Jon A. Lehrmann

When Residents Need Health Care: Stigma of the Patient Role

ObjectiveWhether and under what circumstances medical residents seek personal health care is a growing concern that has important implications for medical education and patient welfare, but has not been thoroughly investigated. Barriers to obtaining care have been previously documented, but very little empirical work has focused on trainees who seek health care at their home institution.MethodsA self-report survey on special issues in personal health care of residents was created and distributed at the University of New Mexico School of Medicine in 2001. The authors report findings regarding stigma, fear of jeopardy to training status, and attitudes toward seeking self-care for residents in dual roles as patients and trainees.ResultsResidents (N = 155) rated their concerns regarding stigma and jeopardy to training status and the likelihood of seeking care at their training institution for six vignettes. The vignettes were paired to make comparisons between attending or supervisor as treating physician and between clinical scenarios. Alcohol abuse, nausea and diarrhea, panic attacks, and pregnancy were the most highly stigmatizing to residents; diabetes and hypertension were the least. Differences were also found for gender and specialty.ConclusionResidents’ perceived stigma for clinical situations was an influential factor, strongly affecting concern about jeopardizing training status and likelihood of avoiding care at their home institution.

Maintenance ECT for recurrent medication-refractory mania

Maintenance electroconvulsive therapy (ECT) can sometimes be the only treatment that yields extended periods of euthymia to patients with severe, treatment-resistant mania. We describe a case of a patient with recurrent and severe mania who responded acutely to ECT after failing various medication trials and could only maintain euthymia with maintenance ECT.

Medical Students’ Affirmation of Ethics Education

ObjectiveDespite the acknowledged importance of ethics education in medical school, little empirical work has been done to assess the needs and preferences of medical students regarding ethics curricula.MethodsEighty-three medical students at the University of New Mexico participated in a self-administered written survey including 41 scaled questions regarding attitudes, needs, and preferences toward medical ethics and ethics education.ResultsStudents reported strong personal interest in learning more about ethics in clinical medicine and research. They most strongly endorsed as valid objectives of ethics education the goals of helping professionals “better recognize ethical issues and clarify values-laden choices,” “improve patient care and clinical decision-making,” and “improve ethical practices in clinical research.” Participants strongly agreed that “professional attitudes and values are an appropriate focus for medical education” and also expressed strong interest in learning more about specific ethical topics and learning methods. Women more strongly endorsed interest in additional ethics education and a preference for increased ethics education than men. Preclinical participants expressed a greater desire for additional training on all ethics topics than clinical students.ConclusionThe medical students surveyed strongly affirmed ethics education in medical school and expressed clear preferences for curricular topics and teaching methods.

Personal Health Care of Residents: Preferences for Care Outside of the Training Institution

ObjectiveThe personal health care issues of residents are important but have received minimal study. Available evidence suggests that residents experience difficulties obtaining care, partly related to both the demands of medical training and concerns about confidentiality and privacy.MethodsA self-report survey was distributed in 2000–2001 to advanced residents at the University of New Mexico Health Sciences Center. Questions related to personal health and health care attitudes, behaviors, preferences, and experiences, and vignettes related to personal illness and treatment. Here the authors report findings regarding preferences for obtaining health care “at” versus “outside” of one’s training institution.ResultsData from 141 residents are presented. A substantial minority of residents had obtained care outside of their institution in the preceding year. Residents expressed concerns about their medical privacy and confidentiality related to obtaining care within their own institution, including concerns about being seen by other residents or by past or future attendings. Women expressed more concern than did men on numerous issues, as did residents in primary care versus specialty training. Residents expressed a preference for care outside the training institution when taking into account confidentiality and prevention of embarrassment; care at their own institution was preferred when considering expense and scheduling. Outside care was more strongly preferred for more stigmatizing illnesses (e.g., mental health-related). Most residents felt poorly informed regarding their personal health care confidentiality rights and did not know whether their institution had confidentiality policies regarding residents who develop physical or mental health problems.ConclusionResidents worry about confidentiality and privacy when deciding where to obtain personal medical care. Trainees’ concerns are relevant to crafting policies on resident health care. Programs should strive to inform residents thoroughly about policies and rights pertaining to personal health care.

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.

Leadership Considerations for Executive Vice Chairs, New Chairs, and Chairs in the 21st Century

The need to fulfill academic goals in the context of significant economic challenges, new regulatory requirements, and ever-changing expectations for leadership requires continuous adaptation. This paper serves as an educational resource for emerging leaders from the literature, national leaders, and other “best practices” in the following domains: 1. Mentorship; 2. Faculty Development; 3. Promotion; 4. Demonstrating value in each of the academic missions; 5.Marketing and communications; and 6. Barriers (see Table 1).

The Role of the Vice Chair for Education in Departments of Psychiatry

Increasingly, Departments of Psychiatry are appointing leaders for the education mission, typically called Vice Chairs or Associate Chairs for Education (hereafter referred to as VCE). However, little is known about how commonly Departments of Psychiatry have a VCE, the roles, responsibilities, and full-time equivalent effort (FTEE) associated with this position, or the advantages and disadvantages of having an individual in this role. In survey studies, VCEs in medicine, surgery, and radiology have described their responsibilities as being ill-defined and vague, but typically including oversight of educational programs, faculty development related to teaching and education, possessing educational expertise, promoting educational scholarship, and in some cases, developing and maintaining the department’s education budget [1–3]. VCEs in Departments of Surgery identified primary career development needs as the ability to develop resident selection systems, conduct educational research, and develop mentorship programs [2]. Sanfey et al. outlined career development resources for this group [4]. Job descriptions for the VCE have been proposed for Radiology [3] and Surgery [4]. Finally, Pangaro has suggested that the VCE can play an important role in the next phase of medical education, fostering a collaborative educational system within and across departments, grounded in educational theory and research [5]. In the current study, we explored the role of the VCE in Departments of Psychiatry by surveying two groups of key stakeholders, namely Chairs and general Psychiatry Residency ProgramDirectors (PDs), about the responsibilities and contributions of the Vice Chair and the advantages and disadvantages, to them and their departments, of having an individual in this position. This study was not designed to be a survey of VCEs.

Special collection: suicide awareness and prevention in psychiatric education: introduction and dedication

Charles E. Kubly died as a young man after struggling with severe and recurring depression for many years. Charlie’s mother, Billie, and father, Michael, with the full efforts of their family, have responded to this tragedy with passion and tremendous strength, actively and constantly working to improve the lives of those who struggle with depression. They established the Charles E. Kubly Foundation in 2003, and its mission is seeking “to better the lives of those affected by depression by increasing public awareness of the disease and its devastating effects, eliminating the stigma associated with it, supporting suicide prevention programs and promoting improved access to quality mental health resources within communities.” Through the Foundation’s competitive small grant program, the editor-in-chief, Laura Weiss Roberts, submitted a proposal for an issue of our journal to include a focus on education in psychiatry related to suicide, and this special collection of papers is the result. The editors thank Jon A. Lehrmann, M.D., the Charles E. Kubly Professor of Psychiatry and Behavioral Medicine of the Medical College of Wisconsin, who worked with us to create this collection. The Charles E. Kubly Foundation has raised over

How to Interview for a First Academic Position

1.3 million over the past 10 years and uses these funds to support diverse projects. Readers of the journal may wish to learn more by looking at the Foundation’s website, http:// charlesekublyfoundation.org/. A few examples of projects they have supported include an art education engagement program for high school students, a mental health summit at a local college, stigma reduction talks at local schools, youth education retreats focusing on helping develop coping skills, and “Train the Trainer” education for correctional officers on depression and suicide prevention. The Charles E. Kubly Foundation produces an annual event in Milwaukee, “Beyond the Blues,” where people gather for fun, music, and great food, symbolizing hope and fostering the role of community in addressing depression and its impact. This special collection in Academic Psychiatry is dedicated to Charlie and all who loved him.

Nonpsychotic, nonparaphilic self-amputation and the internet

Perhaps the most important conversation that academic clinicians ever have in their career with regard to defining their role, impact, and implications on eventual success, as well as aligning academic goals and fit within a department, is the first job interview. This critical conversation initiates what could be a lifelong relationship and defines the new faculty member’s value/worth/salary. Despite the significance of this first interview, clinicians and scientists routinely receive little training or practice in preparation for it and, perhaps more important, do not learn about the process of negotiating a contract. It is true that all physicians interview for medical school and for a residency, but interviewing for the first academic medicine job is very different. In interviewing for medical school and residency, there is an assessment of overall fit from both sides of the interview, but unlike in the academic position, salary is not negotiated and there is really no negotiating over the specifics for the job.