Training Psychiatry Residents in Professionalism in the Digital World.

Professionalism is an abstract concept which makes it difficult to define, assess and teach. An additional layer of complexity is added when discussing professionalism in the context of digital technology, the internet and social media - the digital world. Current physicians-in-training (residents and fellows) are digital natives having been raised in a digital, media saturated world. Consequently, their use of digital technology and social media has been unconstrained - a reflection of it being integral to their social construct and identity. Cultivating the professional identity and therefore professionalism is the charge of residency training programs. Residents have shown negative and hostile attitudes to formalized professionalism curricula in training. Approaches to these curricula need to consider the learning style of Millennials and incorporate more active learning techniques that utilize technology. Reviewing landmark position papers, guidelines and scholarly work can therefore be augmented with use of vignettes and technology that are available to residency training programs for use with their Millennial learners.

Psychogenic polydipsia, hyponatremia and osmotic myelinolysis.

OBJECTIVE: Description of a case of osmotic myelinolysis associated with hyponatremia produced as a consequence of compulsive water drinking. METHOD: Case report and review of relevant literature. RESULTS: Compulsive water drinking or psychogenic polydipsia is a common cause of hyponatremia among individuals with chronic mental illness. Central pontine myelinolysis and extrapontine myelinolysis are serious neurological complications resulting from rapid correction of serum sodium and associated changes in serum osmolality. A case of extrapontine myelinolysis confirmed by characteristic MRI findings following an episode of extreme hyponatremia caused by psychogenic polydipsia is described involving a patient with an adult lifelong history of chronic mental illness diagnosed as schizoaffective disorder. With supportive care the related cognitive deficits and balance difficulties resolved completely. CONCLUSIONS: Clinicians should be aware of the potential for hyponatremia resulting from compulsive water drinking to cause myelinolysis with delayed development of cognitive and gait symptoms that responds to supportive care if identified early.