Physician homicide: Reports in the National Violent Death Reporting System (2003-2018).

OBJECTIVE: To explore the occurrence, demographics, and circumstances of homicides of physicians. METHOD: Authors interrogated the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention's surveillance system tracking violent deaths between 2003 and 2018 which integrates data from law enforcement and coroner/medical examiner reports. Authors identified cases of homicide decedents whose profession was physician, surgeon, or psychiatrist. Data collected included decedents' demographics as well as circumstances of death. RESULTS: Data were provided by 7-41 states as participating states increased over time. Fifty-six homicides were reported, most were male (73.2%) and white (76.8%). Most (67.9%) identified assailants reportedly knew decedents: 23.2% were perpetrated by partners/ex-partners; 10.7% by patients/patients' family members. Deaths were mainly due to gunshot wounds (44.6%), stabbing (16.1%), and blunt force trauma (16.1%). More (58.9%) homicides occurred at victims' homes than work (16.1%). CONCLUSIONS: Physician homicides are relatively rare and occur at lower rates than in the general population. Physicians were more frequently killed by partners or ex-partners than by patients. Most homicides occurred away from the workplace. Broader efforts are needed to promote interventions throughout America's violent society to reduce domestic/partner violence and gun violence.

Psychologists and Integrated Behavioral Health Simulation Training: A Survey of Medical Educators and Perspectives of Directors of Clinical Training.

It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.

Homicides of psychologists, physicians, nurses, pharmacists, social workers, and other health professionals: National Violent Death Reporting System data 2003-2020.

OBJECTIVE: Homicide is the extreme endpoint along the continuum of interpersonal violence. Violence in healthcare settings and directed toward healthcare workers has been a growing concern. Analysis of health professionals' homicides is needed to inform prevention interventions. METHODS: Decedent numbers, age, and sex in the National Violent Death Reporting System are reported for 10 types of health professionals: advance practice registered nurses, dentists, nurses, pharmacists, physicians, physician assistants, psychiatrists, psychologists, social workers, and veterinarians. RESULTS: Between 2003 and 2020, 944 homicides of these professionals were reported to the NVDRS. Nearly 80% of victims were women; 53% of homicides involved guns. Nurses, social workers, physicians, and pharmacists comprised the most victims. In 2020, nurses, social workers, pharmacists, and psychologists had the highest homicide rates relative to their workforce size. Few of these homicides were related to professionals' work. The number of homicides within these professions correlated highly with the size of professions' workforces. CONCLUSIONS: Health professionals' homicides constitute a small proportion of US homicides generally at lower rates than seen in the general population. Age is likely one of the protective factors. Future, more comprehensive data will provide greater insights into emerging trends to inform strategies to mitigate homicide risk in health professionals. Prevention needs to go beyond healthcare settings and address societal roots of violence.

Interprofessional Education in Psychology Doctoral Programs, Internships, and Postdoctoral Training: A Survey of Training Directors.

Interprofessional Education (IPE) is intended to prepare health professionals for teambased care. Little is known about IPE offerings for psychology trainees. The article reports on a survey of training directors (263) from graduate school, internship, and fellowship programs about IPE in a 39-item survey. Most programs have IPE activities across 17 types (e.g., classroom didactics, IP team care, Grand Rounds, simulations, etc.), though 34% reported no or poorly coordinated IPE. Barriers included limited funding/protected time and conflicting student schedules. Resources needed for implementing IPE included incorporating IPE into clinical settings, curricular materials, and evaluation tools. Only 15% felt institutional leadership considered IPE a high priority. Training directors need leadership engagement and support, protected time, and administrative support as well as faculty development for event design and facilitation skills. This study is an exploratory first step, more granular investigation of quality and quantity of IPE from training directors' perspectives is needed.

Suicide and homicide deaths of PAs: Analysis of the National Violent Death Reporting System.

OBJECTIVE: This study describes physician associate/assistant (PA) deaths in the US CDC's National Violent Death Reporting System (NVDRS) from 2003 to 2020. METHODS: PAs' violent deaths were analyzed and summarized in terms of decedents' numbers and demographics, methods of death, locations of death, and relationships with assailants. RESULTS: The NVDRS identified 93 suicides and 9 homicides in this period. PAs who died by suicide were mostly White (93.5%) and male (67.7%); mean age was 49.7 years. A third of the PAs who died by homicide were Black; most were female (55.6%), and the mean age was 48.7 years. Firearms (41.7%) were most commonly involved in deaths by suicide, and blunt impact (33.3%) was most commonly seen in deaths by homicide. A plurality (46.1%) of suicides and homicides occurred in the South. Homes (72.5%) were the most frequent location. No homicides were reported in medical settings. Known perpetrators were mainly relatives and male; none were patients. CONCLUSIONS: Incidence of PA death by suicide or homicide is low relative to the general population. These deaths generally are not related to PAs' work. Delineating the incidence of violent deaths is a step toward informing preventive efforts.

Sabbaticals in US Medical Schools.

BACKGROUND: Sabbaticals are an important feature of academia for faculty and their institutions. Whereas sabbaticals are common in institutions of higher learning, little is known about their role and utilization in US medical schools. This perspective piece examining sabbaticals in medical school faculty was undertaken at a time that well-being of health professionals was increasingly being recognized as a workforce health priority. METHODS: We surveyed associate deans at US medical schools in 2021 about faculty who had taken sabbaticals within the past 3 years, the parameters of the sabbaticals, and institutional policies and respondents' predictions of future sabbatical use. RESULTS: A total of 53% of respondents reported any faculty had taken sabbaticals in the past 3 years (M = 6.27; Median = 3; range = 1-60). Institutions rated enhancing research as the most important objective, while recognizing other benefits. Sabbaticals were more commonly taken by male, white, senior faculty PhDs. Details about sabbaticals, including eligibility, expectations, length, financial support, and benefits were reviewed. Most (54.8%) respondents expected no change in the number of faculty seeking sabbaticals. Nearly all anticipated the COVID-19 pandemic would not affect sabbatical policies. CONCLUSION: In contrast to other institutions of higher learning, sabbatical-taking by medical school faculty is rare. We explore factors that may contribute to this phenomenon (eg, the tripartite mission, faculty clinical responsibilities, culture of medicine, and student debt). Despite financial and other barriers, a closer look at the benefits of sabbaticals is warranted as a mechanism that may support faculty well-being, retention, and mental health.

Suicides of psychologists and other health professionals: National Violent Death Reporting System data, 2003-2018.

Suicide is a prevalent problem among health professionals, with suicide rates often described as exceeding that of the general population. The literature addressing suicide of psychologists is limited, including its epidemiological estimates. This study explored suicide rates in psychologists by examining the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention's data set of U.S. violent deaths. Data were examined from participating states from 2003 to 2018. Trends in suicide deaths longitudinally were examined. Suicide decedents were characterized by examining demographics, region of residence, method of suicide, mental health, suicidal ideation, and suicidal behavior histories. Psychologists' suicide rates are compared to those of other health professionals. Since its inception, the NVDRS identified 159 cases of psychologist suicide. Males comprised 64% of decedents. Average age was 56.3 years. Factors, circumstances, and trends related to psychologist suicides are presented. In 2018, psychologist suicide deaths were estimated to account for 4.9% of suicides among 10 selected health professions. As the NVDRS expands to include data from all 50 states, it will become increasingly valuable in delineating the epidemiology of suicide for psychologists and other health professionals and designing prevention strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Interprofessional Education: Current State in Psychology Training.

Healthcare reform has led to the consideration of interprofessional team-based, collaborative care as a way to provide comprehensive, high-quality care to patients and families. Interprofessional education is the mechanism by which the next generation health professional workforce is preparing for the future of health care-team-based, collaborative care. This literature review explored the extent and content of published studies documenting Interprofessional Education (IPE) activities with psychology trainees across learner level. A systematic review following PRISMA guidelines was conducted of studies describing IPE involving psychology learners. Electronic databases (MEDLINE, CINAHL, PsychINFO, and EMBASE) were searched for the following terms: inter/multi-professional education/practice, inter/multidisciplinary education/practice, and psychology/psychologists. Thirty-seven articles were identified that included psychology in clinical outcome studies or other reviews of interprofessional education initiatives. The review addresses the nature of current IPE learning activities, the impact of IPE activities on participating trainees, opportunities for, and challenges of, involving psychology trainees in IPE, and future directions for research. This review illuminates the relative paucity of the literature about IPE in psychology training. Given the trend toward increasing team-based collaborative care, the limited inclusion of psychology in the IPE literature is concerning. The next generation of health professional trainees is learning about, from, and with each other with the objective of building collaboration and teamwork. Given the few articles documenting psychology trainees' involvement in IPE, future health professionals quite possibly will have limited understanding of, and contact with, psychologists. Our findings are a call to action for greater psychology involvement in IPE.

Psychologist homicide victims: The National Violent Death Reporting System and other sources.

OBJECTIVE: Homicide of healthcare workers has been reported but little is known about psychologists as victims of homicide. This study aimed to investigate what is known about homicide of psychologists. METHODS: The Centers for Disease Control and Prevention's National Center for Injury Prevention and Control's National Violent Death Reporting System (NVDRS) provides insights into violent deaths, including homicide. This study interrogated the NVDRS and conducted Internet searches about psychologist decedents of homicide. RESULTS: Between 2003 and 2018 the NVDRS identified 12 psychologist homicides. Internet searches revealed 15 psychologist homicides. Only three (11.1%) were known to have been killed by current or former patients. Another was by a colleague's patient. Another assailant was suspected to be a patient. We summarize patterns and circumstances of deaths, address issues related to violence in healthcare, and review selected resources addressing violence prevention. CONCLUSION: Psychologists, like other health professionals, may be victims of homicide. Such deaths have diverse contributing factors and are rarely perpetrated by patients. As concern about health professional safety mounts and the NVDRS becomes better established, it will hopefully become a more sensitive, precise, comprehensive and useful mechanism for tracking trends in violent deaths of psychologists and other health professionals and ultimately inform preventative strategies.

Depression, Quantified Medication Adherence, and Quality of Life in Renal Transplant Candidates and Recipients.

Like patients with many chronic illnesses, ESRD patients experience psychological challenges with greater incidence of depression and reduced quality of life (QoL). A series of 139 transplant candidates' depression and QoL, and a subset of 82 candidates' medication adherence were monitored, revealing heterogenous patterns of depression and adherence and reduced QoL. Twenty-eight patients who received kidney transplants were re-evaluated 6 months post-transplant revealing mixed patterns. Mean depression and quantitated adherence decreased and QoL increased. Some patients improved whereas others declined in depression and adherence. Pre-transplant depression was negatively correlated with post-transplant adherence but positively correlated with post-transplant depression. Nevertheless, the ability to predict individuals' post-transplant adherence and depression, principal objectives of pre-transplant psychological evaluations, is limited. Consequently, it is important to provide periodic screening of ESRD patients for depression and adherence pre- and post-transplant as they reflect changing states, rather than static traits, with variable patterns across patients.

Patterns of Psychologists' Interprofessional Collaboration Across Clinical Practice Settings.

Healthcare increasingly emphasizes collaborative treatment by multidisciplinary teams. This is the first research focusing on psychologists' participation in team-based care, the mix of professionals with whom psychologists collaborate, and how these collaborations vary across practice settings. Data are from 1607 respondents participating in the American Psychological Association Center for Workforce Studies' 2015 on-line Survey of Psychology Health Service Providers. Practice settings differed markedly in systemic organizational support for interprofessional collaboration and in psychologists' participation in collaborative activities. Psychologists in individual private practice reported least support for and least occurrence of interprofessional collaboration. Psychologists' collaboration with non-behavioral health professionals, such as non-psychiatrist physicians and nurses, was more frequent in general hospitals and VA medical centers. Across settings, greater contact with another health profession was generally associated with psychologists being more confident about working with that profession. However, for work with psychiatrists, that association was attenuated. A collaborative practice model is presented for psychotherapy patients also treated by physicians or other professionals who manage a patient's psychotropic medication.

Psychologists' Contributions to Medical Education and Interprofessional Education in Medical Schools.

Recognition of the importance of behavioral and psychological phenomena has grown. Patients and physicians are receptive to psychological insights and processes in health and healthcare. Psychologists serve in diverse roles in medical schools, spanning activities such as didactics, rounds, precepting, supervising, mentoring, participating in educational projects, directing courses, and serving on educational committees. They address multiple content areas fundamental to medicine. Their participation in medical education and professional development activities for faculty are well-regarded. As healthcare becomes more interprofessional, with services delivered via interprofessional teams, opportunities for psychologists to contribute to, and play leadership roles in, interprofessional education (IPE) are expanding. It is critical that psychologists seize them. This article reviews psychologists' historic roles in medical education and provides a snapshot of their educational, faculty development, and IPE activities based on the 2017 survey of members of the Association of Psychologists in Academic Health Centers and their colleagues.

Academic Psychiatry Department Names: Reflections on Research, Practice, and Education.

OBJECTIVE: Medical schools' departments reflect changes in health care and medical school organization. The authors reviewed psychiatry department name categories associated with school age, research, and primary care focus. METHODS: Department names were identified and categorized for US allopathic and osteopathic medical schools. A multinomial regression model analyzed the relationship between department name category and established year, adjusted for school type. Fisher's exact tests analyzed the relationships between name category and research/primary care foci. RESULTS: Among 147 allopathic schools, 52% had departments with names limited to psychiatry, 42% had names with psychiatry plus other terminology, and 5% had no identified psychiatry department. In 34 osteopathic schools, 12% had psychiatry departments, 12% had departments named psychiatry plus other terminology, and 75% had no identified psychiatry department. Age of school was related to departmental name: for a 1-year increase in the school's established year, the odds of having a department name other than psychiatry were 1.02 times the odds (p < 0.001) of having the name psychiatry. Newer schools were less likely to have departments with "psychiatry" in their name. Associations were found between department name and research and primary care rankings. CONCLUSIONS: Variability in the names of psychiatry departments in medical schools may suggest changing views within and about academic psychiatry. The limited presence of formal psychiatry departments in newer schools raises questions about psychiatry's impact on educational pathways, the future workforce, and participation in schools' research mission and clinical enterprise.

Serum Urate Lowering with Allopurinol and Kidney Function in Type 1 Diabetes.

BACKGROUND: Higher serum urate levels are associated with an increased risk of diabetic kidney disease. Lowering of the serum urate level with allopurinol may slow the decrease in the glomerular filtration rate (GFR) in persons with type 1 diabetes and early-to-moderate diabetic kidney disease. METHODS: In a double-blind trial, we randomly assigned participants with type 1 diabetes, a serum urate level of at least 4.5 mg per deciliter, an estimated GFR of 40.0 to 99.9 ml per minute per 1.73 m2 of body-surface area, and evidence of diabetic kidney disease to receive allopurinol or placebo. The primary outcome was the baseline-adjusted GFR, as measured with iohexol, after 3 years plus a 2-month washout period. Secondary outcomes included the decrease in the iohexol-based GFR per year and the urinary albumin excretion rate after washout. Safety was also assessed. RESULTS: A total of 267 patients were assigned to receive allopurinol and 263 to receive placebo. The mean age was 51.1 years, the mean duration of diabetes 34.6 years, and the mean glycated hemoglobin level 8.2%. The mean baseline iohexol-based GFR was 68.7 ml per minute per 1.73 m2 in the allopurinol group and 67.3 ml per minute per 1.73 m2 in the placebo group. During the intervention period, the mean serum urate level decreased from 6.1 to 3.9 mg per deciliter with allopurinol and remained at 6.1 mg per deciliter with placebo. After washout, the between-group difference in the mean iohexol-based GFR was 0.001 ml per minute per 1.73 m2 (95% confidence interval [CI], -1.9 to 1.9; P = 0.99). The mean decrease in the iohexol-based GFR was -3.0 ml per minute per 1.73 m2 per year with allopurinol and -2.5 ml per minute per 1.73 m2 per year with placebo (between-group difference, -0.6 ml per minute per 1.73 m2 per year; 95% CI, -1.5 to 0.4). The mean urinary albumin excretion rate after washout was 40% (95% CI, 0 to 80) higher with allopurinol than with placebo. The frequency of serious adverse events was similar in the two groups. CONCLUSIONS: We found no evidence of clinically meaningful benefits of serum urate reduction with allopurinol on kidney outcomes among patients with type 1 diabetes and early-to-moderate diabetic kidney disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; PERL ClinicalTrials.gov number, NCT02017171.).

Psychologists' Practices, Stressors, and Wellness in Academic Health Centers.

Burnout has been identified as widely prevalent in physicians and other health professions. However, relatively little has been written about burnout in psychologists. The current study reviews the literature investigating professional wellness, sources of stress, and burnout in practicing psychologists. Based on a survey of members of the Association for Psychologists in Academic Health Centers' (n = 93), stress levels, burnout, and work satisfaction in health service psychologists in academic health centers (AHCs) were examined. Respondents indicated some level of burnout ranging from having no symptoms (8%) to being occasionally stressed (59%), symptoms won't go away (12%), definitely burning out (18%), or being completely burned out (3%). Most respondents described working at high levels, including "at full capacity" (41%) or being "over-extended" (39%). Despite these concerns, most respondents indicated satisfaction with their positions (42% "very satisfied," 44% "somewhat satisfied") and recommended careers as psychologists in medical settings (50% strongly; 34% moderately). Most commonly perceived sources of stress included clinical load, salary, insufficient protected time for research, teaching, education, and supervision, insufficient psychologists to meet the need, and non-billable clinical activities. Consistent with the physician literature, workload was associated with burnout and burnout was associated with decreased professional satisfaction. The current study narrows the gap in the literature on the stress psychologists experience in AHCs and explores findings within the broader literature about health professional burnout. Greater understanding is needed about factors that affect burnout in health service psychologists, identification and modification of risk factors, and prevention strategies.

Medication adherence is associated with an increased risk of cancer in kidney transplant recipients: a cohort study.

Background: Nonadherence to posttransplant immunosuppressive medication is associated with increased rates of rejection and graft loss, yet it is unknown to what degree ideal adherence is associated with the sequelae of overimmunosuppression. Specifically, we questioned whether excellent adherence increased the posttransplant cancer risk. Methods: Between August 1998 and August 2006, 195 consenting kidney transplant recipients had electronic monitoring of theirimmunosuppressive medication adherence. Results: Based on their average quantitative adherence to a single immunosuppressant drug over the first 6 months posttransplant, recipients were grouped into adherence tertiles (highest, >97.9% adherence; middle, 91-97.8%; lowest, <91%). The cumulative incidence of cancer was calculated for patients in each tertile, treating death as a competing risk. The association between adherence and cancer rate was calculated after adjusting for recipient risk factors, using a competing risk proportional hazards model. The median duration of follow-up was 10.1 years. The 10-year estimated cumulative cancer incidence was 59.4% in the most adherent, 36.1% in the middle group and 38.1% in the least adherent group (P = 0.006). Excluding nonmelanocytic skin cancers, cancer incidence remained significantly higher in the highest adherence group (P = 0.002). Conclusions: These data provide additional support for the need to individualize immunosuppression to minimize both rejection and immunosuppressive drug-related complications including cancer.

Managing Difficult Patients: Roles of Psychologists in the Age of Interdisciplinary Care.

Various problems can occur during encounters between health providers and patients. In some instances, clinicians attribute these problems to patients being "difficult." However, clinicians' perception of difficulties in the clinical encounter are also influenced by: clinicians' own attitudes, thoughts, and behavior; the specific setting in which patient and clinician interact; and properties of the healthcare organization in which they are embedded. This article explores how psychologists in medical settings can serve as a resource that: improves patient care for difficult patients; supports provider wellness; provides relevant education to clinical providers; and reduces the stress that difficult patients place on the healthcare system. The definition, scope, and impact of difficult patients in healthcare settings are reviewed, including an examination of patient, clinician, and systems factors that contribute to the etiology of difficult clinical encounters. Strategies are discussed that may prevent or limit the adverse impact of difficult patients in healthcare, with special emphasis on the roles of psychologists in interprofessional healthcare teams.