The role of the photographic arts in psychiatry.

Photography is a medium that has historical roots in psychiatry. It is an art form that shares some concepts with psychodynamic psychotherapy and can also provide psychotherapeutic value. In addition, it can provide a means of stress reduction for the burned-out clinician. Photographs can also be utilised for educational activities to stimulate reflection and discussion.

Growing the Psychiatry Workforce Through Expansion or Creation of Residencies and Fellowships: the Results of a Survey by the AADPRT Workforce Task Force.

OBJECTIVE: The USA needs to produce more psychiatrists to meet projected workforce deficits. The American Association of Directors of Psychiatric Residency Training Directors (AADPRT) sought to examine opportunities for and obstacles to expanding or creating residencies and fellowships. METHODS: In November 2019, the authors conducted a survey of residency and fellowship directors. The survey gathered information about new positions, new programs, participation in interprofessional education, and loss of residency or fellowship positions. RESULTS: The survey was distributed to psychiatry residency (N=231) and fellowship (N=194) directors, with a response rate of 33.4%. One quarter of responding residencies and fellowships reported creating new programs; 24.7% of residency and 17.5% of fellowships reported expansion. The most common reason to develop or expand programs was the shortage of psychiatrists, with the local institution as the most common funding source. Fifty-seven percent reported that they had wanted to expand, but faced barriers, primarily lack of funding. Recruitment and retention of faculty are major challenges. Psychiatry departments frequently (87.5%) participate in interprofessional education, generally perceived as positive. Unfortunately, 15.7% of respondents reported loss of positions or closure of programs. CONCLUSIONS: Creating and expanding residencies and fellowships are common strategies for addressing the shortage of psychiatrists. Barriers include lack of funding and challenges recruiting/retaining faculty. The loss of residency/fellowship positions or closure of programs is a worrisome trend.

The Impact of Mental Illness Disclosure in Applying for Residency.

OBJECTIVE: Medical students have higher rates of depression than age-matched peers. Given the societal stigma against mental illness, students with depression often seek guidance on disclosing this in residency applications. This study aimed to answer whether disclosing a mental illness during the residency application process affects an applicant's success in the National Resident Matching Program. The authors hypothesized candidates disclosing mental illness would receive fewer interviews and would be ranked lower than those disclosing physical illness. METHODS: The authors randomized program directors from residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) to receive one of two surveys. Both surveys included similar demographic information and three applicant vignettes, varying only in presence and type of illness disclosed (major depression or diabetes mellitus). The authors analyzed data using the Generalized Estimating Equation method for ordinal logistic regression. RESULTS: Out of 3838 ACGME residency programs, 596 responded (16.9%). A total of 380 (10.7%) program directors (survey 1, n = 204, 5.3%; survey 2, n = 176, 4.6%) completed the survey. Applicants who disclosed a history of depression had higher odds of being in a lower category of receiving an invitation (OR = 3.60, p < .001 for a "perfect" applicant, OR = 2.39, p < .001 for a "good" applicant with leave of absence) and a lower category for match ranking (OR = 1.94, p = .01 for a perfect applicant, OR = 2.30, p < .001 for a good applicant with leave of absence) compared with the candidate who disclosed a history of diabetes. However, strong applicants who disclosed depression still fared better in the application process than an average applicant without disclosed illness (OR = 0.13, p < .001 for invite and OR = 0.04, p < .001 for rank). CONCLUSION: Disclosing depression during the residency application process puts an applicant at a notable, however not insurmountable, disadvantage compared with applicants who do not disclose mental illness.

Suicide Symposium: A Multidisciplinary Approach to Risk Assessment and the Emotional Aftermath of Patient Suicide.

Introduction: The loss of a patient to suicide is a common experience among mental health practitioners and trainees. Research suggests that younger, less experienced clinicians are often most keenly affected by the experience. Given the prevalence of patient loss to suicide and the subsequent emotional aftermath, our goal in creating a multidisciplinary suicide symposium was to provide a safe, structured environment where trainees and mental health practitioners could obtain collegial support and education to reduce the stigma surrounding patient suicide. Methods: Mental health trainees and practitioners (including medical students, nurse practitioner students, psychiatry residents, psychology interns, and practicing psychologists and psychiatrists) were invited to a 4-hour symposium. The curriculum focused on assessment of risk and possible interventions, as well as addressing the loss of a patient to suicide. Teaching methods included a PowerPoint lecture; case-based, small-group discussion; and role-play. Attendees completed numbered, anonymous surveys looking at attitudes about loss and suicide before and after the symposium. Results: Of 35 total attendees, 22 completed both pre- and postsymposium surveys. Paired t tests revealed several statistically significant increases, including increases in comfort seeking support from a colleague after losing a patient to suicide (p = .043) and comfort seeking support from a professional after losing a patient to suicide (p = .030). Discussion: The symposium appears to have had the desired effect of increasing attendees' comfort working with patients at risk for suicide, as well as their comfort reaching out for support from others following the loss of a patient to suicide.

Suicide prevention and postvention resources: what psychiatry residencies can learn from the Veteran's Administration experience.

Suicide risk assessment and coping with the loss of a patient through suicide are two of the more challenging aspects of psychiatry residency. Over the last decade, the Department of Veterans Affairs has focused on a significant effort into the development of a comprehensive suicide prevention. This article aims to describe the initiatives and resources in place at the VHA to help address the issue of suicidal behavior in veterans and how residency programs can use this to enhance teaching of suicide prevention and postvention.