Paul C. Mohl

Can We Predict "Problem Residents"?

Purpose This study investigates whether data available at the time of residency application can be used to predict more accurately future problems of performance, both during and after residency. Method The authors identified all residents with reported problematic behavior across 20 years (1987–2007) at a single residency program and created a set of matched controls. Problems were further divided into “major” (leading to significant disruptions of performance and disciplinary action) and “minor” (remediable and resolved). Application materials were then reviewed for United States Medical Licensing Examination (USMLE) scores, evidence of academic failures, interviewer ratings, negative interviewer comments, negative comments in the deans letter, and negative comments in letters of recommendation. Results The presence of any negative comments in the deans letter yielded significant correlations with future problems. Further, those applicants with future major problems had significantly more negative comments in the deans letter than did those with future minor problems. Other factors such as USMLE scores, failed courses, letters of recommendation, and interviewer ratings and comments did not predict future problems. Conclusions Most of the factors the authors assessed in prospective applicants did not predict future problems, with the exception of negative (even mildly so) comments in the deans letter. The authors suggest that more attention should be paid to the use of the deans letter to assess risk among applicants, and prospective study of this assessment should be performed.

The cognitive context of examinations in psychiatry using Bloom's taxonomy

Summary. Psychiatric practice involves complex thinking patterns. In addition to commanding a huge number of facts, the student must learn to manipulate factual knowledge to solve diagnostic problems, develop treatment plans, and critically evaluate those plans. This study demonstrates an empirical method for evaluating the level of cognitive processes tested in multiple choice examinations. Use of Blooms taxonomy in evaluating test items demonstrated the majority of test items on a psychiatry clerkship examination and a resident in‐training examination fell into the most basic cognitive level, that of simple recall. The utility of Blooms taxonomy is discussed along with implications for medical education.

Patients who leave the hospital against medical advice: The role of the psychiatric consultant

Previous studies have identified characteristics of patients who threaten to leave non-psychiatric units against medical advice, but few have described the role of the psychiatric consultant in the patients decision. This study compared the medical records of 31 patients who threatened to leave the hospital against medical advice (AMA) and who were seen in consultation with the records of AMA-discharged patients who were not seen by a psychiatric consultant. Most patients who received consultations remained hospitalized or were discharged in regular fashion. Those seen soon after admission were most likely to stay. Patients were more likely to remain hospitalized if the consultants recommendations had a practical, rather than a psychological, orientation.

Prepuce restoration seekers: Psychiatric aspects

A new subgroup of patients within the homosexual community has been identified who are characterized by preoccupation with their absent foreskins. They associate their circumcised status with a sense of incompleteness, anger over a lack of choice, and their sense of masculinity. Four patients who sought surgical reconstruction are reported. None were Jewish or psychotic. All tolerated surgery well. Preliminary etiologic hypotheses are advanced, emphasizing psychodynamic and imprinting possibilities.

Hospital unit stressors that affect nurses: Primary task vs social factors

Abstract Liaison psychiatrists often define needs of hospital units in terms of their primary task, such as coronary care. However, it is possible that social systems variables also affect these needs. This study tests the assumption that primary task determines nurses stress and attitudes by comparing the work attitudes and clinical distress of nurses on two general medical units (GMUs) and two medical intensive care units (ICUs). The nurses in the ICUs differed from those in the GMUs in some work attitudes, but not in level of clinical distress. One ICU had much lower levels of clinical distress than any of the other units. The findings suggest that while primary task is an important element in determining some attitudes of nurses, social systems variables also contribute substantially to the stress level of unit nurses.

A systems approach to liaison psychiatry

Abstract The systems approach views hospital units as self contained social systems whose collective attitudes–often unconscious–affect the quality of health care delivery. Nurses, as the only permanent group within the social system, are the primary socializing agents. Group process interventions by the liaison psychiatrist in weekly nurses’ meetings can dramatically improve the entire units operation. The author presents five case vignettes to illustrate the effectiveness of such interventions.

Basic readings in consultation psychiatry.

Dr. Mohl is an associate professor ofpsychiatry at the University ofTexas Health Science Center. and Dr. Cohen-Cole is an associate professor ofpsychiatry at Emory University. Reprint requests to Dr. Mohl in the Department ofPsychiatry. University ofTexas Health Science Center at San Antonio. 7703 Floyd Curl Drive. San Antonio. TX. 78284. As tertiary care medicine has grown more specialized, the clinical need for and cost-effectiveness of psychiatric and psychosocial care for medical patients have increasingly been recognized. Similarly, the growth of primary care programs in medicine and family practice has led to parallel needs for psychiatric and psychosocial services for general medical patients, and for psychiatric training of medical housestaff. In recognition of these relatively new demands and opportunities for psychiatric services and training, the Consultation-Liaison (C-L) Section of the Association for Academic Psychiatry (AAP) has been working to develop a more thorough and intellectually coherent basis for C-L psychiatry. Under the chairmanship of Don Lipsitt, M.D., the C-L section has encouraged required C-L rotations in general psychiatry residencies and it has proposed a set of basic objectives for provision of competent consultation to medical colleagues. I These objectives, developed by a task force chaired by one of the authors (SC-C), were derived from recommendations of leading academic C-L psychiatrists concerning the basic knowledge and skills needed by general psychiatrists in consultation psychiatry. To increase the usefulness of these objectives, the Section then sought to develop a set of readings tied to each of them. It was thought that such a reading list would help the field of C-L psychiatry, as a relatively new area of practice and training, and would further define its distinct educational content and clinical approaches. In order to create this reading list, a task force, chaired by the two authors, solicited readings from AAP members as well as from several additional nationally prominent C-L programs (eg. at UCLA). In all, 617 different readings from 18 different programs were proposed for the final list. Evaluation forms were developed to rate each articles comprehensiveness, relevance, clarity. brevity, current content, and overall suitability for a basic reading list. All recommended readings were evaluated by at least one of 27 reviewers as well as by one of II task force members (see Appendix). Task force members then made final recommendations for the list based on these evaluations. When there was disagreement or lack of certainty, the two co-authors collaboratively made final decisions concerning which readings should be recommended for each objective. A draft reading list was presented to the C-L section of the AAP at its annual meeting in March 1984. This presentation led to additional modifications. The final choice of 86 recommended readings tied to 46 specific objectives is listed below. These are suggested as basic readings on material that the Section believed should be mastered by psychiatrists.

What Is a Balanced Program

Abstract“Balance” has become the watchword of psychiatry programs. It seems that almost all residency training programs claim to be balanced. But what do we mean by this term? This article summarizes the author’s evolving thinking about what makes for a balanced program and suggests that diversity may be a better term. The author advocates that balance is not as simple as teaching both psychodynamics and biological psychiatry. Instead, it entails a considered, intellectual approach that involves long-term vs. other psychotherapies, neuro-science vs. psychopharmacology, theoretical pharmacology vs. practical pharmacology, social psychiatry vs. treating minority patients, representing all viewpoints in psychiatry vs. integrating them.

Downsizing psychiatric residency programs : a pilot study.

Under the varied pressures of decreasing recruitment of American medical school graduates into psychiatry, the thrust of health care policymakers to decrease the production of specialist physicians, and financial cutbacks for training by hospitals, universities, and governments at all levels, many psychiatric training programs are considering downsizing or have already implemented plans to do so. The authors describe the motivations, early experiences, anticipated concerns, and thoughts regarding downsizing obtained from interviews or questionnaires provided by 17 programs in 1993. On the basis of the authors’ experiences, some recommendations are offered for the many programs likely to deal with this issue in the future.

A Value-Added Methodology for Assessing the Effectiveness of Psychiatric Residency Training

Educators often find it difficult to identify variables that accurately assess the knowledge that residents have gained due to their training. Recently in professional education circles, attention has shifted from process to outcome variables, with more emphasis being placed on student gains rather than on program resources. A methodology used extensively to assess undergraduate education is the value-added approach. This methodology is often demonstrated by a change in scores from two administrations of a test instrument that measures students’ specific knowledge or aptitudes. Residency training programs that offer standardized examinations to their residents are in a good position to utilize this evaluation technique. This article will demonstrate how the value-added technique can be used to demonstrate cognitive growth in psychiatric residents by using the Psychiatry Resident In-Training Examination.