Molly Gathright

Racial/Ethnic Disparities in Mental Health Care Utilization among U.S. College Students: Applying the Institution of Medicine Definition of Health Care Disparities

ObjectiveThe authors apply the Institute of Medicine’s definition of health care disparities to college students.MethodsThe analysis pools data from the first two waves of the Healthy Minds Study, a multicampus survey of students’ mental health (N = 13,028). A probit model was used for any past-year service utilization, and group differences in health status were adjusted by transforming the entire distribution for each minority population to approximate the white distribution.ResultsDisparities existed between whites and all minority groups. Compared to other approaches, the predicted service disparities were greater because this method included the effects of mediating SES variables.ConclusionsHealth care disparities persist in the college setting despite improved access and nearly universal insurance coverage. Our findings emphasize the importance of investigating potential sources of disparities beyond geography and coverage.

The Use of Collaborative Problem Solving to Address Challenging Behavior Among Hospitalized Children With Complex Trauma: A Case Series

Professionals working in a psychiatric hospital for children are often faced with challenging patients with histories of complex trauma, which manifests as impairments in multiple domains. These children are serviced by numerous systems beyond mental health, and it is important for these systems to interact with them in a nurturing manner. Collaborative Problem Solving (CPS) is a cognitive-behavioral psychosocial intervention with increasing empirical support that emphasizes cognitive lags associated with aggression and behavioral outbursts. This article utilizes case studies to illustrate how CPS was used on a child psychiatric inpatient unit to understand and treat children with complex trauma.

An Innovative, Interdisciplinary Model of Care for Inpatient Child Psychiatry: an Overview

There are profound effects of childhood psychiatric disorders on families and communities. Given that each year over half a million youth receive mental health services through inpatient psychiatric hospitals, focus on assessment and treatment strategies for this group is paramount The purpose of this paper is to present an overview of an innovative, evidenced-based model of inpatient child psychiatric care that challenges commonly used traditional practices of inpatient child psychiatry. The highlighted model utilizes an interdisciplinary approach to clarify psychiatric diagnoses; create a comprehensive biopsychosocial formulation of the child and family; establish a rational medication regimen; provide individually tailored recommendations; and address the “revolving door” of repeated psychiatric hospitalizations. Descriptive analyses are presented that provide demographic, developmental, and psychiatric characteristics of the children admitted to the unit. The potential benefits of using this innovative model with developmentally and psychiatrically complex children are discussed.

Identifying Areas for Curricular Program Improvement Based on Perceptions of Skills, Competencies, and Performance

ObjectiveEducational program evaluation and program improvement are processes that can be enhanced by involving multiple stakeholders and measurement tools. The purpose of this study was to compare faculty and resident physician perceptions of both teaching quality and resident competence for 13 core psychiatric skills and the six Accreditation Council for Graduate Medical Education general competencies. Additionally, resident performance as assessed by portfolios was descriptively examined relative to these perceptions of skills and competencies. Using this combination of data, the authors propose a useful approach for identifying areas for improvement within a medical residency’s program curriculum.MethodsTen teaching faculty members (100%) and 18 residents (82%) within a psychiatry department completed parallel surveys. Trained raters scored resident-completed portfolio entries. Nonparametric and descriptive analyses were used to compare the various data sources.ResultsIn general, faculty and residents showed congruence in their perceptions about resident performance. They agreed on the quality of teaching skills and general competencies. General competency scores from the portfolios were congruent with this perspective. However, there were mismatches in perceptions and performance on portfolios for some areas. Of the 13 core psychiatric skills examined, only one area, neuropsychiatry, was rated below average by both faculty and residents, while the median portfolio performance score was below competent for four skills, including neuropsychiatry. Faculty rated resident competence significantly higher than residents rated themselves for biopsychosocial formulation and medical psychiatry.ConclusionThis study describes and highlights the usefulness of a multidimensional approach that includes resident and faculty perspectives and externally rated performance measures to assist in identifying potential target areas for curriculum improvement.

Crystal clear or tin ear: how do medical students interpret derogatory comments about patients and other professionals?

Purpose To assess the learning environment at our medical school, third-year medical students complete an 11-item survey called the Learning Environment for Professionalism (LEP) at the end of each clerkship. The LEP survey asks about the frequency of faculty and resident professional and unprofessional behaviors that students observed; two of the items specifically address derogatory comments. This study used focus group methodology to explore how medical students interpret the derogatory comments they reported on the LEP survey. Methods Seven focus groups were conducted with 82 medical students after they completed the LEP survey. Analysis of focus group transcripts was performed to better understand the nature and meaning that students ascribe to derogatory comments. Results The study results provide insights into the types of derogatory comments that medical students heard during their clerkship rotations, why the comments were made and how they were interpreted. Emergent themes, labeled by the authors as 1) ‘onstage-offstage’, 2) ‘one bad apple’, and 3) ‘pressure cooker environment’, highlight the contextual aspects and understandings ascribed by students to the derogatory comments. Incidentally, students felt that the comments were not associated with fatigue, but were associated with cumulative stress and burn-out. Conclusions The results suggest students have a clear understanding of the nature of unprofessional comments made by role models during clerkships and point to important systems-related issues that could be leveraged to improve clinical learning environments.

Lesbian, Gay, Bisexual, and Transgender (LGBT) Content Representation on the Psychiatry Resident In-Training Examination, 2009–2013

This article explores the extent to which lesbian, gay, bisexual, or transgender (LGBT) content is included in the Psychiatry Residency in Training Exam (PRITE®) questions and how these rates compare with other specialized topics. Five PRITE in-training examinations from 2009–2013 were reviewed for questions relating to LGBT issues, trauma and abuse, pregnancy and postpartum, and religion and culture. Totals for each category were tabulated and compared with each other and to the total number of questions (300 questions for each year analyzed). The LGBT category had the fewest number of questions of the categories examined. Out of a total of 1,500 questions over five years, three question stems or answer choices had LGBT content. This is an average of less than one item per year (out of 300 questions). Given the increased national attention devoted to improving health care disparities for sexual minorities, increased coverage of this topic in the residency education examination in psychiatry appears to be warranted.

Do They Stay or Do They Go? Residents Who Become Faculty at Their Training Institutions.

ObjectiveFew data exist on the topic of internal hiring of trainees in academic medicine. This study examines nationally representative data to determine the frequency of faculty psychiatrists who are employed in the same department in which they completed their residency training.MethodEstimates of internal faculty hiring were obtained by reviewing a random sample of publically available psychiatry department websites in the United States.ResultsAmong the 26 departments reviewed, there was wide variation in the rates of psychiatrists who received training in the same department in which they were currently employed as faculty members, with a median of 45.5%, ranging from 0% to 71%.ConclusionResults suggest that departmental hiring of one’s own graduates is common practice in academic psychiatry, and there is wide variation in this practice across psychiatry departments in the United States.