Capacitación no escolarizada en psicoterapia: problemas y perspectivas / Non-school training in psychotherapy: problems and perspectives

Introducción: la capacitación no escolarizada en psicoterapia se define como la enseñanza de esta intervención por fuera de los entornos clínicos universitarios y de la normativa de educación universitaria. Aunque esta forma de estudios es bastante aceptada por psiquiatras y otros profesionales de la salud mental, esta podría no garantizar una adecuada capacitación y certificación. La presente revisión describe las características de la capacitación no escolarizada en psicoterapia en el Perú y aborda los potenciales problemas con la capacitación y certificación. Método: se realiza un análisis de la capacitación no escolarizada de psicoterapia y se la compara con el modelo formativo en psicoterapia de la residencia de Psiquiatría. Resultados: la capacitación no escolarizada en psicoterapia es una modalidad válida de estudios. Sin embargo, su alcance académico y profesional debe ser mejor valorado ya que estos programas podrían no contar con los recursos para reemplazar la capacitación universitaria, y no cuentan con el valor legal para facultar el ejercicio profesional de la psicoterapia de acuerdo a las normativas actuales de la educación universitaria y de licenciamiento profesional. Conclusión: es necesario fortalecer la capacitación de psicoterapia en la residencia de Psiquiatría y la apertura de programas universitarios de postgrado (programas de especialización, maestría o doctorado) para que la capacitación y certificación de psicoterapia sigan los canales formativos y de licenciamiento profesional oficiales.

Introduction: non-school training in psychotherapy is defined as the teaching of this intervention outside of university clinical settings and university education regulations. Although this form of study is widely accepted by psychiatrists and other mental health professionals, it may not guarantee adequate training and certification. This review describes the characteristics of non-school training in psychotherapy in Peru and addresses possible problems with training and certification. Method: an analysis of the non-schooled psychotherapy training is carried out and compared with the training model in psychotherapy of the psychiatric residency. Results: non-school training in psychotherapy is a valid study modality. However, their academic and professional scope should be better valued since these programs may not have the resources to replace university training, and they do not have the legal value to license the professional practice of psychotherapy according to current regulations of college education and professional licensing. Conclusion: it is necessary to strengthen psychotherapy training in psychiatry residency and the opening of postgraduate university programs (specialization, master or doctorate programs) so that psychotherapy training and certification follow the official training and professional licensing channels.

Estigma y enfermedad mental: intervención en estudiantes de Medicina / Mental illness and stigma: an intervention in medical students / Estigma e doença mental: intervenção em estudantes de medicina

Resumen: El estigma generado por el personal de salud constituye una barrera que limita la accesibilidad a la asistencia de las personas que padecen enfermedades mentales. Por este motivo, la Clínica Psiquiátrica de la Universidad de la República generó estrategias didácticas aplicables durante el pasaje de los estudiantes de Medicina por la especialidad, para concientizar acerca de la estigmatización hacia las personas con enfermedad mental. Para ello, se diseñó un trabajo cuyos objetivos fueron valorar el impacto de la pasantía mediante la utilización de cuestionarios confeccionados por las autoras, autoaplicados al inicio y al final de ésta, así como revisar y adecuar las estrategias propuestas. Se encuestaron 1.356 estudiantes al inicio y 933 (68,8%) al final de la pasantía entre los años 2013 y 2016. Se evidenció una disminución en las actitudes estigmatizantes, una mayor comprensión de la enfermedad mental y un aporte en la formación integral de los médicos generales luego de la rotación. El procesamiento estadístico de los datos se realizó con el programa Graph Pad Prism versión 4.0. Se utilizó la estadística descriptiva para el análisis de los datos y el test no paramétrico de Mann-Whytney para la comparación de medias. Fueron considerados significativos valores de p menores de 0,05. Se concluyó que el contacto de los estudiantes con las personas con enfermedad mental, junto con una intervención específica en esta temática, constituyen una estrategia útil para la reducción del estigma.

Summary: Health professionals' stigma towards mental illness creates serious barriers to access healthcare services by patients who suffer from them. Therefore, the Psychiatric Clinique of the University of the Republic devised didactic strategies to apply during the time medical students complete this specialization, to raise awareness about stigma towards people with mental illness. To that end, a study was designed with the objective of assessing the impact of this internship by means of questionnaires that had been prepared and applied by the students themselves at the beginning and at the end of the internship. It also aimed to revise and adapt the proposed strategies. 1.356 students were interviewed the beginning and 933 (68.8%) at the end of the internship, between 2013 and 2016. A decrease in stigmatizing attitudes was evidenced, as well as a greater understanding of mental illness and a contribution to the comprehensive training of general practitioners after covering the different specializations. Statistic processing of data was done with Graph Pad Prism version 4.0 software. Descriptive statistics was used to analyse date and the Mann-Whytney non-parametric test was used to compare medians. Values below 0.05 were considered significant. The study concluded that both the contact between medical students and patients with mental illnesses and specific interventions on this issue constitute a useful strategy to reduce stigma.

Resumo: O estigma gerado pelo pessoal de saúde constitui uma barreira que limita o acesso aos cuidados para pessoas com doença mental. Por esse motivo, a Clínica Psiquiátrica da Universidad de la República gerou estratégias didáticas aplicáveis durante a passagem dos alunos de medicina pela especialidade, para conscientizar sobre a estigmatização das pessoas com doença mental. Com esse fim foi elaborado um estudo cujos objetivos eram avaliar o impacto do estágio aplicando questionários elaborados pelas autoras, autopreenchidos no início e ao final do mesmo, bem como revisar e adaptar as estratégias propostas. Foram pesquisados 1.356 alunos no início e 933 (68,8%) ao final do estágio entre 2013 e 2016. Houve evidências de diminuição das atitudes estigmatizantes, de uma maior compreensão da doença mental e de contribuição para a formação integral dos médicos de medicina geral após o estágio na especialidade. O tratamento estatístico dos dados foi realizado com o programa Graph Pad Prism versão 4.0. A análise dos dados foi realizada por estatística descritiva e o teste não paramétrico de Mann-Whytney para comparação de médias. Valores de p menores que 0,05 foram considerados significativos. Concluiu-se que o contacto dos alunos com pessoas com doença mental, juntamente com uma intervenção específica sobre este tema, constituem uma estratégia útil para a redução do estigma.

Work Environment Evaluation Instrument (WEEI): development, validation, and association with burnout

Abstract Introduction Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results The final version had high reliability (Cronbach's alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p < 0.01). Cutoffs defining the environment as healthy (>32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts.

Indicadores asociados al desarrollo de competencias clínicas para el ejercicio de la psicoterapia en Argentina / Indicators Associated with the development of clinical competencies for the practice of psychotherapy in Argentina

En las últimas décadas, han aumentado los estudios sobre las competencias para el ejercicio de profesiones de la salud. En psicología y en particular, en la psicoterapia, se han elaborado diferentes escritos que detallan las competencias que deben adquirir los y las psicoterapeutas durante su formación. Sin embargo, no se encuentran estudios sistemáticos que detallen las actividades y experiencias asociadas a su desarrollo, denominadas en este trabajo como indicadores asociados. Con el objetivo de conocer cuáles son las actividades y experiencias asociadas al desarrollo de competencias clínicas, se realizaron 20 entrevistas semi-dirigidas que fueron sometidas a un análisis temático en el que complementariamente participaron expertos, quienes actuaron como jueces en diferentes etapas del proceso. Como resultado, se identificaron cinco indicadores asociados: i. Formación de base y actualización, ii. Desarrollo personal y trabajo sobre sí mismo, iii. Pertenencia a instituciones y red de profesionales, iv. Supervisión y v. Experiencia personal y profesional.

In recent decades, studies on the competencies for the exercise of health professions have increased. In psychology, particularly for psychotherapy, various writings have been produced detailing the competencies that psychotherapists must acquire during their training. However, no systematic studies are detailing the activities and experiences associated with their development, in this work called Associated Indicators. In order to know the activities and experiences associated with the development of clinical competencies, 20 semi-structured interviews were carried out subjected to a thematic analysis in which experts participated as judges in different stages of the process. As a result, five associated indicators were identified: Basic training and refresher training, personal development and work on oneself, membership of institutions and networks of professionals, supervision and personal and professional experience.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina

Objective: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). Methods: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. Results: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. Conclusions: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

PTSD in mental health outpatient settings: highly prevalent and under-recognized

Objectives: To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training. Methods: We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records. Results: Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals. Conclusions: These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.

Viajes y redes profesionales en los orígenes del alienismo español / Travel and professional networks in the origins of Spanish psychiatry

Resumen Este artículo examina la importancia de los viajes y las redes profesionales en los orígenes de la psiquiatría en España. Tras una revisión de los antecedentes ilustrados y los periplos terapéuticos y profesionales en el primer alienismo, se describen los desplazamientos a instituciones psiquiátricas extranjeras, durante el segundo tercio del siglo XIX, de un grupo de médicos exiliados, comisionados y pioneros españoles. Posteriormente, con su afianzamiento social, institucional y profesional, algunas figuras de la medicina mental española estrecharon sus vínculos y su proyección internacional organizando o asistiendo a congresos y otros eventos científicos. Su caso ilustra así el importante papel desempeñado por las relaciones internacionales y las redes científicas y profesionales en la difusión de los discursos y prácticas psiquiátricas.

Abstract This article examines the importance of travel and professional networks in the origins of Spanish psychiatry. After reviewing the early alienists’ Enlightenment predecessors and their therapeutic and professional trajectories, it describes the trips to foreign psychiatric institutions made during the second third of the nineteenth century by a group of exiled Spanish doctors, commissioners and pioneers. Later, as they became more socially, institutionally and professionally established, some figures of Spanish psychological medicine cultivated their connections and international profile by organizing or attending conferences and other scientific events. This case illustrates the important role of international relations and scientific and professional networks in the spread of psychiatric discourses and practices.

Aplicación de los siete principios del aprendizaje pleno en una sala de internación de psiquiatría en el entrenamiento médico / Application of perkin's seven principles of teaching in a inpatient psychiatry unit

En esta presentación describiremos la aplicación de los siete principios de aprendizaje pleno, ideados por David Perkins, al trabajo y al aprendizaje en una sala de internación de psiquiatría en un hospital general. (AU)

This presentation will describe the application of David Perkins seven principles of teaching in the psychiatric unit of a General Hospital. (AU)

Educación psiquiátrica y componentes culturales en la formacion del médico: perspectivas latinoamericanas / Psychiatric education and cultural components during medical training: latin american perspectives

La educación médica ha incorporado un componente psiquiátrico, o de salud mental, de manera más consistente en el curso de las últimas décadas, merced a factores tan variados como los avances de la investigación neurobiológica, la creciente prevalencia de trastornos mentales en el escenario de la salud global, la cada vez más estrecha relación entre salud mental y salud pública, comorbilidades con cuadros médicos e impacto de fenómenos socioculturales en expresiones clínicas, diagnóstico, tratamiento, pronóstico y prevención. Basado en la adquisición de competencias nucleares y principios éticos de aceptación universal, el proceso docente examinado en este artículo postula una enseñanza sustentada en la provisión de experiencias clínicas integradas a través del acopio de información adecuada, el desarrollo de capacidades diagnósticas y sujeción a una amplia variedad de modalidades de evaluación académica de estudiantes y residentes en entrenamiento. Los componentes culturales de la educación psiquiátrica reciben mención especial, proveyéndose ejemplos de su sistemática integración con la adquisición de competencias generales. Las herramientas didácticas incluyen actividades teóricas, prácticas y de supervisión. Se presta particular atención a cómo los postulados de la moderna educación médico psiquiátrica, incluidos sus aspectos culturales y la práctica de una atención médica integral como objetivos, pueden y deben tener vigencia en los países latinoamericanos...

Medical education has incorporated psychiatric or mental health components more consistently during the last decades thanks to various factors such as: advances in neurobiological research; the increasing prevalence of mental disorders in global health; the increasingly close relationship between mental health and public health; comorbidities with medical conditions and the impact of sociocultural phenomena in clinical manifestations, diagnosis, treatment, prognosis and prevention. Based on acquisition of core competencies and ethical principles of universal acceptance, the teaching process examined in this article proposes an education based on the provision of clinical experiences integrated throughout the collection of adequate information, the development of diagnostic capabilities, and exposure to a wide variety of forms of academic assessment of students and residents in training. The cultural components of psychiatric education receive special mention; we provide examples of their systematic integration with the acquisition of general skills. The teaching tools include theoretical and applied activities and supervision. Particular attention is paid to how the principles of modern psychiatric medical education, including cultural aspects and practice of holistic health care objectives, can and should be in effect in Latin American countries...

Aplicación de una red social a la práctica y el aprendizaje de la psiquiatría / [Applying a social network for the practice and learning of psychiatry].

Social networking is a virtual space in which people relate and build their identity, share information, publish content and intervene on the content posted by others. We will describe an experiment carried out in the psychiatry service of Italian Hospital in Buenos Aires, in which we use Whatsapp Social Network applied to the development of clinical work and teaching task. From these new ways of relating between professional, emerge a new way to work, participate in groups or try to evaluate various options for dealing with a patient. We analyze the usefulness of this virtual platform as a working tool.

Reforma psiquiátrica brasileira: conhecimentos dos profissionais de saúde do serviço de atendimento móvel de urgência / Brazilian psychiatric reform: knowledges of health professional of mobile service of urgency

Objetivou-se identificar os conhecimentos dos profissionais de saúde do Serviço de Atendimento Móvel de Urgência de Natal sobre a Reforma Psiquiátrica brasileira. As informações foram coletadas por meio de entrevistas semiestruturadas realizadas com 24 profissionais de saúde lotados na instituição. As entrevistas foram transcritas e submetidas à técnica da análise temática, que revelou três categorias de análise: internação do sujeito em crise como demanda social e familiar; Reforma Psiquiátrica: legislação e realidade no SAMU-Natal; e Reforma Psiquiátrica brasileira como promotora de desospitalização. Os profissionais demonstraram compreensões deturpadas e reducionistas da Reforma Psiquiátrica brasileira e, em sua maioria, não deram credibilidade ao atual modelo de atenção à saúde mental pautado no tratamento psicossocial, remetendo suas falas à necessidade de internamento dos pacientes psiquiátricos. Nesse sentido, percebemos que o modelo hospitalocêntrico e excludente concebido pela psiquiatria clássica ainda permanece vivo no ideário desses profissionais como referência para a assistência às urgências psiquiátricas.

Recursos de aprendizaje en la asignatura de Psiquiatría para la formación del Médico Integral Comunitario / Learning resources in the subject Psychiatry for the formation of the comprehensive community physician

Se realizó una investigación descriptiva basada en la revisión bibliográfica de documentos curriculares, normativos y metodológicos de la carrera de Medicina en Cuba y en la República Bolivariana de Venezuela, mediante análisis y discusión con especialistas de Psiquiatría, profesores del Programa Nacional de Formación del Médico Integral Comunitario (PNFMIC) y grupo asesor de diseño de la Coordinación Nacional de la Misión Médica Cubana Barrio Adentro, con el objetivo de diseñar los recursos del aprendizaje a utilizar en dicha asignatura. En la elaboración de los recursos del aprendizaje se tuvo en cuenta que respondieran a los objetivos del programa de estudio de la asignatura de Psiquiatría y al perfil de salida del médico integral comunitario, con las nuevas técnicas de la información y la comunicación en integración sistémica desde la Atención Primaria de Salud

A descriptive study was conducted, on the basis of a literature review of curricular, normative and methodological documents of the medical studies in Cuba and in the Bolivarian Republic of Venezuela. It comprised analysis and discussions with psychiatry experts, professors of the national program of formation of the comprehensive community physician (PNFMIC in Spanish) and the advisory group of the National Coordination System of the Cuban medical mission called Barrio Adentro, with the objective of designing the learning resources to be used in the subject. In preparing the learning resources, it was taken into account that they had to respond to the objectives of the curriculum of the subject Psychiatry and to the output profile of the comprehensive community physician, according to the new information and communication techniques in systemic integration from the primary health care

El cine como dispositivo de ensenanza de lo complejo en Salud Mental / [The cinema as a device for teaching complexity in mental health].

This article proposes the use of Cinema as an instrument for a complex approach to Teaching in the field of Clinical Psychiatry and Psychopathology in Mental Health. With this aim, intends a different look that pretends the approach not only to the conceptual structures on Psychopathology, but also to the complexity involved, choosing Cinema as a powerful way of "empathic recreation". Based on previous work by several authors, the theoretical framework that supports this modality is presented in the philosophical, cognitive, pedagogical-didactic aspects and their consequences into teaching within Mental Health. This task also implies addressing the historical evolution of the representation of subjectivity in fiction. In this way, a new perspective to those working in the field of mental health, as subjects involved in continuous learning processes, is presented. This perspective emphasizes the interactions underlying psychic problematical.

La formación actual de especialistas en psiquiatría: un desafío epistemológico / [Present training for specialists in psychiatry: an epistemological challenge].

Teaching theoretical-technical knowledge aimed at training specialists in psychiatry at postgraduate level requires the explicitness of the theoretical model to which the curricula presented to students should be ordered. First, said model should be coherent with the general curricula for the medical training from which candidates to obtain the specialist degree graduate; second, it should serve to transmit theoretical elements, attitudes and skills that allow their work of excellence, which means acquiring the qualities considered relevant and necessary by the consensus among the members of a specialty, discipline or science (in our case, medical specialty in psychiatry) in the present historical moment. Reference points to meet them in the light of the present data concerning medical and psychiatric paradigms are developed. This article refers to those particular aspects with special emphasis on certain epistemological issues, from whose effects the same specialists do not escape, and which also condition their teaching practice, trying to show that an integrative pedagogical model is the one that best fits the contemporary historical conditions.