2015 AAP Annual Meeting Poster Session Results
We once again had an outstanding poster session at the Annual Meeting. There was outstanding attendance with stimulating discussion at the 41 posters presented by trainees and faculty. These 41 posters were selected from 49 abstracts submitted this year. 26 posters were submitted electronically and judged by the AAP Poster Selection Subcommittee. The winners of the poster competition were recognized at the session: 1st Place Poster 22 The Professionalism E-Frontier: How Are We Teaching Psychiatry Residents to Navigate Pitfalls and Privileges of Online Presence? Author: Juntira Laothavorn, MD* - University of Illinois College of Medicine at Peoria, Peoria, IL Co-Author: Marika Wrzosek, MD - University of Ilinois College of Medicine at Peoria, Peoria, IL Co-Author: Ryan Finkenbine, MD - University of Illinois College of Medicine at Peoria, Peoria, IL Co-Author: Mirjana Domakonda, MD* - University of Massachusetts, Worcester, MA Co-Author: Isheeta Zalpuri, MD* - Stanford University, Palo Alto, CA Abstract: Despite various guidelines (AADPRT, AMA, FSMB), little data exist on how psychiatry residency programs incorporate education on social media and Internet professionalism into curricula. The ACGME identifies specific milestones related to online professionalism in the professionalism and interpersonal communication skills subcompetencies. We conducted an online survey of 310 program directors and coordinators representing 180 adult psychiatry residency programs to understand if and how training programs have integrated e-professionalism teaching into resident education. Our results demonstrated that of the 56 programs that completed the survey, 84% do not have a formal curriculum in place. Despite not having a formal curriculum, most programs educate their residents in various ways about e-professionalism. Notable modalities include presentation by a malpractice attorney, professional seminars, and integration into journal club. Out of eight programs with formal curricula on e-professionalism, six programs use AADPRT guidelines. Additionally, several programs noted occurrences of online professionalism breaches that resulted in disciplinary action for the residents. Results supported our hypotheses that most programs do not have a formal e-professionalism curriculum and that AADPRT is one of the most commonly used curriculum. These data emphasize the growing need to arm trainees with tools to navigate an increasingly complex technological terrain in a professional where privacy and boundaries are paramount. 2nd Place Poster 25 Alcoholics Anonymous and Other Mutual Help Organizations: Impact of a 45-Minute Didactic for Internal Medicine Residents Author: David E. Marcovitz, MD* - MGH/McLean Adult Psychiatry Residency/Harvard Medical School, Boston, MA Co-Author: Julie Cristello, BA - Massachusetts General Hospital, Boston, MA Co-Author: John F. Kelly, PhD - Massachusetts General Hospital/Harvard Medical School, Boston, MA Abstract: Background: Substance-use disorders (SUD) are highly prevalent among primary care patients yet internal medicine trainees are often unprepared to address these disorders effectively. One evidence-based, cost-effective referral option are ubiquitous mutual-help organizations (MHOs) like AA, NA and SMART Recovery, however, little is known about how to effectively increase trainee knowledge and skill with these referrals. Purpose: To evaluate the efficacy of a combined lecture and role play-based didactic about MHOs for internal medicine residents. Methods: The authors developed a 45-minute lecture and role play addressing the evidence for MHOs, their respective background/content, and how to make effective referrals. Participants were administered a brief survey of their MHO-related knowledge and beliefs before and after the session to evaluate the didactic impact. Results: Participants were 55 internal medicine residents divided between PGY1 (27.3%), PGY2 (38.2%) and PGY3 (34.5%). They had a mean age of 29 (SD = 2.62); 49% were female, 69% were Caucasian, 78% reported some religious affiliation. Participants' subjective knowledge about MHOs increased significantly (p<.001) as did their confidence in making referrals (p<.001). Participants’ ratings of the importance of MHOs in aiding successful addiction recovery approached significance (p=.058). The proportion of participants with correct responses to each of four knowledge-based questions increased substantially. DISCUSSION: Role play may be a useful supplementary tool in enhancing resident knowledge and skill in treating patients with SUD. CONCLUSION: Internal medicine residents reported variable baseline knowledge of MHOs and confidence in making referrals, both of which were improved in response to a 45-minute didactic. 3rd Place Poster 2 Coping Strategies and Impact of Patient Suicide on Psychiatrists and Trainees in the United States Author: Rajdip Barman, MD* - Virginia Tech Carilion School of Medicine, Roanoke, VA Co-Author: Anita S. Kablinger, MD - Carilion Clinic-VTCSOM, Roanoke, VA Abstract: Background: Studies all over the globe show patient suicides among psychiatrists, including the trainees, range between 33%- 80%. [1-3] Purpose: To our knowledge, there is no as such data in the USA following a single study [4] in 1988, regarding psychiatrists’ or resident trainees’ emotional response to patient suicide. Objective of our study was to assess the emotional impact of patient suicide and also to identify their coping strategies and support system. Methodology: Data was collected by sending an online version of the survey to 1413 private psychiatrists and 731 program directors to share with their residents and fellows in training. Participants’ stress was assessed by the acute stress disorder scale (ASDS) and the impact of event scale–revised version (IES-R). The Brief COPE inventory measured different coping strategies and self-reported questionnaires assessed support measures. Results: Our study shows 324 (63.6 %) of the participants experienced patient suicide, which included 292 psychiatrists (76.1%) and 31 trainees (27.2%). Among the respondents, 3.8% of the psychiatrists and 9.8% of the trainees had clinically significant stress and trauma related disorders. Discussion: In comparison to other studies, higher number of psychiatrists dealt with patient suicide in United States but it was lower among the trainees. Likely due to imminent availability, higher numbers of trainees benefited from their supervisors, and psychiatrists by family. Conclusion: Presence of higher levels of emotional exhaustion and depression as compared to medical or surgical colleagues [5] depicts need for training programs, formal and informal support, workshops or curricular changes to address this almost inevitable issue in a psychiatrist’s career. Four honorable mentions were also recognized at this session (in order by first author): Poster #30 Behavioral Simulation as a Teaching Tool in Psychiatry: The Use of Interactive Vignettes for Training Incoming Residents Author: Alexandra Regenbogen, MD* - Northwestern University Feinberg School of Medicine, Chicago, IL Co-Author: Joan Meyer Anzia, MD - Northwestern University, Chicago, IL Co-Author: Sara Ashurst, MD* - Northwestern University Feinberg School of Medicine, Chicago, IL Co-Author: Katherine Backes, MD* - Northwestern University Feinberg School of Medicine, Chicago, IL Co-Author: Monica Blumenkrants, MD* - Northwestern University Feinberg School of Medicine, Chicago, IL Co-Author: Molly Lubin, MD* - Northwestern University Feinberg School of Medicine, Chicago, IL Abstract: Background: Behavioral simulation is gaining favor as a teaching tool in many fields of medicine. However, psychiatry has historically relied on a more traditional approach to teaching clinical skills. We sought to use interactive, case-based vignettes in order to teach incoming PGY1 residents how to manage common emergency psychiatry scenarios on call. Methods: We provided a one-hour workshop for residents during their first week of psychiatry training. The workshop included six interactive vignettes that depicted a range of common psychiatric scenarios via role playing. PGY1s acted as on-call physicians; senior residents acted as patients. PGY1 residents completed pre- and post-workshop multiple choice tests. Results were compiled from 2012, 2014 and 2015 data sets. Results: Post-test scores showed significant improvement, demonstrating that residents had more robust clinical knowledge and greater confidence in handling common psychiatric emergencies. Feedback from trainees highlighted the impact of an active learning role on retaining high yield information for future on-call experiences. Conclusion: Despite the small sample size of the study, behavioral simulation appears to be an effective, inexpensive and engaging tool for teaching PGY1 residents how to handle difficult encounters they will face during their training. Poster #23 Effective Mentorship During Residency Training: Needs Assessment and Perspectives of Residents Author: Hermioni Lokko, MD, MPP - Massachusetts General Hospital, Boston, MA Abstract: Background: Mentorship is essential for professional development in medicine, and many academic medical centers offer faculty development programs to train faculty to engage in effective mentorship relationships (both as a mentor and mentee). However, there are no published data on the content or outcomes of mentorship training programs for residents. Purpose: To assess residents’ experience of mentorship during training and to develop, implement, and evaluate the effectiveness of a program to educate residents about how to get the most out of relationships with mentors. Methods: A novel survey (with quantitative and qualitative questions) was created to assess residents’ experiences with mentorship during training. The survey instrument will be administered to senior residents in a range of medical specialties. A seven-session, one-hour bi-weekly mentorship training seminar for residents will be piloted with approximately 20 residents across specialties. A pre- and three months post-program survey will be administered to assess the impact of the program on mentoring relationships between residents and their respective mentors. Results: We will present data on senior residents’ self-reported experiences with mentorship in residency. We will describe the format and content of the mentorship training seminar. We will present pre- and post-seminar survey data to assess the potential impact of such a seminar on future mentoring relationships. Discussion: Residents have a lot to gain from having effective mentoring relationships during their residency. This study will shed light on the potential utility of providing training to residents on how to pursue effective mentorship relationships.
Poster #37 The Comprehensive Write-Up: An Area to Address Grading Discrepancies across Training Sites in the Psychiatry Clerkship Author: Lia Thomas, MD - University of Texas Southwestern Medical Center, Dallas, TX Co-Author: Kathlene Trello-Rishel, MD - University of Texas - Southwestern Medical Center, Dallas, TX Abstract: Introduction: Using a variety of parameters to evaluation medical students in the clerkship results in a more accurate representation of student’s learning . However, grades generated by attending physicians are often not standardized and do not have interrater reliability. We chose to look at the grading of the comprehensive patient write-up as an area where these concerns could be addressed. Instructional Methods and Materials Used: A sampling of previously graded write-ups from the past academic year (2012-2013) was reviewed by the Clerkship Director (KTR) and Associate Clerkship Director (LAT), and an initial draft of a new evaluation schema was produced. This new tool was then independently utilized by members of the Medical Education Committee to grade the same patient write-up to confirm its interrater reliability. It was introduced to faculty and students as the new grading standard of the current (2013-2014) academic year. Outcome: To evaluate standardization of grading, all write-ups from rotation 5 of the past academic year (prior to development of the new grading tool) and from the first two rotations of current academic year (after implementation) were blindly graded by the Associate Clerkship Director (LAT) with the new grading tool. These results were compared to grades given by site clerkship attendings. Conclusion: Clerkship-wide site visits were conducted and the results the above evaluations discussed. Site attendings were also given a survey on their impressions of the new forms (ease of use, impact on grading) in hopes of further encouraging faculty to utilize the new grading tool.
Poster #34 Evaluating Psychotherapy Competence: How Does the Use, Impact and Quality of CBT and Psychodynamic Psychotherapy as Delivered by Junior Psychiatry Residents Change over the Course of Training and Treatment? Author: Paula Ravitz, MD FRCPC - University of Toronto, Toronto, ON Co-Author: Mark Fefergrad, MD, FRCPC3 1 - Sunnybrook Health Sciences Centre, Toronto, ON Co-Author: Dennis Kivlighan Jr., PhD* - University of Maryland, College Park, MD Co-Author: William Lancee, PhD - Mount Sinai Hospital, Toronto, ON Co-Author: Andrea Lawson, PhD* - Mount Sinai Hospital, Toronto, ON Co-Author: Molyn Leszcz, MD FRCPC* - Mount Sinai Hospital, Toronto, ON Co-Author: Robert Maunder, MD FRCPC - Mount Sinai Hospital, Toronto, ON Co-Author: Sian Rawkins - University of Toronto, Toronto, ON Abstract: Background: Students are expected to achieve milestones in the domain of interpersonal and communication skills to work effectively and compassionately with increasingly diverse patients. Purpose: To provide formative feedback to third-year medical students during their psychiatry clerkship using a simulated clinical encounter with an older adult female with irritability, depression, and sexual orientation issues. Methods: Groups of five to six students each facilitated by faculty. Students are provided with the history of present illness and the past psychiatric and medical histories. Students work in tandem to elicit the patient’s agenda, obtain the developmental and social histories, educate the patient, reach common ground, and develop a patient-centered treatment plan. Communication approaches are suggested during “time outs” by faculty and students. Faculty guides self-reflection and faculty-, student- and SP-based formative feedback. Faculty and students fill out quantitative (3 and 6 Likert-type items, respectively) and qualitative self-reports to evaluate the SP performance (faculty) and the learning encounter (students). Results: Evaluations from 47 encounters involving 204 students have been collected since March, 2012. The majority of students (97.5%) strongly agreed (69.6%) or agreed (27.9%) with the statement “Overall, I feel this learning experience was valuable for me.” Discussion: Qualitative evaluations confirm and expand the results, e.g., naming skills students feel will be useful in their clinical work with patients in general. Conclusions: The active ingredients of this formative assessment session targeting interpersonal and communication skills milestones for medical students appear to be an SP case with a sophisticated biopsychosocial formulation and the unique qualifications of psychiatrists.
Thomas Fluent, MD Association for Academic Psychiatry Poster Selection Subcommittee Chair
AAP Bulletin – December 2015 Page 3 of 7
