Jules M. Ranz

Core Elements of a Public Psychiatry Fellowship

As the oldest, largest, and best known program for training psychiatrists to become public-sector leaders, the Columbia University Public Psychiatry Fellowship (PPF) at New York State Psychiatric Institute has frequently been consulted by other departments of psychiatry planning public and community fellowship programs. PPFs faculty has developed seven core elements for such training programs. The fellowships longevity and the career paths of its graduates suggest that these core elements represent a best-practices model for fellowship training in public-community psychiatry.

The role of the psychiatrist : Job satisfaction of medical directors and staff psychiatrists

In a previous survey of Columbia University Public Psychiatry Fellowship alumni, medical directors reported experiencing higher job satisfaction compared to staff psychiatrists. To further this inquiry, the authors conducted an expanded survey among the membership of the American Association of Community Psychiatrists (AACP). We mailed a questionnaire to all AACP members. Respondents categorized their positions as staff psychiatrist, program medical director or agency medical director, and rated their overall job satisfaction. The form also included a number of demographic and job characteristic items. Of 479 questionnaires mailed, a total of 286 individuals returned questionnaires (61%—12 forms were undeliverable). As in our previous survey, medical directors experience significantly higher job satisfaction compared to staff psychiatrists. Program and agency medical directors do not differ significantly. In addition, job satisfaction is strongly and negatively correlated with age for staff psychiatrists but not for medical directors. This survey strengthens the previously reported advantage medical directors have over staff psychiatrists regarding job satisfaction. The finding that job satisfaction decreases with increasing age of staff psychiatrists but not medical directors is particularly interesting, suggesting that staff psychiatrist positions may come to be regarded as “dead-end” over time. Psychiatrists are advised to seek promotions to program medical director positions early in their careers, since these positions are far more available, and provide equal job satisfaction, compared to agency medical director positions.

Integrating Systems-Based Practice, Community Psychiatry, and Recovery Into Residency Training

BackgroundBehavioral health services involving multiple systems of care are increasingly being provided in community as well as hospital settings. Residents therefore should be familiar with multiple systems and the role of the psychiatrist in these systems. The authors describe a curriculum incorporating principles of systems-based practice (SBP), community psychiatry, and recovery.MethodsThis curriculum was designed to include lectures, clinical rotations, specialized written/oral presentations, and supervision focused on SBP and recovery principles. Residents also participate in home and site visits for further immersion into the multiple systems that their patients have to navigate.ResultsThe essential elements of this curriculum are the 1) consistent review and emphasis on the four researched-based SBP roles of the psychiatrist; 2) recovery principles of person-centered care and shared decision-making; 3) requirement that residents interact with patients in community and home settings; 4) integration of didactic courses and clinical rotations; and 5) focus on the supervisor/supervisee relationship.

A Four Factor Model of Systems-Based Practices in Psychiatry

A Four Factor Model of Systems-BasedPractices in PsychiatryJules M. Ranz, M.D., Michael Weinberg, Ed.D.Melissa R. Arbuckle, M.D., Ph.D., Joanna Fried, M.D.Anthony Carino, M.D., Hunter L. McQuistion, M.D.Glen Davis, M.D., Donovan Wong, M.D.Sosunmolu O. Shoyinka, M.D.Benjamin Brody, M.D., Kamala D. Sethi, M.D.Anna Skiandos, D.O., Wesley Sowers, M.D.David Stern, M.D., Anne Sullivan, M.D.Michael J. Vergare, M.D.

Public Psychiatry Fellowships: A Developing Network of Public-Academic Collaborations

In response to the expanding public behavioral health care system, a network of 15 public-community psychiatry fellowships has developed over the past six years. The fellowship directors meet yearly to sustain and develop fellowships to recruit and retain psychiatrists in the public sector. This column describes five types of public-academic collaborations on which the fellowships are based. The collaborations focus on structural and fiscal arrangements; recruitment and retention; program evaluation, program research, and policy; primary care integration; and career development. These collaborations serve to train psychiatrists who will play a key role in the rapidly evolving health care system.

Psychiatry Residents’ Experiences with Systems-Based Practice: A Qualitative Survey

ObjectiveThe aim of this study is to analyze qualitative data collected during field-testing of an instrument to assess psychiatric residents’ experiences with systems-based practice (SBP).MethodsA total of 237 psychiatry residents from 6 levels of training in 12 different psychiatry residency training programs responded to a 60-item instrument measuring their experiences with SBP during residency. Qualitative techniques adapted from content analysis were used to review narrative responses to open-ended questions on the instrument.ResultsCertain themes emerged in the residents’ answers reflecting their opinions about the opportunities for (and barriers to) performing SBP in their work.ConclusionsPsychiatric residents express an eagerness for opportunities to learn about and perform SBP but often feel constrained by the lack of resources, teaching, and supervision. Moreover, many residents desire a better understanding of healthcare economics and how to factor cost consideration into clinical care.

Outpatient training in public/community psychiatry and systems-based practices.

Despite its being one of the six core competencies, SystemsBased Practice (SBP) remains an elusive concept to teach psychiatric residents. In a previous publication, we described the development and implementation of SBP in a community psychiatry curriculum that spans all 4 years of residency training [1]. The approach is based on a conceptualization of SBP as a set of four research-based roles performed by psychiatrists to meet the comprehensive needs of the patient within and beyond the health care system. The roles are (1) patient care advocate, (2) team member, (3) information integrator, and (4) resource manager [2]. Key to this approach is a focus on ensuring that supervisors are well grounded in SBP and recovery principles [3]. In addition to supervision, training in SBP is achieved through four modalities: didactics, clinical rotations, site visits, and an oral/written presentation. This presentation is called a Person-Centered Systems Evaluation (PCSE). This article focuses on the PGY3 year because in our program, the PGY3 year provides the best opportunity for integrating SBP and recovery principles in a community setting.

Public Psychiatrists' Perceptions of Changes over the Past Five Years

This study examines which issues public psychiatrists perceive as having most impacted their careers over the past five years and whether this impact was differentially experienced by staff psychiatrists and medical directors. The authors sent a questionnaire to all members of the American Association of Community Psychiatrists (AACP) in clinical practice for at least 5years. Surprisingly, public psychiatrists report that the impact of recent changes have been primarily positive, except in the domain of economic developments. Both program and agency medical directors report experiencing about the same amount of change, though significantly more positive overall impact, compared to staff psychiatrists. This finding should encourage psychiatrists to become program medical directors, a feasible next step for many staff psychiatrists.

Psychiatry residents' perception of public/community psychiatry fellowship training.

Abstract In order to improve recruitment into public/community psychiatry fellowships, a survey was administered to understand psychiatry residents’ perception of benefits and obstacles to fellowship training. Using standard statistical methods, the responses of those residents who indicated interest in public/community psychiatry training were compared to those who were not. Residents who were interested in public/community psychiatry fellowships were earlier in their training. These same residents gave higher endorsements to items related to quality, location and flexibility of training program, recommendation of colleagues, opportunities for health policy training and networking as compared to residents who were not interested in pursuing a public/community. Those results attained statistical significance while philosophical approaches including emphasis on recovery and tailoring specific training experiences approached significance. Psychiatric residents appear to start residency training with some interest in public/community psychiatry and this interest can be nurtured if public/community psychiatry is emphasized during training.

Broadening the Lens of System-Based Practice: From Micro to Macro and Basic to Complex in Residency Training

ObjectiveThis paper aimed to develop a model for understanding the various dimensions of system-based practice (SBP) and determine the extent to which psychiatry residents perform behaviors along these dimensions.MethodsSixty-one supervisors from seven psychiatry programs rated resident performance of SBP behaviors using a 60-item instrument. Multi-dimensional scaling and cluster analysis were conducted to determine how the instrument items related to one another and the larger concept of SBP. Average supervisor ratings between clusters were compared to determine resident performance along the identified SBP dimensions.ResultsThe data supports a model of SBP defined along two dimensions: (1) from micro (patient) to macro (population-based) interventions and (2) from low to high system complexity. Residents were more likely to perform behaviors at the patient level compared to those at the population-based level.ConclusionsTraining in SBP remains predominately focused on the doctor-patient level and not the greater system of health-care delivery.