Carol A. Bernstein

Burnout in medical students: a systematic review

Background  Burnout is a state of mental and physical exhaustion related to work or care‐giving activities. Distress during medical school can lead to burnout, with significant consequences, particularly if burnout continues into residency and beyond. The authors reviewed literature pertaining to medical student burnout, its prevalence, and its relationship to personal, environmental, demographic and psychiatric factors. We ultimately offer some suggestions to address and potentially ameliorate the current dilemma posed by burnout during medical education.

Normal Pressure Hydrocephalus Presenting as Othello Syndrome: Case Presentation and Review of the Literature

Normal pressure hydrocephalus (NPH), an obstruction in the normal flow of CSF through the subarachnoid space, typically presents with a classic “triad” of cognitive impairment, a gait disturbance, and urinary incontinence (1). The etiology of NPH includes subarachnoid spaceoccupying lesion or hemorrhage, chronic meningoencephalitis, changes following acute bacterial meningitis or spinal anesthesia, and carcinomatosis of the meninges (2). Usually, the underlying cause cannot be identified. Idiopathic NPH is clinically diagnosed in most patients during the sixth or seventh decade of life (3). The cognitive impairment in NPH most often manifests as subcortical dementia, though psychiatric and mood symptoms, most often depression, have been described. Most observations of psychiatric sequelae of NPH have been limited to case reports and have included frontal lobe symptoms such as apathy and akinetic mutism, as well as reports of mania, aggression, mood cycling, and psychosis (4–8). In this article, we report a case of NPH presenting as paranoid psychosis with delusional jealousy, otherwise known as the “Othello syndrome.” Case Presentation

Recruiting Researchers in Psychiatry: The Influence of Residency vs. Early Motivation.

BackgroundThe declining numbers of clinician-researchers in psychiatry and other medical specialties has been a subject of growing concern. Residency training has been cited as an important factor in recruiting new researchers, but there are essentially no data to support this assertion. This study aimed to explore which factors have influenced motivation to conduct research among senior psychiatry residents.MethodsThe authors surveyed senior residents, inquiring about their level of interest in research, demographics, background, research experiences, and factors influencing motivation for research. The authors had confirmed participation from 16 of 33 residency programs with a class size of 10 or more. They received 127 responses, a 67% response rate, from participating programs.ResultsResidents with high stated interest in research differed from those with low and moderate interest in their research-intense post-residency plans. They were more likely to have graduate degrees. Those planning research careers had a consistent pattern of interest and involvement in research, starting well before residency. The majority of residents had had research exposure in college, but research involvement of those with very high versus lower interest diverged sharply thereafter. Those with high research interest were overwhelmingly male and tended to have lower debt than those with less interest.ConclusionThe great majority of residents appear to have decided whether or not to pursue a research career by the time they reached residency, and few of those with less than the highest research interest were enrolled in research tracks. Efforts to increase recruitment into research should center on identifying early developmental influences, eliminating barriers specific to women, and ensuring adequate funding to provide secure careers for talented potential researchers.

Next generation of psychiatrists: What is needed in training?

Populations can be divided into generations. Each generation has its own characteristics and even though not every member of the same generation will share characteristics with other members of that generation, it is possible to identify generational differences. Generations frequently have different values and varying styles of functioning and learning. Since the Second World War, the generations can be divided into four cohorts: the Veterans, the Baby Boomers, Generation X, and the Millennials. Each generation has a collective identity and, in addition to understanding cultural and ethnic differences, these generational differences should also be taken into account in the teaching arena. Values and beliefs about work-life balance, learning styles, comfort with technology, methods of communication, and approaches to leadership are the types of parameters which vary across generations. As a result, medical educators would benefit from appreciating these differences in order to enhance the learning of medical students and residents and to better prepare them for delivering patient care in the twenty-first century. In this paper, the authors highlight some of the challenges and issues related to these generational divides.

Teaching “Global Mental Health:” Psychiatry Residency Directors’ Attitudes and Practices Regarding International Opportunities for Psychiatry Residents

ObjectiveThe authors surveyed Psychiatry Residency Training Directors’ (RTDs’) attitudes about the role and feasibility of international rotations during residency training.MethodA 21-question survey was electronically distributed that explored RTDs’ beliefs about the value, use, and availability of international clinical and research experiences during residency.ResultsOf 171 RTDs, 59 (34.5%) completed the survey; 83% of respondents rated the importance of global mental health education as 3- or- above on a scale of 1 (least important) to 5 (most important), but only 42% indicated that such opportunities were made available. The value of such opportunities was thought to lie primarily in professional development and cultural exposure, less so for enhancing core knowledge competencies. Obstacles to such opportunities included lack of accreditation, financial resources, and faculty/administrative support and supervision.ConclusionRTD respondents endorsed the value of international experiences during residency, but their availability and educational impact are not fully supported.

Impact of the Information Age on Residency Training: Communication, Access to Public Information, and Clinical Care

Access to technology in practice helps physicians manage information, communicate, and research topics; however, those in training receive almost no formal preparation for integrating web-based technologies into practice. One reason for this is that many faculty—aside from junior faculty or those in recent generations—did not grow up using Internet communication, may use it minimally, if at all, in their own practices, and may know little about its forms and varieties. This report presents a case to illustrate how these disparities may play out in the supervisory situation and makes suggestions about helping supervisors integrate technology-awareness into their teaching.

The Future of U.S. Psychiatric Education (According to Sisyphus)

In Greek mythology, “The Myth of Sisyphus” describes a man who was condemned to ceaselessly roll a rock to the top of a mountain only to have the stone fall back down again under its own weight after it reaches the top. Albert Camus wrote a commentary on the myth in which he suggested that “[the] rock is [the] thing,” and, therefore, since the rock is still rolling, this endless task is not drudgery, but a triumph, and it represents the struggle in which we all engage to make the world a better place (1). Depending on one’s point of view, “The Myth of Sisyphus” is a metaphor that illustrates either victory over the challenges that overwhelm us or capitulation in the face of a useless enterprise. Which image reflects the future of graduate medical education in the United States?

An Ounce of Prevention: A Public Health Approach to Improving Physician Well-Being

The physician workforce is facing a crisis, with increasing numbers of physicians reporting distress, career dissatisfaction, burnout, and depression [1, 2]. Impaired well-being is a pressing issue for physicians at all career stages, ranging from medical students to practicing physicians [3, 4]. However, residents are at particularly high risk, enduring long hours, and high stress, with little control over their lives [4]. Improving physician well-being has been identified as an urgent national priority within the medical community [5]. Numerous interventions to improve physician well-being have been proposed and described in the literature. However, many interventions have not been rigorously studied, and those that have, often report only small benefits [6]. It remains unclear how effective any single intervention will be in improving physician well-being on a large scale [7]. Furthermore, educators and administrators who seek to implement well-being interventions in their own institutions may be faced with a long list of potential options, with little guidance about how to choose. Should one implement mindfulness training or burnout screening? Balint groups or increased ancillary staff? Reducedfee mental health treatment or a coaching program? As with any complex public health issue, a comprehensive and integrated approach is needed in order to make a significant impact. To our knowledge, no clear conceptual model has yet been proposed in the literature to help better describe, categorize, and organize the myriad potential interventions available to promote physician well-being.

Responding to the Call for Improving Resident Wellness.

Academic Medicine, Vol. 91, No. 6 / June 2016 750 and providing valuable medical care. However, doctors are facing a modern health care environment that values efficiency over the doctor–patient relationship, metrics over quality of care, and bottom-line profits over physician wellness. It makes sense that under these conditions U.S. physicians are suffering more burnout than other American workers. What can leaders in the medical field do to combat this epidemic? I strongly believe that a national movement is necessary to address wellness and burnout early in training. Residency programs are well positioned to spearhead this effort during the earliest stages of a physician’s career.

An Intervention Framework for Institutions to Meet New ACGME Common Program Requirements for Physician Well-Being

In the past 5 years, increased attention has been focused on the issues relating to physician health and well-being, particularly among trainees [1, 2]. The mental health effects of medical training are becoming increasingly welldocumented, with high rates of burnout, depression, and suicide among residents, fellows, and physicians in practice [3, 4]. It has been reported that burnout rates are as high as 75% among residents [5] and that within 3 months of the start of internship, rates of moderate levels of depression climb from 4 to 26% and continue at that level throughout the year [6]. As institutions grapple with these disturbing trends, both burnout and depressionmust be addressed. Burnout is a workrelated syndrome characterized by emotional exhaustion, depersonalization, and sense of low personal accomplishment [7]. It is subtle and insidious and often resembles depression. Depression is a psychiatric illness characterized by low mood; tearfulness; alterations in sleep, appetite, concentration, and attention; feelings of guilt, hopelessness; and anhedonia. Both burnout and depression are independently related to increased risk for suicidal ideation [8, 9]. Burnout and depression in house staff also have direct effects on patient care. Residents suffering from burnout are more likely to self-report medical errors, and interns who meet screening criteria for depression are more likely to highlight the bureaucratic burdens of internship, disappointment with the teaching faculty, feelings of isolation, and uncertainty about career choice [10]. These experiences detract from the significant and meaningful patient interactions and the social support received during intern year that are described by interns without depression [10].