Craigan Usher

'Paging' child and adolescent psychiatrists: Reviewing the developmental canon

w i t w a g a a l e t p n W hile reading children’s literature in our training program, my colleagues and I discovered that Katniss Everdeen, Bella Swan, and “Some Pig” are outstanding child psychiatric educators. Therefore, our novel approach to training includes a bookstore field trip, where we pair a faculty member from child and adolescent psychiatry who teaches development with a children’s literature expert. At the conclusion of this tour, we require child and adolescent psychiatry residents to read and review at least one children’s or young adult novel. We do this exercise to reinforce the power of fantasy and literature in the lives of the young people and parents with whom we work, to immerse child and adolescent psychiatry residents in the world of their patients, and because stories written for and about children and teens provide longitudinal “case” material, which can be essential for physicians in training who may have worked with children and families for only days or weeks and thus may not readily recognize links among the past, present, and future. During our tour, we stop first at infant board books. Here, among copies of The Very Hungry Caterpillar and Good Night, Gorilla, we discuss the importance of primary caregivers taking time to read with their young children, noting that literacy correlates with book exposure and child– parent interaction. We also read a book aloud, watch children and parents do this in the infant/ toddler area, and explore the skills fostered and benefits derived from the experience of reading together—including physical intimacy, shared attention, the softening of a parent’s voice as he moves from talking mode to reading mode, and the stimulation of curiosity. When we move to books meant for toddlers and preschoolers, the residents begin to reflect on their own childhoods and those who are also parents on their experiences reading to their own

A Peace of Advice

G researched foundation from which an authority on a topic began. It pays to be vigilant for those moments when, for example, an empirically grounded grand rounds presentation turns into grandiose rounds. This is particularly true of books. Over hundreds of pages, readers can easily find themselves swayed by advice that starts close to “the evidence” but, again without the author making note of it, draws more and more on the writer’s opinion. Often this means explaining all phenomena in a manner that fits with the author’s strong central thesis. It can be difficult to find books that offer advice to parents that avoid the trap of moving from fact to—if you’ll pardon the neologism— factpinion. This month our reviewers address precisely this concern as they reflect on books about adolescent risk-taking, attention-deficit/hyperactivity disorder (ADHD) and epigenetics, and screen time. The reviewers note, in different ways, that the authors of these three works avoid bombast and submit that parents may find peace of mind in their pages. First, academic pediatrician Suzy Tomopoulos provides her perspective on National Public Radio lead education blogger, Anya Kamenetz’s The Art of Screen Time. Tomopoulos lauds Kamenetz’s effort as being by no means heavy-handed, but instead delightfully delicate, a foundation which parents may “find a media strategy that will work for their own family.” Kamenetz’s main advice is similar to what Michael Pollan has said of food: “Enjoy screens; not too much, mostly together.” In her review of Jess Shatkin’s Born to Be Wild: Why Teens Take Risks, and How We Can Help Keep Them Safe, neuroscientist Anita Cservenka appreciates the way the author announces his methodology in combining “personal experiences and relatable stories to explain how underlying

Meals, Mindfulness, & Moving Forward: A Feasibility Study to a Multi-Modal Lifestyle Approach in Early Psychosis

The primary aim was to demonstrate adherence to a novel 6‐week lifestyle intervention program (“Meals, Mindfulness, & Moving Forward” [M3]) designed to help improve lifestyle practices of youth with a history of at least 1 psychotic episode.

Lessons from the Launch: Program Directors Reflect on Implementing the Child and Adolescent Psychiatry Milestones

Beginning in July 2014, the Accreditation Council for Graduate Medical Education (ACGME) required all psychiatry residency programs in the USA to implement milestonebased assessments as a critical component of the Next Accreditation System (NAS). Milestones are competencybased developmental outcomes (i.e., knowledge, skills, attitudes, and performance) that a trainee is expected to progressively attain over the course of training [1]. The new milestone-based assessment was derived from the ACGME’s original six core competencies of patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills, which are assessed among all medical specialties. The ACGME Psychiatry Milestone Working Group developed 22 sub-competencies for assessment within general psychiatry. A year later, the Child and Adolescent Psychiatry (CAP) Milestone Working Group derived 21 CAP-specific sub-competencies from those established for general psychiatry.Within each sub-competency are five levels, each of which details specific milestones that are achieved before one progresses to the next level. This national approach to assessment was developed to ensure that residents and fellows in graduate medical education are capable of independently providing high-quality, safe patient care upon completion of training [2]. Prior to the formal July 2014 implementation, there were publications describing the purpose and intent of the Psychiatry Milestones Project, the development process, potential evaluation tools and techniques to assess milestone acquisition, and a resident perspective on the potential utility of milestones [3–5]. Since implementation of the milestones, some educators have raised concerns about whether the shift to milestone-based assessments was premature. One concern is that the milestones were based solely on consensus expert opinion in the absence of empirical evidence of their validity in assessing meaningful markers of psychiatric competence that actually translate to positive patient outcomes. Another

What we Talk about when we Talk about Supervision: The Clear and the Confusing in Graduate Psychiatric Education.

NP7 and now, on conscious and unconscious levels. Family and individual work have often seemed at odds with each other, perhaps in part because we have not been able to articulate and measure an individual’s pathology in the light of the family’s developmental needs. The Dynamic Family Functioning Instrument attempts to bridge that gap, measuring how family work can complement or enable an individual’s work in therapy.