions framework.

Methods: We designed a pilot assessment by identifying Likert scale items from validated tools designed to assess racial attitudes and structural competency that were deemed mission-aligned and relevant to health, medicine, and education policy as well as an open-constructed response item. The pilot assessment was distributed to all interviewees to a CAP fellowship during the 2020-2021 applicant cycle (n = 29). We conducted a thematic analysis and descriptive quantitative analysis of the responses to the pilot assessment to understand patterns and trends.

Results: On the Likert scale items, there was general agreement on items related to social determinants of health. There was more spread in responses to questions related to biological race and policies to combat structural racism. Thematic analysis of the open-constructed response items revealed six core themes: disparities in healthcare access, social determinants of health, racial bias in society, inequities in medicine, with some responses coded as cautionary indicators, which expressed potentially negative racial attitudes or limited engagement with question content.

Conclusions: A novel mission-aligned assessment provided applicants with an additional opportunity to demonstrate anti-racism competencies, identified as mission-aligned for a CAP fellowship program. Responses to the pilot assessment appeared to yield meaningful differences, which may be valuable for incorporating into a holistic review framework. Such program-specific assessment within the supplementary application is a promising strategy to enhance holistic review by deepening programs' ability to select mission-aligned applicants.

Objective: Inpatient psychiatric units provide needed care for individuals experiencing acute mental health issues, but many individuals report negative experiences from hospitalization, and most have histories of trauma, increasing the risk of retraumatization in these settings. The promotion of trauma-informed care over the last two decades represents a step in the right direction, but specific training of medical students and residents on how to apply this to clinical practice in inpatient psychiatric settings is lacking. The authors conducted a narrative review to fill this gap in the literature.

Methods: A search of the databases PubMed, Ovid MEDLINE, PsycINFO, CINAHL, and Embase was conducted in December 2024 using relevant search terms. After reviewing titles, abstracts, full-length articles, and reference lists, 49 articles were identified and reviewed.

Results: The included articles represented a wide range of countries, study approaches, and participant demographics. Based on the review of the data, the authors identified 25 concrete, practical strategies that medical students and residents can be educated on to apply trauma-informed care to their clinical practice in inpatient mental health settings.

Conclusions: From increasing sensitive inquiry of all patients about trauma, to engaging patients in collaborative discussion about treatments, to educating staff about the widespread impacts of trauma (including microaggressions) and how observed patient behaviors may be related to this, to seeking and advocating for training in the care of specific populations, the authors' findings can inform the education of medical students and residents on the use of trauma-informed care in inpatient mental health settings.