Using Longitudinal Curriculum to Improve Psychiatry Residents' Attitudes Regarding Firearm Anticipatory Guidance.

OBJECTIVE: Over the last decade, there has been an increased focus on firearm use in violent acts and suicides. There is no known published firearm safety curriculum specific to psychiatric training and limited guidance on curriculum development from national organizations. The authors' goals were to develop a firearm lecture series that would encompass essential knowledge related to firearm safety and risk assessments and assess its effect on psychiatric residents' interest and confidence in firearm safety guidance. METHODS: The authors developed a six-lecture series on firearm safety that was conducted over all post-graduate year (PGY) training levels and a grand rounds on basic firearm safety. All levels of psychiatry residents at one urban academic center participated in a pre- and post-lecture series questionnaire designed to evaluate attitudes related to firearm safety guidance. They developed and administered the questionnaire through New Innovations collecting qualitative and quantitative data for analysis. The quantitative analysis was completed using paired t-test. RESULTS: Forty-seven residents participated. Twenty-seven respondents met inclusion criteria: attended at least one lecture or the grand rounds, completed pre- and post-lecture surveys, and submitted their pre-lecture survey before their first lecture. After the educational intervention, there was a statistically significant increase (p<0.05) in interest in firearm safety, and confidence in all areas surveyed-risk assessment, safety guidance, and pertinent legislation. CONCLUSIONS: The curriculum increased residents' interest and confidence in providing firearm safety guidance. Areas of development include assessing the curriculum's impact on clinical practice.

Velocity measurements in a hypersonic flow using acetone molecular tagging velocimetry.

In the present work, a non-intrusive diagnostic technique known as molecular tagging velocimetry was used to collect quantitative freestream velocity measurements in the Mach 7 Ludwieg Tube Wind Tunnel located at The University of Texas at San Antonio. This laser-based diagnostic technique used a single Nd:YAG 4th harmonic laserline to excite acetone molecules seeded in the flow field. From the resulting emitted light, mean and instantaneous velocity profiles in the hypersonic freestream flow and facility boundary layer were measured. Uncertainty in the velocity measurements for individual test runs is estimated at ≤ 8% while overall 1D freestream mean velocity measurements were recorded with ±2.4% (± 21 m/s) accuracy. The effect of acetone seeding on the speed of sound was also quantified.

Naphthalene laser-induced fluorescence measurements at low temperature and pressure.

Few studies on naphthalene vapor fluorescence have been conducted at low temperature and pressure conditions. The current study focuses on conducting measurements of naphthalene quenching and absorption cross section in a temperature- and pressure-regulated test cell with 266 nm laser excitation. The test-cell measurements were of the naphthalene-fluorescence lifetime and integrated fluorescence signal over the temperature range of 100 to 525 K and pressure range of 1 to 40 kPa in air. These data enabled the calculation of naphthalene-fluorescence quantum yield and absorption cross section over the range of temperatures and pressures tested, which were then fit to simple functional forms for future use in the calibration of naphthalene laser-induced fluorescence (LIF) measurements. Furthermore, the variation of naphthalene-fluorescence signal with respect to temperature was investigated for four different excitation wavelengths, demonstrating that a two-line naphthalene LIF thermometry technique may be feasible.

Psychiatry Resident Quality of Life.

OBJECTIVE: The objective of this study was to evaluate psychiatry resident physician quality of life. METHODS: A voluntary, anonymous, 10-min survey was e-mailed to residents from all 14 Accreditation Council for Graduate Medical Education (ACGME)-accredited programs in Pennsylvania, New Jersey, and Delaware. Included in the survey was the Multi-Cultural Quality of Life Inventory (MQLI). RESULTS: Response rate was 112 (34.1%). Internal consistency of the MQLI was high (Cronbach's alpha 0.92), and follow-up exploratory factor analysis extracted only one underlying factor (60.1% variance among all 10 items). Average total MQLI score was 80.6. No significant difference in MQLI total was found for therapy status, sex, or race. Post-graduate year (PGY) 4 residents scored higher on total MQLI score (86.7) (F = 2.80, p = 0.04) and ranked occupational functioning and community and services support subscales significantly higher (occupation F = 2.73, p = 0.048, community F = 3.11, p = 0.030). Total MQLI score for residents over the age of 40 (n = 3) was significantly lower (F = 3.45, p = 0.019). CONCLUSION: Despite the stresses of residency training, residents from a variety of programs in one geographic area report an encouraging quality of life on the MQLI. Psychiatry resident quality of life is similar to that reported in other populations of mental health professionals.

Use and characterization of personal psychotherapy by psychiatry residents.

OBJECTIVE: The authors evaluated psychiatry resident participation in and description of personal psychotherapy, reasons for being in psychotherapy, and barriers to personal psychotherapy. METHODS: All 14 program directors for programs accredited by the Accreditation Council for Graduate Medical Education in Pennsylvania, New Jersey, and Delaware provided e-mail addresses for current categorical residents. The authors e-mailed a voluntary, anonymous, 10-min survey to residents through www.SurveyMonkey.com . The survey inquired about time spent in various aspects of training, value assigned to aspects of training, residents' involvement in their own psychotherapy, reasons for being in or not being in therapy, and overall resident wellness. RESULTS: Of the 328 residents e-mailed, 133 (40.5 %) replied to the survey, of which 34 (26.5 %) were in personal psychotherapy. Most residents described their psychotherapy as psychodynamic, once weekly, and located in a private practice not affiliated with the resident's academic center. Approximately half (49 %) were in treatment with a social worker (MSW, LCSW) or psychologist (PhD or PsyD). "Self-awareness and understanding" was the most commonly reported primary and contributing reason for being in psychotherapy. Close to half of the respondents (44.5 %) listed personal stress, substance dependence, mood, anxiety, or other psychiatric symptoms as the primary reason for seeking personal psychotherapy. The most common reasons for not entering psychotherapy were time and finances. Residents who were in personal psychotherapy valued personal psychotherapy as more important to training than residents who were not in personal psychotherapy. Half of all respondents reported that their program recommends psychotherapy. CONCLUSION: Far fewer residents responding to the survey reported being in psychotherapy than residents from some previous surveys. A continuing discussion of whether and how to accommodate personal psychotherapy in the training and education of psychiatry residents by psychiatry educators is warranted.

Psychotherapy Training: Residents' Perceptions and Experiences.

OBJECTIVE: This survey examined actual training hours in psychotherapy modalities as reported by residents, residents' perceptions of training needs, and residents' perceptions of the importance of different aspects of psychotherapy training. METHOD: A brief, voluntary, anonymous, Internet-based survey was developed. All 14 program directors for Accreditation Council for Graduate Medical Education accredited programs in Pennsylvania, New Jersey, and Delaware provided email addresses for current categorical residents. The survey inquired about hours of time spent in various aspects of training, value assigned to aspects of training, residents' involvement in their own psychotherapy, and overall resident wellness. The survey was e-mailed to 328 residents. RESULTS: Of the 328 residents contacted, 133 (40.5%) responded. Median reported number of PGY 3 and 4 performed versus perceived ideal hours of supportive therapy, cognitive behavioral therapy (CBT), and psychodynamic therapy did not differ. Answers for clinical time utilizing these modalities ranged from "none or less than 1 h" per month to 20+ h per month. PGY 3 and 4 residents reported a median of "none or less than 1 h" per month performed of interpersonal, dialectical behavior therapy, couples/family/group, and child therapies but preferred more time using these therapies. Residents in all years of training preferred more hours of didactic instruction for all psychotherapies and for medication management. Residents ranked teaching modalities in the following order of importance: supervision, hours of psychotherapy performed, personal psychotherapy, readings, and didactic instruction. Residents engaged in their own psychotherapy were significantly more likely to rank the experiential aspects of psychotherapy training (personal psychotherapy, supervision, and hours performed) higher than residents not in psychotherapy. CONCLUSION: Current psychotherapy training for psychiatry residents is highly variable, but overall, residents want more psychotherapy education than they are receiving. Further research and discussion about how much psychotherapy training is feasible in an evolving field is required.

Impression management or real change? Reports of depressive symptoms before and after the preoperative psychological evaluation for bariatric surgery.

BACKGROUND: Many bariatric surgery programs require that candidates undergo a preoperative mental health evaluation. Candidates may be motivated to suppress or exaggerate psychiatric symptoms (i.e., engage in impression management), if they believe doing so will enhance their chances of receiving a recommendation to proceed with surgery. METHOD: 237 candidates for bariatric surgery completed the Beck Depression Inventory-II (BDI-ll) as part of their preoperative psychological evaluation (Time 1). They also completed the BDI-II approximately 2-4 weeks later, for research purposes, after they had received the mental health professional's unconditional recommendation to proceed with surgery (Time 2). RESULTS: There was a small but statistically significant increase in mean BDI-II scores from Time 1 to Time 2 (11.4 vs 12.7, P<.001). Clinically significant changes, defined as a change from one range of symptom severity to another, were observed in 31.2% of participants, with significant increases in symptoms occurring nearly twice as often as reductions (20.7% vs 10.5%, P<.008). Demographic variables were largely unrelated to changes in BDI-II scores from Time 1 to Time 2. CONCLUSION: Approximately one-third of bariatric surgery candidates reported a clinically significant change in depressive symptoms after receiving psychological "clearance" for surgery. Possible explanations for these findings include measurement error, impression management, and true changes in psychiatric status.

The medical and economic impact of preoperative cardiac testing in elderly patients with hip fractures.

PURPOSE: To assess the medical and economic impact of preoperative cardiac testing (stress thallium imaging or echocardiography) on the treatment of elderly patients with hip fractures. MATERIALS AND METHODS: 235 consecutive patients over the age of 60 treated for a hip fracture (236 fractures) (OTA 31) at a single Level I trauma centre were identified from a prospective orthopaedic trauma database and studied as part of a retrospective cohort series. 35 (15%) had cardiac testing prior to treatment of their hip fracture. The indication for testing was a newly diagnosed cardiac abnormality in 16 of these cases and a prior history of cardiovascular disease without an acute cardiac problem in 19. RESULTS: Cardiac evaluation did not change the orthopaedic management in any case. No patient underwent cardiac surgery or coronary angioplasty as a result of the testing. In 48% of cases, cardiac testing did not lead to new medical treatment. In 52%, recommendations were only made for medical management of previously known cardiac disease. Patients who had cardiac testing had a significantly greater average delay to surgery (3.3 days) than those who did not (1.9 days), (P<.001). The cost of preoperative cardiac testing totalled more than $44,000 for the 35 patients. DISCUSSION AND CONCLUSION: Preoperative cardiac testing did not lead to changes in perioperative orthopaedic or medical management of elderly patients with hip fractures. Patients undergoing testing had a significant delay to surgery. Extrapolated to the population of elderly hip fracture patients in the United States (250,000 annually), preoperative cardiac testing (performed in 15% of cases) would cost nearly $47,000,000 annually. Preoperative cardiac testing may add profoundly to the healthcare costs associated with treating this population of patients without influencing orthopaedic or medical management.