The Columbia Academy for Psychoanalytic Educators: A Pilot Program for Developing Analysts and Supervisors of Analytic Candidates.

The Columbia Academy for Psychoanalytic Educators supports graduate analysts' professional development at the Columbia University Center for Psychoanalytic Training and Research. In 2018, a pilot program was launched for faculty interested in analyzing and supervising candidates, whose aim is to support and educate those interested in taking on these essential training functions. The focus is on educating the educators, which is a significant departure from the historical focus on evaluation, vetting, and faculty hierarchies. In the process of developing and piloting the program, complex and long debated issues in psychoanalytic education and development were considered that are relevant to many institutes, including training of supervisors and analysts of candidates, addressing problematic faculty hierarchies, creating safety for those presenting clinical work to colleagues, building professional peer relationships, and engagement of faculty in time consuming and nonremunerative activities. The authors report on their experience developing and evaluating this pilot program.

Documenting Educational Impact in the Promotion Dossier with an Enhanced Curriculum Vitae.

ABSTRACT: Faculty with a career focus on education in the health professions often have difficulty representing their academic accomplishments for due consideration in promotion decisions at their respective institutions. This problem occurs because the traditional curriculum vitae (CV) format which is most often used tends to focus on peer-reviewed accomplishments easily presented in lists, such as grants and publications. In some institutions, an educator portfolio is required in place of or in addition to the CV. However, creating or reviewing such a narrative-oriented document takes large amounts of time-time that most faculty or reviewers do not have. Having to use an educator portfolio also calls out the educator as different from the traditional research faculty member. To address this problem, we propose the solution of an Enhanced CV. The Enhanced CV includes much of what is presented in an educator portfolio but in a format closer to the traditional CV. Unlike a traditional CV, the Enhanced CV includes categories inclusive of educational contributions (eg, teaching, mentoring, and course leadership) and includes brief descriptions and/or impact statements to clarify the significance of the listed accomplishments. The Enhanced CV has been adopted at two very different institutions, where evidence is accumulating regarding the viability of the Enhanced CV as a solution to educators' problem of presenting their accomplishments for promotions. The lessons learned from these institutions illustrate how the Enhanced CV can increase the ability of educators to present their accomplishments and advance in rank in their academic careers.

Beyond Progression: Devising a New Training Model for Candidate Assessment, Advancement, and Advising at Columbia.

Research over several decades has identified significant problems with the progression model-the traditional approach to assessment and advancement of psychoanalytic candidates-including candidates' anxiety and uncertainty about the methods and fairness of their assessment, avoidance of conflictual issues with patients in order to keep cases, and reluctance to share their challenges with supervisors and advisors. In light of these findings, the Columbia Center for Psychoanalytic Training and Research restructured its psychoanalytic training programs. The progression committee, the progression advisor role, candidate application to advance through the program, and routine committee discussion of candidates were eliminated and replaced by confidential mentorship and a clear and predictable system of trainee advancement. Analytic competency-a requirement for graduation-is now determined solely from detailed written feedback regarding the candidate's achievement of the Center's learning objectives. The number of months of supervised analysis required for graduation has been reduced, as has the required length of the candidate's longest case; in addition, three-times-weekly analyses are now accepted for credit. These changes are meant to increase the transparency, objectivity, and predictability of the training experience and reduce the pressure on clinical decision making and communication between trainees and faculty. An extensive evaluation of the impact of these innovations is currently under way.

Psychotherapy Tracks in US General Psychiatry Residency Programs: A Proxy for Trends in Psychotherapy Education?

OBJECTIVE: The authors studied the goals and design of psychotherapy tracks in the US general psychiatry residency programs and the perceived barriers to psychotherapy tracks in programs without them. METHODS: The authors emailed 226 US general psychiatry residency program directors, asking them to complete an anonymous, online, Qualtrics survey about psychotherapy training and tracks in their program. RESULTS: Seventy-nine programs (35%) participated. Of these, 22% (n = 17) reported having a psychotherapy track, 4% (n = 3) reported currently developing a psychotherapy track, and 74% (n = 56) reported not having a psychotherapy track. Of those without a psychotherapy track, 81% (n = 44) reported not wanting one. Time, personnel, resident interest, and funding were the most common reasons for not having a track, but programs with tracks generally reported additional personnel and funding were not needed. Most programs with a track reported being satisfied with it. A sizeable minority of reporting programs (overrepresented by those without psychotherapy tracks) did not require supervision or didactics for all three Accreditation Council for Graduate Medical Education required psychotherapy modalities. CONCLUSIONS: Commonly perceived barriers to having a psychotherapy track may not be as limiting as they seem, and the diverse types of psychotherapy tracks may offer flexibility for programs seeking to design one. The finding that not all programs offer a full complement of supervision and didactics in core psychotherapy modalities is concerning for the future of psychotherapy training in residency programs. The presence of a psychotherapy track may be a proxy for the value a program places on psychotherapy education.

Emergency Remote Training in Psychoanalysis and Psychotherapy: An Initial Assessment from Columbia.

The Covid-19 pandemic and the social distancing required to combat it have set in motion an experiment in psychoanalytic education of unprecedented scope. Following an abrupt shift from in-person study to remote classes, supervision, clinical work, and training analyses, the Columbia University Center for Psychoanalytic Training and Research polled its psychotherapy and psychoanalysis trainees to assess their initial experience of remote training. Most candidates found the technical aspects of online learning easy and were satisfied with remote training overall. Across all programs, most trainees considered class length and reading load about right and felt their class participation was unaffected, though they found it harder to concentrate. Most found it no harder to start a training case, felt the shift to remote supervision had no negative effect, and were satisfied with seeing their training analyst remotely. Most trainees preferred in-person classes, clinical work, and training analyses to those offered remotely, yet in light of the health risks they said they were less likely to continue training in fall 2020 if in-person work resumed. Trainees suggested several modifications of teaching techniques to improve their participation and concentration in class. These findings' implications for the debate regarding remote training in psychoanalysis are explored.

Beyond Informed Consent: Talking to Patients About Therapeutic Action.

Psychodynamically oriented psychotherapists are faced with the question of what to say to new patients about the therapy they are beginning. This article reviews historical attitudes about early treatment discussions with patients in psychoanalysis with an emphasis on how these discussions have evolved as informed consent became a standard of care. Approaches to talking to patients about therapeutic action in psychodynamic psychotherapy are discussed, including the development and application of a psychoeducational document that is being used to facilitate these discussions in the outpatient residents' clinic of a large urban academic medical center. Finally, qualitative data are presented to describe residents' experiences with this document. The overwhelmingly positive responses suggest that this intervention is helpful for patients and residents and can serve to deepen the treatment relationship through mutual trust and understanding.

Teaching Neuroscience: A Primer for Psychotherapists.

From the beginning of their psychotherapy training, students need to think about how talking changes the brain, how development is encoded in the body, and how connecting neuroscience and psychotherapy can help us improve psychosocial interventions to optimally help patients. But teaching neuroscience doesn't come naturally to many psychotherapy educators-myself included. We were trained as clinicians, not as researchers, so for many of us, reading and searching the neuroscience literature is challenging. Over many years, and with the help of wonderful colleagues, I am learning to read neuroscience papers and to incorporate what I learn into my psychotherapy teaching. When I teach neuroscience in a psychotherapy course, I do it with great humility. I make it very clear to my students that I'm not a neuroscientist and that I'm not an expert in the field. Instead, I learn with my students, as together we try to understand the science and what it can tell us about the mind, development, and psychotherapy. I also make it very clear that I'm not presenting this material as if it proves something about psychotherapy. We don't know enough about the neuroscience of psychotherapy to do that. Rather, I'm trying to get my students as excited as I am about what neuroscience can teach us about psychotherapy. My hope is that it will stimulate them to think about connections between neuroscience and psychotherapy when they are talking to patients, thinking about formulation, conceptualizing experiments and choosing their careers. Over the years, I've found that using carefully chosen neuroscience papers that I can understand really helps me to get the neuroscience/psychotherapy conversation going in a classroom. To that end, I offer five papers that I use when I teach psychotherapy. They are all written by top researchers and published in the nation's premiere scientific journals. Each one provides interesting potential insights into a different aspect of psychotherapy.

Evaluating an Advisor Program for Psychiatry Residents.

PURPOSE: A formal residency advisory program was instituted in 2010 to assist psychiatry residents in achieving academic and personal goals and to help identify additional mentors. In this project the authors sought to evaluate and improve resident and faculty satisfaction with the residency advisory program. METHODS: At the end of the 2013-2014 academic period, residents completed an anonymous survey to determine baseline satisfaction with the residency advisory program. A series of interventions were then implemented including the addition of a resident liaison to the program, formal recognition of faculty advisors, and email reminders regarding regular residency advisory meetings. Eight months later a follow-up survey was distributed to assess the impact of the interventions on resident and faculty satisfaction with the residency advisory program and mentoring within the residency program. RESULTS: There were notable improvements in overall satisfaction with a 58% increase (p<0.05) in residents meeting with their advisors. After the intervention, residents were more likely to seek their resident advisor for help in facilitating relationships with potential career mentors (28% vs 72%, OR=6.64, 95% CI =1.83-24.08). Although 87% of all residents reported having mentors outside of the formal residency advisory program, approximately half of those who are in their first year post medical school (PGY1s) reported having no mentors outside of the residency advisory program (notably all women). CONCLUSIONS: Resident advisory programs benefit from continuous evaluation and quality improvement with enhanced structure, including a senior resident position, leading to improved satisfaction. Residency advisory programs may be particularly useful in helping to facilitate relationships with other mentors, which may be particularly important for women early in their training.

Thinking Outside of Outpatient: Underutilized Settings for Psychotherapy Education.

OBJECTIVE: Although psychiatry residents are expected to achieve competency in conducting psychotherapy during their training, it is unclear how psychotherapy teaching is integrated across diverse clinical settings. METHODS: Between January and March 2015, 177 psychiatry residency training directors were sent a survey asking about psychotherapy training practices in their programs, as well as perceived barriers to psychotherapy teaching. RESULTS: Eighty-two training directors (44%) completed the survey. While 95% indicated that psychotherapy was a formal learning objective for outpatient clinic rotations, fifty percent or fewer noted psychotherapy was a learning objective in other settings. Most program directors would like to see psychotherapy training included (particularly supportive psychotherapy and cognitive behavioral therapy) on inpatient (82%) and consultation-liaison settings (57%). The most common barriers identified to teaching psychotherapy in these settings were time and perceived inadequate staff training and interest. CONCLUSIONS: Non-outpatient rotations appear to be an underutilized setting for psychotherapy teaching.

Smartphones, Smart Feedback: Using Mobile Devices to Collect In-the-Moment Feedback.

OBJECTIVE: The goal of this study was to streamline the collection of resident feedback in order to support faculty development and program improvement in psychiatry training. METHODS: The authors developed and implemented a brief, free, mobile survey to track resident feedback and class attendance. RESULTS: Prior to instituting this system, resident feedback was obtained semi-annually for each course (n = 90) and not each individual class. In comparison, this new system allowed the authors to collect feedback on 477 of the 519 classes held over the 2014-15 academic year (92 %). Written comments about the curriculum increased over tenfold from 42 in 2013-14 to 541 during a comparative time period in 2014-15. One year after instituting this new system, resident participation increased to 81 % on average (compared to 64 % previously). CONCLUSION: Mobile devices may provide an inexpensive and relatively untapped mechanism for improving the process of collecting resident feedback and tracking class attendance.

Teaching Dialectical Behavior Therapy to Psychiatry Residents: The Columbia Psychiatry Residency DBT Curriculum.

OBJECTIVE: Dialectical behavior therapy (DBT) is an evidence-based psychosocial treatment with efficacy in reducing self-harm behaviors in borderline personality disorder (BPD). This study describes and evaluates a clinical curriculum to teach DBT to psychiatry residents, developed at a large urban university hospital. The curriculum objectives are to (1) have psychiatry residents achieve basic understanding of DBT theory and clinical skill, (2) increase residents' ability and confidence in treating self-harm behaviors (both suicidal behavior and non-suicidal self-injury), and (3) enhance residents' willingness to treat individuals with BPD. METHODS: In addition to a 6-week didactic course on DBT offered to all residents (n = 62), 25 elected to enroll in a year-long DBT clinical training curriculum over the course of a 5-year period. The DBT clinical training consisted of 15 h of additional didactics, ongoing conduct of individual therapy and group DBT skills training, videotaping of individual therapy sessions, and weekly supervision meetings utilizing videotape to provide feedback. Residents participating in the clinical training program videotaped baseline and later sessions, which were rated for DBT adherence. All 62 graduates of the program were surveyed regarding the impact of the training on their practice of psychiatry. RESULTS: Upon graduation, a high percentage (87 % in the curriculum and 70 % in the didactic course only) reported incorporating DBT into their psychiatry practice, as well as willingness and confidence in treating BPD and self-harm behaviors. Residents participating in the clinical training demonstrated significant improvement in their ability to utilize DBT interventions, particularly in structuring sessions, problem assessment, problem solving, and using validation and dialectical strategies. CONCLUSION: This DBT curriculum was effective in preparing psychiatrists-in-training to incorporate evidence-based practices for effective treatment of BPD and self-harm behaviors and can serve as a model for teaching DBT during psychiatry residency training. Limitations include a small sample size and lack of baseline survey measurement of attitudes for pre- and post-curriculum comparison.

A Qualitative Study of Factors Affecting Morale in Psychiatry Residency Training.

OBJECTIVE: Resident morale is an important yet poorly understood aspect of the residency training experience. Despite implications for program quality, resident satisfaction, patient care, and recruitment, little is known about the variables influencing this complex phenomenon. This study sought to identify important factors affecting morale in psychiatry residency training. METHODS: The authors conducted four semi-structured focus groups at a moderately sized, urban, psychiatry residency program during the 2013-2014 academic year. They used qualitative data analysis techniques, including grounded theory and content analysis, to identify key themes affecting resident morale across training levels. RESULTS: Twenty-seven residents participated in the focus groups with equal distribution across post-graduate years (PGY) 1-4. Five major conceptual categories affecting resident morale emerged: Sense of Community, Individual Motivators, Clinical Work, Feeling Cared For, and Trust in the Administration. CONCLUSIONS: Morale is an important topic in residency education. The qualitative results suggest that factors related to a Sense of Community and Individual Motivators generally enhanced resident morale whereas factors related to a lack of Feeling Cared For and Trust in the Administration tended to contribute to lower morale. The authors describe the possible interventions to promote stronger program morale suggested by these findings.

Special-"T" Training: Extended Follow-up Results from a Residency-Wide Professionalism Workshop on Transgender Health.

OBJECTIVE: Transgender people face unique challenges when accessing health care, including stigma and discrimination. Most residency programs devote little time to this marginalized population. METHODS: The authors developed a 90-min workshop to enhance residents' ability to empathize with and professionally treat transgender patients. Attendees completed pre-, post, and 90-day follow-up surveys to assess perceived empathy, knowledge, comfort, interview skill, and motivation for future learning. RESULTS: Twenty-two residents (64.7 %) completed pre- and post-workshop surveys; 90.9 % of these completed the 90-day follow-up. Compared to baseline, there were statistically significant post-workshop increases in perceived empathy, knowledge, comfort, and motivation for future learning. However on 90-day follow-up, there were no statistically significant differences across any of the five domains, compared to baseline. CONCLUSIONS: This workshop produced significant short-term increases in resident professionalism toward transgender patients. However, extended follow-up results highlight the limitations of one-time interventions and call for recurrent programming to yield durable improvements.