"Doctor" Badge Promotes Accurate Role Identification and Reduces Gender-Based Aggressions in Female Resident Physicians.

OBJECTIVE: Role misidentification among hospital staff is common. Female resident physicians are more likely to be misidentified as non-physicians. This study utilized a pre-post examination to determine if the usage of a "doctor" badge by resident physicians at a Veterans Affairs Medical Center influences role identification, gender-based aggressions, and workplace experience. METHODS: Twenty-six psychiatry residents at the Veterans Affairs Boston Healthcare System participated in a voluntary, anonymous electronic pre-survey in December 2020 and post-survey in March 2021 to report their experiences with role identification and gender-based aggressions before and after the implementation of a "doctor" badge. RESULTS: Females were significantly more likely than males to report role misidentification (x2(1)=10.8, p=0.001). Females were significantly more likely to experience gender-based aggressions compared to males (x2(1)=19.5, p<0.001). Compared to pre-intervention, females who wore the badge were significantly less likely to be misidentified (x2(1)=9.6, p=0.002). There was no significance when comparing males who were misidentified pre- to post-intervention (x2(1)=1.1, p=0.294). Compared to pre-intervention, females who wore the badge were significantly less likely to experience gender-based aggressions (x2(1)=17.3, p=<0.001). Compared to pre-intervention, there was no significant change in gender-based aggressions for males who wore the badge (x2(1)=1.05, p=0.306). CONCLUSIONS: Female residents were more likely than male residents to report role misidentification. Usage of the "doctor" badge resulted in improved role identification and a reduction in gender-based aggressions for females, but not males. "Doctor" badges can improve role identification, gender-based aggressions, workplace experience, patient communication, and care.

Sharing perspectives on feedback: a combined resident-faculty workshop.

BACKGROUND: Feedback is essential to medical education. Although the need for effective feedback delivery is well known, more recent focus is on understanding and strengthening the faculty-trainee relationship within which the feedback process is carried out. The authors developed and implemented a combined resident-faculty feedback workshop within a psychiatry residency training program to enhance participants' understanding of challenges residents and faculty experience with the feedback process. METHODS: The one-hour workshop consisted of small group activities and large group discussions, focused on (i) feedback challenges for both residents and faculty and (ii) potential ways to address identified challenges. Participants completed pre-and post-workshop questionnaires to rate their level of understanding of, and answer open-ended questions regarding, feedback challenges. Mixed-methods assessment of questionnaire responses examined quantitative rating changes from pre- to post-workshop, as well as emergent qualitative themes from the open-ended responses. RESULTS: From a pool of 30 workshop participants, 26 completed each of the pre- and post-workshop questionnaires. Overall, participants were satisfied with the programming. Important considerations for the feedback process were (i) specific/constructive/timely feedback, (ii) meeting logistical/administrative feedback requirements, (iii) setting norms/expectations of effective/routine feedback, and (iv) relational/emotional considerations surrounding feedback. It appeared both faculty and residents were able to increase perspective taking about how the other group perceived the feedback process. CONCLUSIONS: This pilot project is one of the first to examine a joint resident-faculty workshop focused on understanding how faculty and residents can interact to better understand each other's perspective on the feedback process. Further work in this area is needed to identify common misperceptions and design programming to help correct them. Further research is also needed to examine the impact of such programming on the feedback process.

Assessment of QTc and Risk of Torsades de Pointes in Ventricular Conduction Delay and Pacing: A Review of the Literature and Call to Action.

BACKGROUND: Assessment of the heart rate-corrected QT-interval on the 12-lead electrocardiogram when prescribing medications known to increase the risk of Torsades de Pointes has become a common part of consultation-liaison psychiatry practice. OBJECTIVES: Highlighted by a patient who experienced psychiatric decompensation due to inaccurate interpretation of QTc prolongation in the setting of a wide QRS complex, we aimed to describe the approach to QTc interpretation in patients with ventricular conduction delay. METHODS: We reviewed the current literature on the approach to assessment of prolonged repolarization in patients with ventricular conduction delay due to bundle branch block (BBB) and ventricular pacing. RESULTS: Physicians of any specialty may perform initial electrocardiogram interpretation and should be proficient in the definition, recognition, and understanding of the basic pathophysiology of electrocardiographic abnormalities. We discuss current approaches to assessment of the QT-interval in patients with a wide QRS complex due to bundle branch block and ventricular pacing, including bivariate QTc modification, univariate QT-interval modifications, and use of the JT-interval. CONCLUSIONS: The QT-interval is prolonged ipso facto in patients with a wide QRS complex from ventricular conduction delay/ventricular pacing and must be adjusted for QRS duration. Multiple formulae have been proposed to account for wide QRS complex in this setting with no single universally accepted methodology. We suggest the use of either the Bogossian formula or JT-interval followed by Hodges or Framingham heart-rate correction to adjust for a wide QRS complex. It is critical that the C-L psychiatrist be able to identify a wide QRS complex on the electrocardiogram, understand implications for accurate assessment of prolonged depolarization, and apply an appropriate correction methodology.

COVID-19 Pandemic: Impact on psychiatric care in the United States.

The World Health Organization declared the coronavirus outbreak a pandemic on March 11, 2020. Infection by the SARS-CoV2 virus leads to the COVID-19 disease which can be fatal, especially in older patients with medical co-morbidities. The impact to the US healthcare system has been disruptive, and the way healthcare services are provided has changed drastically. Here, we present a compilation of the impact of the COVID-19 pandemic on psychiatric care in the US, in the various settings: outpatient, emergency room, inpatient units, consultation services, and the community. We further present effects seen on psychiatric physicians in the setting of new and constantly evolving protocols where adjustment and flexibility have become the norm, training of residents, leading a team of professionals with different expertise, conducting clinical research, and ethical considerations. The purpose of this paper is to provide examples of "how to" processes based on our current front-line experiences and research to practicing psychiatrists and mental health clinicians, inform practitioners about national guidelines affecting psychiatric care during the pandemic, and inform health care policy makers and health care systems about the challenges and continued needs of financial and administrative support for psychiatric physicians and mental health systems.