Geriatric Education on Telehealth (GET) Access: A medical student volunteer program to increase access to geriatric telehealth services at the onset of COVID-19.

The coronavirus disease 2019 pandemic placed an unprecedented demand on health systems to rapidly shift ambulatory in-person care to virtual care. Geriatric patients face more challenges with video visit access compared to younger patients due to discomfort with technology and less access to devices and internet. Medical students at the University of Michigan created an initiative to improve access to and comfort with video visits for geriatric patients. The program's goals were to (a) explore options for the delivery of personalized training to older adults, (b) create materials for volunteers to successfully navigate conversations with patients and caregivers, (c) provide patients one-to-one remote guidance while identifying and overcoming barriers-with practice sessions to increase comfort, (d) share with the larger health system, and (e) ensure program sustainability. Over a 10-week evaluation period, providers whose patients worked with our geriatric education on telehealth access volunteers had a video visit rate of 43% compared to 19.2% prior to participation in the program (adjusted odds ratio = 3.38, 95% confidence interval = 2.49, 4.59), ultimately providing a platform for geriatric patients to foster stronger connections with their providers, while increasing Michigan Medicine's overall proportion of video telehealth visits.

How to design and implement a Group Poem activity.

Museum-based learning activities provide interactive and innovative ways to integrate the arts and humanities into medical education. Like other museum-based activities, the Group Poem supports the development of multiple clinically relevant skills and attributes, such as observation, communication, perspective-taking, empathy, and implicit bias awareness. In this paper, we present a step-by-step guide for educators seeking to design and implement a museum-based Group Poem activity for medical learners. The overall 'task' of the activity is for learners to collectively create a poem that they perform for others, a process that participants find to be engaging and meaningful to their formation as physicians. In this paper, we provide specific directions on pre-selecting the works of art, preparing the supplies, dividing into small groups, providing iterative instructions to learners, managing the timing of the session, and debriefing the activity. Although designed to be experienced in an art museum, we note that the Group Poem activity can also be conducted in the classroom or virtually using photographic or digital reproductions of artwork.

Training dementia care professionals to help caregivers improve the management of behavioral and psychological symptoms of dementia using the DICE Approach: A pilot study.

Most persons living with dementia (PLWD) exhibit behavioral or psychological symptoms of dementia (BPSD) over the course of the illness. The DICE Approach (DICE) is a framework that enables caregivers to identify, evaluate, and manage BPSD. This pilot pre-post test study examined the effects of DICE training on dementia care professionals' self-efficacy, knowledge, and attitudes regarding care of patients with BPSD. Participants underwent either in-person DICE training or, during the pandemic, online training. Case consultations were offered as additional learning opportunities in challenging situations. Of 134 participants in the trainings, 122 (91.0%) provided survey data for one or more instruments before and after training. Participants experienced significant improvement in knowledge and attitudes with respect to BPSD and improvement in self-efficacy with respect to helping caregivers respond to BPSD. Training dementia care professionals in DICE can improve their capacity to support caregivers in the management of BPSD.

Going Virtual During a Pandemic: An Academic Psychiatry Department's Experience with Telepsychiatry.

Background: The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine. Objectives: This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole. Design and Sample: A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care. Results: A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high. Conclusions: The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery.

Correction: Factors Influencing Patients' Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey.

[This corrects the article DOI: 10.2196/25469.].

Factors Influencing Patients' Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey.

BACKGROUND: Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients' initial decisions to participate in telepsychiatry in the midst of a public health crisis. OBJECTIVE: This paper seeks to examine factors influencing patients' initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. METHODS: Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor's stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. RESULTS: A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8%) initially chose to receive psychiatric care through video visits, while 13.5% (n=33) chose telephone visits and 1.2% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95% CI 0.02-0.06). Patients aged ≥44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1%) stated they were likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. CONCLUSIONS: In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth.

Moving Evidence-Informed Assessment and Management of Behavioral and Psychological Symptoms of Dementia into the Real World: Training Family and Staff Caregivers in the DICE Approach.

OBJECTIVE: To investigate the impact of a one-day training program on caregivers' confidence and knowledge in managing aspects of dementia care. DESIGN: One-day caregiver training program featuring: 1) an interactive, multi-media format; 2) a companion manual; and 3) a "brain-storming" session at the end of the day that utilized attendees' real-world cases where the use of the DICE (Describe, Investigate, Create, and Evaluate) approach was illustrated "live." SETTING: Three different geographical sites in Michigan. PARTICIPANTS: Family (n = 40) and professional (paid; n = 140) caregivers (total n = 180) for people with dementia. MEASURES: Pre- and post self-ratings related to confidence in aspects of dementia care management before and directly after the training. RESULTS: Comparing self-ratings pre- and post-training, more than 50% of family caregivers showed improvement in confidence post-training on 11 of 12 items with significant improvement in 4 items. Among professionals, more than 50% of caregivers showed improved confidence on 3 of 12 items, with 4 items showing significant improvement. Family caregivers were significantly more likely than professionals to show improved confidence on 6 of 12 items. CONCLUSIONS: The number of people with dementia and their family caregivers is large and growing every day with the aging of the population. Living well with dementia is the goal. Current care systems are inadequate and lead to multiple poor outcomes. Innovative solutions like the DICE Approach with delivery methods including a manual and interactive training can put the key components of good dementia care at the fingertips of the people who need it most.

Millennials in Psychiatry: Exploring Career Choice Factors in Generation Y Psychiatry Interns.

OBJECTIVE: There is a national shortage of psychiatrists. To grow the workforce, educators must understand the factors that influence the choice of psychiatry as a specialty for medical students in the Generation Y cohort. METHODS: Psychiatry residents born between 1981 and 2000 were recruited from six psychiatry training programs across the USA and were interviewed in the fall of their first year. The interviews were coded and analyzed qualitatively for themes. Career Construction Theory (CCT) was applied to relate the themes within the four domains of Career Adaptability (a focus of CCT): concern, control, curiosity, and confidence. RESULTS: The majority of themes mapped onto the four domains. A fifth domain, "contribution," was created to capture additional themes. Themes associated with choosing psychiatry as a career included Practice Concerns and Economic/Lifestyle Concerns (concern), Changes in Stigma and Changes in Legitimacy (control), Exploring Humanity and Exposures to Psychiatry (curiosity), Abilities Called Upon by the Field, Recognized Qualities in the Participant, and Recognized Qualities in the Faculty/Residents (confidence), and Hoping to Make a Difference and Engaging in Research/Technology (contribution). CONCLUSIONS: With the knowledge generated from this study, educators now have a guide for the kinds of learning experiences that may attract Generation Y students to the field, and can identify those with the background, values, or personality traits most likely to find a career in psychiatry to be attractive.

Development of Geriatric Mental Health Learning Objectives for Medical Students: A Response to the Institute of Medicine 2012 Report.

America is aging as the population of older adults increases. The shortage of geriatric mental health specialists means that most geriatric mental healthcare will be provided by physicians who do not have specialty training in geriatrics. The Institute of Medicine Report of 2012 highlighted the urgent need for development of national competencies and curricula in geriatric mental health for all clinicians. Virtually all physicians can expect to treat older patients with mental health symptoms, yet currently there are no widely accepted learning objectives in geriatric mental health specific for medical students. The authors describe the development of a set of such learning objectives that all medical students should achieve by graduation. The iterative process included initial drafting by content experts from five medical schools with input and feedback from a wider group of geriatric psychiatrists, geriatricians, internists, and medical educators. The final document builds upon previously published work and includes specific knowledge, attitudes and skills in six key domains: Normal Aging, Mental Health Assessment of the Geriatric Patient, Psychopharmacology, Delirium, Depression, and Dementia. These objectives address a pressing need, providing a framework for national standards and curriculum development.

Person-Centered Primary Care Strategies for Assessment of and Intervention for Aggressive Behaviors in Dementia.

With an increase in the number of individuals affected by dementia, it is imperative for health care providers to be well versed in the most effective ways to manage neuropsychiatric symptoms, such as aggression. Aggression can be particularly hard to manage because it creates risk of harm for formal and informal caregivers, and options for medical intervention are complex and situation dependent. Although multiple guidelines for management of aggression in dementia are available in the literature, their scope is widespread and suggested treatments often vary, making decision making difficult to navigate for busy clinicians. Using a composite case as a model, the current article provides guidelines that take outpatient providers through the steps needed to provide effective treatment for aggression in individuals with dementia. Shifting the current focal point of health care for aggressive dementia patients toward a more person-centered approach will have a positive impact on patient care. [Journal of Gerontological Nursing, 43(2), 9-17.].

Managing behavioral disturbances in a patient with dementia.

A 92-year-old patient with Parkinson disease and dementia provides an opportunity for the advanced practice registered nurse to shift thinking about behavioral disturbances in dementia, away from controlling behavior with pharmacologic approaches, such as antipsychotics, toward understanding behavior by applying the nonpharmacologic Describe, Investigate, Create, and Evaluate method.

Spaced learning using emails to integrate psychiatry into general medical curriculum: Keep psychiatry in mind.

OBJECTIVES: Traditionally, medical students on clinical rotations receive instruction on principles of mental health only during the psychiatry clerkship. We used emails to insert teaching of psychiatric concepts beyond the psychiatry clerkship into other rotations using the method of spaced learning, the delivery of brief morsels of information repeated over time intervals. We predicted that the intervention would improve attitudes and confidence towards the integration of psychiatry and knowledge retention. METHODS: We developed and distributed a series of emails relating key psychiatric concepts targeted to the other core clerkships. RESULTS: In a cluster-randomized trial over one academic year (intervention group n = 71, control group n = 61), scores on the Attitudes and Confidence in the Integration of Psychiatry scale and on the knowledge quiz did not differ significantly. Students who actively engaged with the emails demonstrated significantly higher scores on the knowledge test. Email users valued the timing, format of delivery and application of psychiatric principles outside the psychiatric setting. Participants recommended simplifying the format and previewing the benefits of spaced learning to increase utilization. CONCLUSION: Delivering spaced learning through emails, within a curriculum designed to foster engagement, may provide an efficient means of addressing the widely-recognized but elusive goal of integrating teaching across medical disciplines.

Attitudes and Confidence in the Integration of Psychiatry Scale.

OBJECTIVE: The authors sought to measure attitudes and confidence in the integration of psychiatry into other fields of medicine. METHODS: The Attitudes and Confidence in Integration of Psychiatry in Medicine (ACIP) scale was developed through discussion with content experts across disciplines and pilot testing of items and administered to third- and fourth-year medical students at University of Iowa, University of Michigan, Rush University for validation, focused on assessment of variability, internal consistency, factor structure, and test-retest reliability. RESULTS: A total of 310 medical students completed the survey (35% participation rate). The scale had a high internal consistency (Cronbach's alpha = 0.88) and was without ceiling or floor effects. Students rated the integration of psychiatry into the practice of surgery and its subspecialties as less relevant than its integration into other specialties; however, scores were not biased by students' interest in procedural vs. non-procedural specialties. Test-retest reliability was high (Cronbach's alpha = 0.90). CONCLUSIONS: The ACIP may serve a useful role in determining the outcome of educational efforts toward integrated care.

The ADMSEP Milestones Project.

OBJECTIVE: Credentialing bodies mandate that a medical school's curriculum be based upon recognized guidelines. Within the field of psychiatry, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) has previously published recommended guidelines for the pre-clinical and clerkship curriculum. Ongoing changes within the Liaison Committee on Medical Education's requirements for medical school curricula, and the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, necessitated review of these guidelines. METHODS: ADMSEP convened a task force of psychiatric educators to develop a consensus report outlining new guidelines. The ADMSEP membership reviewed and approved this final document. RESULTS: The guidelines outline six core learning objectives with corresponding competencies. Each of these competencies specifies accompanying milestones to be achieved through the course of medical school. CONCLUSIONS: ADMSEP believes these guidelines will aid educators in crafting a school's psychiatric curriculum. Clearly articulated milestones may foster the further development of validated educational and assessment tools by ADMSEP and other organizations.