Richard Belitsky

Teaching brief motivational interviewing to Year three medical students.

Objectives  In 2005, the authors developed and tested a curriculum to teach Year 3 Yale University medical students a behaviour change counselling approach called ‘brief motivational interviewing’ (BMI). Brief motivational interviewing is a patient‐centred approach designed to promote changes in patient behaviour within the time constraints imposed by a busy medical practice.

Graduate Education and Training for Contemporary Behavioral Health Practice

Over the past decade, a new paradigm in behavioral health care has emerged. It places emphasis on cost control, evidence-based practice, patient safety, access to care, treatment relevance for diverse populations, consumerism, and quality of care. Unfortunately, graduate education and training programs have had difficulty keeping pace with the dramatic changes in the field. As a consequence, there is concern that the graduates of many of these programs are not being adequately prepared to practice in current health care systems. This article reviews the nature of recent changes in behavioral health care, the current status of graduate education programs with respect to these changes, and offers 15 recommendations for increasing the relevance of graduate education to contemporary clinical practice.

Recruiting Researchers in Psychiatry: The Influence of Residency vs. Early Motivation.

BackgroundThe declining numbers of clinician-researchers in psychiatry and other medical specialties has been a subject of growing concern. Residency training has been cited as an important factor in recruiting new researchers, but there are essentially no data to support this assertion. This study aimed to explore which factors have influenced motivation to conduct research among senior psychiatry residents.MethodsThe authors surveyed senior residents, inquiring about their level of interest in research, demographics, background, research experiences, and factors influencing motivation for research. The authors had confirmed participation from 16 of 33 residency programs with a class size of 10 or more. They received 127 responses, a 67% response rate, from participating programs.ResultsResidents with high stated interest in research differed from those with low and moderate interest in their research-intense post-residency plans. They were more likely to have graduate degrees. Those planning research careers had a consistent pattern of interest and involvement in research, starting well before residency. The majority of residents had had research exposure in college, but research involvement of those with very high versus lower interest diverged sharply thereafter. Those with high research interest were overwhelmingly male and tended to have lower debt than those with less interest.ConclusionThe great majority of residents appear to have decided whether or not to pursue a research career by the time they reached residency, and few of those with less than the highest research interest were enrolled in research tracks. Efforts to increase recruitment into research should center on identifying early developmental influences, eliminating barriers specific to women, and ensuring adequate funding to provide secure careers for talented potential researchers.

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.

Model Curriculum for Academic Child and Adolescent Psychiatry Training

ObjectiveThe United States is facing a severe shortage of academic child and adolescent psychiatrists. This article reviews a model integrated pathway to improve recruitment.MethodsThe authors review training portals for research in child and adolescent psychiatry. There is a summary of a focus group discussion of the advantages and disadvantages of the Integrated Research Pathway in Child and Adolescent Psychiatry (IRPCAP).ResultsThe University of Colorado and Yale University have initiated integrated pathways. These pathways integrate research into a 5 or 6-year residency to train the next generation of physician-scientists.ConclusionThe innovative Integrated Research Pathway in Child and Adolescent Psychiatry training model has enhanced recruitment of talented physician-scientists. Challenges include long-term financial viability and incorporating all training requirements. Novel pilot models of training are encouraged.

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.