Marika I. Wrzosek

Sluggish vagal brake reactivity to physical exercise challenge in children with selective mutism

Cardiovascular response patterns to laboratory-based social and physical exercise challenges were evaluated in 69 children and adolescents, 20 with selective mutism (SM), to identify possible neurophysiological mechanisms that may mediate the behavioral features of SM. Results suggest that SM is associated with a dampened response of the vagal brake to physical exercise that is manifested as reduced reactivity in heart rate and respiration. Polyvagal theory proposes that the regulation of the vagal brake is a neurophysiological component of an integrated social engagement system that includes the neural regulation of the laryngeal and pharyngeal muscles. Within this theoretical framework, sluggish vagal brake reactivity may parallel an inability to recruit efficiently the structures involved in speech. Thus, the findings suggest that dampened autonomic reactivity during mobilization behaviors may be a biomarker of SM that can be assessed independent of the social stimuli that elicit mutism.

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.

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.

Social Media and Networking Competencies for Psychiatric Education: Skills, Teaching Methods, and Implications

The Internet has revolutionized medicine and health education, including person-centered and interdisciplinary collaborative patient care [1]. Millennial learners (born between 1981 and 1996) are often considered “digital natives,” including medical students, residents, and early career faculty. They utilize technology to search for information for education or pleasure [2, 3].Medical students and residents often start medical school with a robust online and social media presence for personal use [4–6], but have not begun to develop and hone general clinical skills, much less professional skills about the Internet and technologies. Except for telepsychiatric competencies, medical education as a whole has not kept pace with the media explosion [7]. The current hazards to the technology explosion include patients accessing misinformation about diagnoses and treatments [5], breach of confidentiality, privacy, and professional boundaries. Novice and more advanced learners, alike, require competency-based education related to this topic. Mid and advanced career faculty, often referred to as “digital immigrants,” may be technologically ill-informed [4], and most have not yet applied andragogy (adult learning theories) to the topics of Internet use, social media, and professionalism. Therefore, we have a paradox and a crisis: faculty may trail trainees with regard to hands on experience and expertise with technology and they may require faculty development training to keep current with benefits and potential pitfalls of media [8]. The AmericanMedical Association Professional Guideline on Social Media [9] proposes questions and scenarios as a starting place for clinicians to learn, advice, explore, and mentor others on the opportunities and challenges that arise in new and changing online platforms. Compliance officers and other healthcare leaders do not recommend social media engagement as part of care. An alternative perspective about social media guidelines and best practices comes from the Council of Residency Directors Social Media Task Force, which suggests that a residency program develops a social media policy and a training plan in concert with institutional officials, particularly via the offices of the designated institutional officer (DIO), public affairs, legal or privacy officer, and the information technology (IT) department [10]. This paper advances a framework for social and digital media competency development as the link between clinical care and training. It has three levels of competencies and provides suggestions to implement and teach them, while addressing faculty development needs in this area. Example competencies are described with a vignette, skills involved, and instruction on the teaching methods that may be particularly useful.

Required and Elective Experiences During the 4th Year: An Analysis of ACGME Accredited Psychiatry Residency Program Websites

ObjectiveThe objective of this study was to assess and describe required and elective components of the 4th post-graduate year (PGY4) in psychiatry residency programs.MethodsWe reviewed the websites of all 193 2014–2015 ACGME accredited psychiatry residency programs for content describing the specific components of the PGY4 year.ResultsNearly all residency programs (99xa0%) had some form of required experiences during the PGY4 year. Ninety-four percent had clinical requirements for PGY4 residents, with longitudinal outpatient clinic being the most common (77xa0%). All programs offered some elective time during PGY4, but the amount of time ranged from 2xa0months to 100xa0%.ConclusionVirtually all residency programs include some requirements in the 4th year (most commonly didactics and outpatient clinic) in addition to a broad array of elective experiences. Although 3xa0years may suffice for residents to complete ACGME requirements, a variety of factors may motivate programs to include required 4th year curricula. Future studies should explore the rationales for and possible benefits of programmatic requirements throughout 4 versus only 3xa0years of psychiatric training.

The R-Rated Comedy Ted: A Teaching Tool for Psychiatric Education

Movies are powerful teaching tools that can demonstrate key concepts in psychiatry. Produced byMedia Rights Capital and distributed by Universal Pictures, Ted is the 2012 full-length directorial debut of Seth MacFarlane. The full-length comedy about a grown man and his live teddy bear, with an R rating for foul language, drugs, and sexual innuendo, is—perhaps surprisingly—a rich source of material to teach classic developmental concepts and theories to medical students, psychiatry residents, and child and adolescent psychiatry fellows [1]. Ultimately a coming of age story, Ted taps into universal experiences, further enriching its potential as an unconventional teaching tool. This paper describes how Ted can be utilized to highlight classic concepts and theories of child development, as well as more general psychiatric principles. Through tapping into the affective learning domain, cinema in medical education has been described as effectively promoting reflection and humanistic perspectives of medicine [2]. The literature describing cinematic incorporation into teaching involves both undergraduate and graduate medical education across specialties. Further, the use of television and cinema in medical education has helped with attaining knowledge, improving engagement, stimulating discussion and reflection, and improving retention [3]. Faced with increasing facts, decreasing time in the curriculum, as well as learners who grew up in increasingly digital world, educators must utilize a wide range teaching tools to remain effective. Some curricula are entirely built around cinema as a core teaching tool for professionalism [4], impressions of psychiatric illness [5], or acculturation [6]. There is a smaller literature describing popular culture movies and TV series in psychiatric education at various levels; for instance, Buffy the Vampire Slayer [7], The Breakfast Club [8], Breaking Bad [9], Star Wars [10], Crazy Heart [11], and several medical dramas [12] have been described for their educational potential. Other compilations of cinema that may be particularly relevant to psychiatry have also been described [13, 14]. The use of video in psychiatric education is not new, and there is a small body of literature focusing on stimulus video to teach key psychiatric principles [15]. Further, other disciplines show that movies can effectively increase retention of key historical concepts provided there are caveats that warn of inaccuracies [16]. Given the relative paucity of cinematic examples as they can specifically relate to psychiatric education and normal development, this paper presents the R-rated comedy Ted as a viable educational tool that educators can harness to teach key concepts in child and adolescent psychiatry, and spur discussion of general principles relevant to the field. Comedy may seem like an odd choice given that distress is what frequently brings patients into psychiatric offices, but that very genre offers an avenue to also examine that, which is not pathological. The author has used Ted in several educational settings, including as a reflective exercise among independently practicing child and adolescent psychiatrists (via a “Media Theatre” presentation at the American Academy of Child and Adolescent Psychiatry Annual Meeting), as an independent didactic for child and adolescent psychiatry fellows, and as part of required didactic material in a normal development course for PGY 2 and 3 general psychiatry residents. The use of specific clips from Ted, even if learners have not seen the movie in its entirety, are an effective stimulus for discussion and demonstrate key theories and concepts of normal development. In this paper, the author suggests which concepts may be particularly relevant to teaching, and encourages readers to * Marika Inga Wrzosek mwrzosek@mcw.edu