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1.
Psychiatr Serv ; 75(5): 492-495, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38291887

ABSTRACT

Verbal mistreatment of staff by patients is common in health care settings. Experiencing or witnessing mistreatment can have harmful psychological impacts, affecting well-being and clinical practice. As part of an effort to become an antiracist organization, an academic community mental health center based in Connecticut developed an initiative to address verbal mistreatment. Training in the Expect, Recognize, Address, Support, Establish (ERASE) framework was provided to 140 staff members. This training and subsequent actions to enhance the culture of safety were perceived as helpful by staff. Further development of the initiative is proceeding as the center's primary performance improvement program.


Subject(s)
Community Mental Health Centers , Humans , Connecticut , Professional-Patient Relations , Health Personnel/psychology , Organizational Culture
2.
AMA J Ethics ; 25(5): E324-331, 2023 05 01.
Article in English | MEDLINE | ID: mdl-37132617

ABSTRACT

Trauma-informed care is a transdisciplinary framework that existed well before 2020, but it is now more imperative to teach it and incorporate it into medical education. This paper describes a novel interprofessional curriculum and its focus on trauma-informed care-notably, including institutional and racial trauma-that was implemented by Yale University for medical, physician associate, and advanced practice registered nursing students.


Subject(s)
Education, Medical , Interprofessional Education , Curriculum , Humans , Systemic Racism , Diversity, Equity, Inclusion
3.
Psychiatr Clin North Am ; 45(4): 717-734, 2022 12.
Article in English | MEDLINE | ID: mdl-36396275

ABSTRACT

Sleep disruption is common in older adults and is associated with many poor health outcomes. It is vital for providers to understand insomnia and other sleep disorders in this population. This article outlines age-related changes in sleep, and medical, psychiatric, environmental, and psychosocial factors that may impact sleep. It addresses the evaluation of sleep symptoms and diagnosis of sleep disorders. It aims to examine the evidence for non-pharmacological and pharmacologic treatment options for insomnia while weighing factors particularly germane to the aging adult..


Subject(s)
Sleep Initiation and Maintenance Disorders , Sleep Wake Disorders , Humans , Aged , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/therapy , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/therapy , Sleep , Aging
4.
Psychiatr Clin North Am ; 45(4): 765-777, 2022 12.
Article in English | MEDLINE | ID: mdl-36396278

ABSTRACT

The older adult population in the United States is poised to reach 83.7 million by 2050, and up to 20% will suffer from cognitive and mental illnesses. We do not have the workforce available to meet this need; therefore, general psychiatrists will care for many older psychiatric patients. Enhancing learning opportunities during general medical education and residency could improve the knowledge of general psychiatrists and encourage recruitment into geriatric psychiatry. This article outlines geriatric psychiatry education in medical school, residency, and geriatric psychiatry fellowship with suggestions for recruitment into the field, along with recommendations for enhanced learning for general psychiatrists.


Subject(s)
Internship and Residency , Psychiatry , Students, Medical , Humans , United States , Aged , Geriatric Psychiatry , Psychiatry/education , Workforce
7.
Hosp Pediatr ; 12(2): 181-190, 2022 02 01.
Article in English | MEDLINE | ID: mdl-35102377

ABSTRACT

OBJECTIVE: Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS: In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS: We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS: We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.


Subject(s)
Health Personnel , Patient Safety , Child , Cross-Sectional Studies , Family , Humans , Surveys and Questionnaires
8.
Am J Geriatr Psychiatry ; 30(1): 78-86, 2022 01.
Article in English | MEDLINE | ID: mdl-34053835

ABSTRACT

Mistreatment by patients is unfortunately common in clinical medicine, including geriatric subspecialties. Despite the prevalence of this problem, there are few standardized approaches for addressing it at both interpersonal and institutional levels. The "ERASE" framework is a novel, practical approach for addressing mistreatment by patients. "ERASE" includes Expecting and preparing for mistreatment by patients, Recognizing mistreatment, Addressing mistreatment in real time, Supporting members of the healthcare team who have been mistreated, and Establishing a positive institutional culture. The framework may prove particularly helpful and applicable to providers specializing in geriatrics and can be used by administrators, educators, and all members of the healthcare team to promote safe, dignified clinical care and learning environments.


Subject(s)
Geriatrics , Aged , Humans , Learning
11.
Acad Psychiatry ; 45(6): 708-715, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34350548

ABSTRACT

OBJECTIVE: Suicide is a leading cause of death for young adults, and medical students experience elevated rates of suicide and suicidal ideation. The present study uses mediation analysis to explore relationships between suicidal ideation and two dysfunctional mindsets common among medical students: maladaptive perfectionism, high standards accompanied by excessive self-criticism, and impostor phenomenon, pervasive feelings of inadequacy despite evidence of competence and success. METHODS: Two hundred and twenty-six medical students at a single institution completed an online survey which assessed maladaptive perfectionism, impostor phenomenon, and suicidal ideation. After calculating measures of association between all study variables, linear regression was conducted to establish the relationship between maladaptive perfectionism and suicidal ideation. To evaluate whether impostor phenomenon mediated the relationship between maladaptive perfectionism and suicidal ideation as hypothesized, a series of regression models were constructed and the regression coefficients were examined. The statistical significance of the indirect effect, representing the mediated relationship, was tested using bootstrapping. RESULTS: Significant positive associations between maladaptive perfectionism, impostor phenomenon, and suicidal ideation were observed. Impostor phenomenon score was found to mediate the relationship between maladaptive perfectionism and suicidal ideation. CONCLUSIONS: Medical students who exhibit maladaptive perfectionism are at increased risk for feelings of impostor phenomenon, which translates into increased risk for suicide. These results suggest that an intervention targeted at reducing feelings of impostor phenomenon among maladaptive perfectionists may be effective in reducing their higher risk for suicide. However, interventions promoting individual resilience are not sufficient; systemic change is needed to address medicine's "culture of perfection."


Subject(s)
Perfectionism , Students, Medical , Anxiety Disorders , Humans , Self Concept , Suicidal Ideation , Young Adult
12.
Curr Geriatr Rep ; 10(3): 82-90, 2021.
Article in English | MEDLINE | ID: mdl-34336549

ABSTRACT

PURPOSE OF REVIEW: The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management. RECENT FINDINGS: The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines. SUMMARY: All older adults should be routinely screened for AUD with standardized screening tools. If a patient's screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.

14.
Acad Psychiatry ; 45(4): 435-439, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33721231

ABSTRACT

OBJECTIVE: With the number of geriatric psychiatry fellows declining from a peak of 106 during 2002-2003 to 48 during 2020-2021, this study aims to investigate characteristics of the geriatric psychiatry training requirement across U.S. psychiatry residency programs and to identify specific factors which may influence residents to pursue geriatric psychiatry subspecialty training. METHODS: The authors queried the American Medical Association's Fellowship and Residency Electronic Interactive Database Access system to compile a list of program directors from the Accreditation Council for Graduate Medical Education sponsored general adult psychiatry residency programs. Program directors were emailed an anonymous multiple-choice survey to ascertain specific characteristics of their program's geriatric psychiatry training experiences. This study's primary outcome was the percentage of residents entering geriatric psychiatry fellowship after completion of general psychiatry training. Linear regression analysis determined which variables may be associated with this primary outcome. RESULTS: Of 248 surveyed, 60 programs (24%) responded to the survey. Only one of the independent variables revealed a statistically significant association with the percent of residents that became geriatric psychiatry fellows: the number of geriatric psychiatrists at the residents' home institution (p=0.002). CONCLUSIONS: Consistent with previous data, the presence of geriatric psychiatry faculty members is strongly associated with the decision to pursue subspecialty training in geriatric psychiatry.


Subject(s)
Fellowships and Scholarships , Internship and Residency , Accreditation , Adult , Aged , Education, Medical, Graduate , Geriatric Psychiatry/education , Humans , Surveys and Questionnaires , United States
16.
FASEB Bioadv ; 3(3): 175-181, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33363271

ABSTRACT

Strong and effective clinical teamwork has been shown to improve medical outcomes and reduce medical errors. Incorporating didactic and clinical activities into undergraduate medical education in which students work in teams will develop skills to prepare them to work in clinical teams as they advance through their education and careers. At the Yale School of Medicine, we foster the development of team skills in the classroom through team-based learning (TBL) and in clinical settings with the Interprofessional Longitudinal Clinical Experience (ILCE). Both TBL and ILCE require students work in close physical proximity. The COVID-19 pandemic forced us to immediately adapt our in-person activities to an online format and then develop clinical and interprofessional experiences that adhere to social distancing guidelines. Here we describe our approaches to solving these problems and the experiences of our students and faculty.

17.
Am J Geriatr Psychiatry ; 29(4): 365-374, 2021 04.
Article in English | MEDLINE | ID: mdl-32828618

ABSTRACT

OBJECTIVE: The American Association for Geriatric Psychiatry (AAGP) Scholars Program was developed to recruit trainees into geriatric psychiatry fellowships and is considered a pipeline for fellowship recruitment. Nonetheless, the number of trainees entering geriatric psychiatry fellowship is declining, making it important to identify modifiable factors that may influence trainees' decisions to pursue fellowship. We analyzed survey data from Scholars Program participants to identify demographic characteristics, attitudes toward program components, and behaviors after the program that were independently associated with the decision to pursue fellowship. METHODS: Web-based surveys were distributed to all 289 former Scholars participants (2010-2018), whether or not they had completed geriatric psychiatry fellowships. We conducted a hierarchical binary logistic regression analysis to examine demographics, program components, and behaviors after the program associated with deciding to pursue geriatric psychiatry fellowship. RESULTS: Sixty-one percent of Scholars decided to pursue geriatric psychiatry fellowship. Attending more than one AAGP annual meeting (relative variance explained [RVE] = 34.2%), maintaining membership in the AAGP (RVE = 28.2%), and rating the Scholars Program as important for meeting potential collaborators (RVE = 26.6%) explained the vast majority of variance in the decision to pursue geriatric psychiatry fellowship. CONCLUSION: Nearly two-thirds of Scholars Program participants decided to pursue geriatric psychiatry fellowship, suggesting the existing program is an effective fellowship recruitment pipeline. Moreover, greater involvement in the AAGP longitudinally may positively influence Scholars to pursue fellowship. Creative approaches that encourage Scholars to develop collaborations, maintain AAGP membership, and regularly attend AAGP annual meetings may help attract more trainees into geriatric psychiatry.


Subject(s)
Fellowships and Scholarships , Geriatric Psychiatry/education , Adult , Aged , Female , Humans , Internet , Male , Surveys and Questionnaires , United States
19.
Med Sci Educ ; 30(3): 1273-1276, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32837784

ABSTRACT

Medical schools around the world have been grappling with how to adapt undergraduate medical curricula in the face of the COVID-19 pandemic. Our institution made the decision to suspend all clinical clerkships the day before the Association of American Medical Colleges (AAMC) recommended to US medical schools a similar suspension of "medical student participation in any activities that involved patient contact." This manuscript describes the rapid evolution in our decision-making as we weighed various information, values, and priorities in the face of the emerging public health crisis. We discuss how a compromised learning environment and concerns about student, patient, and the public health led to the suspension. We also consider next steps as we move forward in this uncertain time.

20.
Am J Geriatr Psychiatry ; 28(9): 989-992, 2020 09.
Article in English | MEDLINE | ID: mdl-32593495

ABSTRACT

OBJECTIVE: Social isolation and loneliness-common concerns in older adults-are exacerbated by the COVID-19 pandemic. To address social isolation in nursing home residents, the Yale School of Medicine Geriatrics Student Interest Group initiated a Telephone Outreach in the COVID-19 Outbreak (TOCO) Program that implements weekly phone calls with student volunteers. METHODS: Local nursing homes were contacted; recreation directors identified appropriate and interested elderly residents. Student volunteers were paired with elderly residents and provided phone call instructions. RESULTS: Three nursing homes opted to participate in the program. Thirty elderly residents were paired with student volunteers. Initial reports from recreation directors and student volunteers were positive: elderly residents look forward to weekly phone calls and express gratitude for social connectedness. CONCLUSIONS: The TOCO program achieved initial success and promotes the social wellbeing of nursing home residents. We hope to continue this program beyond the COVID-19 pandemic in order to address this persistent need in a notably vulnerable patient population.


Subject(s)
Community-Institutional Relations , Coronavirus Infections/psychology , Nursing Homes , Pneumonia, Viral/psychology , Social Isolation/psychology , Telephone , Volunteers , Aged , Betacoronavirus , COVID-19 , Connecticut , Humans , Pandemics , SARS-CoV-2 , Students, Medical
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