Russell F. Lim

Diversity Initiatives in Academic Psychiatry: Applying Cultural Competence.

ObjectiveThis article describes the process of change in an academic department of psychiatry that has led to the development of a diversity initiative in teaching, research, recruitment, and services.MethodsThe authors performed a literature review of diversity initiatives using PubMed. The authors then wrote a case study of the development of a diversity initiative at UC Davis.ResultsSome articles on diversity initiatives were found, but none that detailed the administrative process, funding, or sustainability of such initiatives. In 1999, the UC Davis Department of Psychiatry and Behavioral Sciences recognized the importance of issues of diversity and established the Diversity Advisory Committee, a group of department faculty and residents that explores and addresses the diversity needs of the department. In our observations, there are at least three requirements for a successful diversity initiative: a diverse patient population, a “critical mass” of interested faculty, and support of the administration. With these three factors in place, the Diversity Advisory Committee produced four Continuing Medical Education symposia focused on diversity topics, developed a 4-year cultural psychiatry curriculum and a 4-year religion and spirituality curriculum within the residency, and supported nine residents who received awards from the APA’ s Minority Fellowships in 8 years. Future plans include department-wide and medical school faculty-wide diversity training, educational research, and a postgraduate fellowship in cultural psychiatry.ConclusionThis article shows that a diversity initiative can be undertaken with interested minority and nonminority faculty, administrative support, and a diverse patient population. The authors hope this article will provide assistance to other academic departments in developing diversity initiatives.

Using non-feature films to teach diversity, cultural competence, and the DSM-IV-TR outline for cultural formulation

ObjectiveFeature films have been used for teaching in psychiatry for many years to demonstrate diagnoses, but the use of documentary and instructional films in resident and staff cultural competence training have not been extensively written about in the medical and psychological literature. This article will describe the films that have been used by the authors and suggest methods for their use in cultural competence and diversity training.MethodsA literature search was done using MEDLINE and PsychINFO and the authors were asked to describe their teaching methods.ResultsOne article was found detailing the use of videotapes as a stimulus but not for cultural competence education, and two articles were found documenting the use of The Color of Fear as a stimulus for the discussion of racism. However, many educators use these films all across the country for the purpose of opening discussion about racism.ConclusionDocumentary, instructional, and public service announcements can be useful in teaching culturally competent assessment and treatment.

Culture and Psychiatric Education

Received February 21, 2008; accepted March 26, 2008. Dr. Lim isaffiliated with the Department of Psychiatry and BehavioralSciencesat the University of California Davis School of Medicine; Dr. Lu isaffiliated with the Department of Psychiatry at the UniversityofCali-fornia San Francisco. Address correspondence to Russell F. Lim,M.D., Psychiatry and Behavioral Sciences, UC Davis School ofMedicine, 2230 Stockton Blvd., Sacramento, CA 95817; rflim@ucdavis.edu (e-mail).Copyright 2008 Academic Psychiatry

Evaluating a Lecture on Cultural Competence in the Medical School Preclinical Curriculum.

ObjectiveThe authors aim to evaluate the effectiveness of a presentation designed to increase cultural competence.MethodsA measure was developed to evaluate the attainment of knowledge and attitude objectives by first-year medical students who watched a presentation on the effect of culture on the doctor-patient relationship and effective methods of interpretation for non-English-speaking patients. The test was administered before and after the presentation and data were analyzed using a linear mixed-effects regression model.ResultsBoth knowledge and attitudes improved over the course of the lecture.ConclusionsThose who give individual presentations in multiple instructor medical school courses should supplement their course evaluations with lecture-specific surveys targeted to their specific learning objectives for knowledge and attitudes.

The Chief Resident in Psychiatry: Roles and Responsibilities

ObjectivePsychiatric residency programs have had chief residents for many years, and several articles previously published describe the chief residents’ unique role as both faculty and resident. This article describes chief resident roles and responsibilities and explores trends in academic psychiatry departments from 1995 to 2006.MethodsThe authors mailed a survey about the roles and responsibilities of chief resident positions to psychiatric residency training directors using the American Association of Directors of Psychiatric Residency Training (AADPRT) mailing list in 1995 and e-mailed the AADPRT e-mail list in 2006. Data were collected by mail in 1995 and collected in 2006 by a web-based survey similar to the instrument used in 1995.ResultsJoint selection of chief resident by faculty and residents, 12-month terms protected time for administrative duties and written job descriptions were helpful features common to most programs.ConclusionOur results demonstrate that the majority of general psychiatry residency programs use the joint selection method with a negotiated job description, as well as a 12-month term.

THE PSYCHOTIC PATIENT

Psychotic disorders are relatively rare in the primary care setting, compared with depressive and anxiety disorders, but patient suffering is significantly higher for patients with psychotic symptoms. Primary care physicians are assuming more responsibility for the area of these patients in todays managed care environment. The practitioner needs to eliminate medical, substance, and mood origins of the psychotic symptoms before assuming a patient has a psychotic disorder (e.g., schizophrenia). This article outlines a diagnostic and treatment approach for patients with psychotic symptoms who are managed in the primary care setting.

Introduction to the Special Issue on Culture and Community Mental Health

Since 1980, the racial/ethnic diversity of the United States has rapidly increased. Also in this time, though the population of the United States has aged in general, the difference between the youngest and oldest age groups and their percentage of non-White population has widened (U.S. Census Bureau, 2002). From 1980 to 2000, the population of races other than White non-hispanic grew by 88% while the White non-hispanic population grew by 7.9%. By 2000, four states and the District of Columbia had minority populations in total exceeding 50% of the population. Data on age by race and Hispanic origin reveals that throughout the period between 1980 and 2000 White non-Hispanics and Asian and Pacific Islanders were relatively older than Black Americans, American Indians and Alaska Natives, and Hispanic Americans. The median age for White non-Hispanics in 1980 was 31.7-years-old and in 2000 was