Cheryl S. Al-Mateen

The Muslim child, adolescent, and family

This article reviews the basic tenets of Islam, the second-most populous religion in the world. The practice of Islam can be affected by ethnic and cultural factors; therefore, the influence of various cultures (such as Arab, Pakistani, and African American) as seen in practice with Muslim children and their families is discussed.

Psychiatry Clerkship Students’ Preparation, Reflection, and Results on the NBME Psychiatry Subject Exam

ObjectivePsychiatry clerkship training involves many learning components, one of which is acquisition of scholarly knowledge. The authors investigate the reading materials and learning methods used by clinical clerks in their preparation for the National Board of Medical Examiners (NBME) Psychiatry Subject Exam (PSE).MethodsClerkship students from six U.S. medical schools who had recently completed their psychiatry clerkship and PSE were surveyed regarding reading material use, teaching methods encountered, and other relevant resources which may have influenced their PSE scores.ResultsThe most frequently used PSE preparation material was a “step-or-prep” book, followed by practice questions, handouts and assigned texts. No single preparation material type or combination proved significantly different in influencing PSE scores. The didactic methods used in clerkships did differ significantly in their influence on PSE scores. Students in the top quartile used slightly more books and different combinations of books than students in the bottom quartile.ConclusionStudents exhibited several trends in their preparation for the PSE. The most striking findings were the heavy student reliance on step-or-prep books over other learning resources and that step-or-prep books did not demonstrate significance as a superior preparation resource for the PSE. These trends in third-year psychiatric rotations have important implications for medical student education.

A 2-year Progress Report of the AACAP-Harvard Macy Teaching Scholars Program

ObjectiveThe American Academy of Child and Adolescent Psychiatry (AACAP) has partnered with the Harvard Macy Program for Healthcare Educators so that selected child and adolescent psychiatry academic faculty might enhance their teaching expertise in order to possibly enhance recruitment of medical students into child and adolescent psychiatry.MethodsThirteen child psychiatry faculty have graduated from the AACAP-Harvard Macy Teaching Scholars Program (HMTSP). There are 10 additional child and adolescent psychiatry faculty members in the process of completing the program. A survey was created to broadly assess the effect of the AACAP-HMTSP training on the first 13 graduates of the program as a pilot to guide future study of the program. Three teaching scholars who are the first authors of this article (JH, DS, MH) conducted this survey and the data interpretation for this study.ResultsThirteen of the scholars submitted responses to the survey. All participants indicated a high degree of satisfaction with the HMTSP and with the overall usefulness of the concepts learned. All but one of the scholars reported that the program enhanced their teaching effectiveness. The scholars reported increased teaching of medical students (9 of 13) and psychiatry residents (6 of 13) after the HMTSP.ConclusionThe AACAP-Harvard Macy Teaching Scholars reported high levels of satisfaction with the overall program. Whether the reported increase in medical student and psychiatry resident mentoring and teaching will eventually lead to increased medical student recruitment into child and adolescent psychiatry remains to be determined.

Vicarious Traumatization and Coping in Medical Students: a Pilot Study

ObjectiveThis study explored the impact of traumatic experiences on medical students during their clerkships.MethodsMedical students completed an anonymous online survey inquiring about traumatic experiences on required clerkships during their third year of medical school, including any symptoms they may have experienced as well as coping strategies they may have used.ResultsTwenty-six percent of students reported experiencing vicarious traumatization (VT) during their third year of medical school.ConclusionsThe experience of VT in medical students is relevant to medical educators, given that the resulting symptoms may impact student performance and learning as well as ongoing well-being. Fifty percent of the students who experienced VT in this study did so on the psychiatry clerkship. It is important for psychiatrists to recognize that this is a potential risk for students in order to increase the likelihood that appropriate supports are provided.

Sexual Abuse and Perimenstrual Symptoms in Adolescent Girls

This study was designed to investigate the relationship between sexual abuse and perimenstrual symptoms in adolescent girls. Perimenstrual symptoms include somatic and affective complaints that occur immediately prior to and during menstruation. Patients from an outpatient adolescent health service completed questionnaires and structured interviews that elicited sexual abuse histories and perimenstrual symptomatology. Of the 68 girls enrolled in the study, 22 had a history of a forced sexual experience. No significant differences in retrospective or prospective reports of perimenstrual symptoms were found between the adolescent girls with and without a history of sexual abuse. Girls with a history of abuse had significantly more premenstrual symptoms than a control group of women reported in a normative study. They also had significantly more menstrual physical complaints than women with premenstrual syndrome or control group women.

Suicide Among African-American and Other African-Origin Youth

Children and youth in the United States descended from African ancestry are a heterogeneous group that may self-identify as Black or African-American. Those who have immigrated to the United States are primarily of African or Caribbean origin. While this group is socioeconomically diverse as well, the existing literature has focused on urban poor youth, who are often at higher risk for sociocultural stressors such as community violence. Historically, Black youth have had lower rates of suicide, but this dramatically increased in the 1980s and 1990s, despite a decrease in European-American youth. It is currently the third leading cause of death for Black youth ages 15–24. Unique risk factors include the impact of discrimination and acculturative stress. This chapter will review the literature regarding risk and protective factors as well as interventions in this population. A case will be presented to illustrate the concepts.

Clinician Response to a Child Who Completes Suicide

Although suicide is a leading cause of death for children and adolescents, there is a dearth of literature on clinician responses to suicides in that age group. However, most psychiatrists experience the death of a patient by suicide, with resulting grief reactions including shock, isolation, rumination, self-doubt, and impact on clinical decision making. The impact is more pronounced in trainee clinicians. Postvention is the clinical, administrative, legal, and emotional processes following a suicide. These processes are discussed in detail, with recommendations for policies and training that assist clinicians with this tragic, but common, professional crisis.

Inpatient Psychiatric Hospitalization

Inpatient hospitalization among African American youth has come under heightened scrutiny in recent years because of increased cost, the restrictive nature of the treatment, and the fact that hospitalized youth are at greater risk of rehospitalization within a few weeks of discharge. Furthermore, evidence suggests that African American and other minority youth are more frequently psychiatrically hospitalized rather than receive other less restrictive evidence-based treatments. Because aggression and impulsivity are the two primary reasons for presentation to emergency and inpatient psychiatric services, many clinical issues are overshadowed by the prominence of these externalizing symptoms. There are individual and societal factors that contribute to the overutilization of inpatient treatment including underutilization of outpatient services. Stigma and access are additional key factors. Many African American youth grow up in neighborhoods where there is a paucity of mental health services. Although there is increased insurance coverage through the Affordable Care Act and the Children’s Health Insurance Program, there remains a deficiency of available providers in numerous localities that continues to restrict accessibility to care. This dearth of available services contributes to youth not receiving appropriate interventions, but also likely adds to the overutilization of hospitalization to the exclusion of other more effective and targeted treatments. Identification of African American youth with mental health issues is a challenge and, when identified, many youth receive diagnoses that are incorrect leading to treatment decisions that may not be in their best interest. Cultural incompetence has been acknowledged as a barrier to effective care. Research over the past 20 years chronicles the problems of incorrect diagnosis, overuse of antipsychotic medication, and how treatment is received in more restrictive placements. The use of evidence-based and culturally competent outpatient care will help us to correct this overutilization while making treatment recommendations that are more acceptable to this patient population.