Robert Li Kitts

Barriers to Optimal Care between Physicians and Lesbian, Gay, Bisexual, Transgender, and Questioning Adolescent Patients

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.

Promoting Interdisciplinary Collaboration: Trainees Addressing Siloed Medical Education

ObjectiveProfessional siloing within medical institutions has been identified as a problem in medical education, including resident training. The authors discuss how trainees from different disciplines can collaborate to address this problem.MethodA group of trainees from psychiatry, developmental medicine, neurology, and education came together to develop a community of practice (CoP) to promote interdisciplinary collaboration.ResultsA key outcome was the development of a seminar including speakers and attendees (N=20 to 35) from psychiatry, developmental medicine, neurology, and education. The CoP, developed in 2008, continues to grow and develop through their seminar, which fosters institution-wide interdisciplinary collaboration.ConclusionIn an attempt to break down interdisciplinary silos, a CoP and interdisciplinary seminar were created. Trainee organizers benefited from an educational context that embodied adult-learning theory and promoted lifelong learning. The unique seminar that was created continues to promote a community sense of learning and practice. Outcome measures are currently being used to objectively measure these efforts.

Does Early Mentorship in Child and Adolescent Psychiatry Make a Difference? The Klingenstein Third-Generation Foundation Medical Student Fellowship Program

ObjectiveThere is a critical shortage of child and adolescent psychiatrists in the United States. Increased exposure, through mentorship, clinical experiences, and research opportunities, may increase the number of medical students selecting child and adolescent psychiatry (CAP) as a career choice.MethodBetween 2008 and 2011, 241 first-year participants of a program to increase exposure to CAP, funded by the Klingenstein Third-Generation Foundation (KTGF) at 10 medical schools completed baseline surveys assessing their opinions of and experiences in CAP, and 115 second-year participants completed follow-up surveys to reflect 1 year of experience in the KTGF Program.ResultsStudents reported significantly increased positive perception of mentorship for career and research guidance, along with perceived increased knowledge and understanding of CAP.ConclusionsResults suggest that the KTGF Program positively influenced participating medical students, although future studies are needed to determine whether these changes will translate into more medical students entering the field of CAP.

Teaching Child and Adolescent Psychiatry in the Twenty-First Century: A Reflection on the Role of Technology in Education

Technology has become an integral part of everyday life and is starting to shape the landscape of graduate medical education. This article reviews the use of technology in teaching child and adolescent psychiatry (CAP) fellows, and 3 main aspects are considered. The first aspect is use of technology to enhance active learning. The second aspect covers technology and administrative tasks, and the third aspect is the development of a technology curriculum for CAP trainees. The article concludes with a brief review of some of the challenges and pitfalls that have to be considered and recommendations for future research.

Lessons from the Launch: Program Directors Reflect on Implementing the Child and Adolescent Psychiatry Milestones

Beginning in July 2014, the Accreditation Council for Graduate Medical Education (ACGME) required all psychiatry residency programs in the USA to implement milestonebased assessments as a critical component of the Next Accreditation System (NAS). Milestones are competencybased developmental outcomes (i.e., knowledge, skills, attitudes, and performance) that a trainee is expected to progressively attain over the course of training [1]. The new milestone-based assessment was derived from the ACGME’s original six core competencies of patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills, which are assessed among all medical specialties. The ACGME Psychiatry Milestone Working Group developed 22 sub-competencies for assessment within general psychiatry. A year later, the Child and Adolescent Psychiatry (CAP) Milestone Working Group derived 21 CAP-specific sub-competencies from those established for general psychiatry.Within each sub-competency are five levels, each of which details specific milestones that are achieved before one progresses to the next level. This national approach to assessment was developed to ensure that residents and fellows in graduate medical education are capable of independently providing high-quality, safe patient care upon completion of training [2]. Prior to the formal July 2014 implementation, there were publications describing the purpose and intent of the Psychiatry Milestones Project, the development process, potential evaluation tools and techniques to assess milestone acquisition, and a resident perspective on the potential utility of milestones [3–5]. Since implementation of the milestones, some educators have raised concerns about whether the shift to milestone-based assessments was premature. One concern is that the milestones were based solely on consensus expert opinion in the absence of empirical evidence of their validity in assessing meaningful markers of psychiatric competence that actually translate to positive patient outcomes. Another