Susan Lieff

Recommendations for staff education and training for older people with mental illness in long-term aged care

BACKGROUND This paper was written as a result of the International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care. The appraisal presented here aims to (1) identify the best available evidence that underpins best practice for geriatric mental health education and training of staff working in long-term care, and (2) summarize the appraisal of the literature to provide recommendations for practice. METHODS An initial search of databases found 138 papers related to the search strategy. Selected papers were summarized and compared against set inclusion criteria. This resulted in 17 papers suitable for review. RESULTS The majority of papers focused on behavior skills training. A number of key factors were identified that determine the success of geriatric mental health education and training and recommendations are outlined. CONCLUSIONS Methodological weaknesses are common and highlight the need for further replication studies using strong research designs.

Rethinking CME: an imperative for academic medicine and faculty development.

To help address the clinical care gap, a working group discussed the future of faculty development in academic medicine, explored problems within the large, current enterprise devoted to continuing medical education (CME), and described four domains core to its revitalization and reformation. These domains are (1) preparing and supporting an engaged clinician-learner, (2) improving the quality of knowledge or evidence shared, (3) enhancing the means by which to disseminate and implement that knowledge and evidence, and (4) reforming the patient, health care, and regulatory systems in and for which the process of CME exists. Reshaping these domains requires the consideration of a more seamless, evidence-based, and patient-oriented continuum of medical education. Revitalizing CME also requires the full engagement of the academic medical community and its faculty. To achieve the goal of creating a new, more effective, seamless process of CME, the working group recommended an active faculty development process to develop strong clinician-learners, strong involvement of academic health center leaders, the development of an educational home for clinician-learners, and a meaningful national conversation on the subject of CME.

Who am I? Key influences on the formation of academic identity within a faculty development program

Introduction: Professional identity encompasses how individuals understand themselves, interpret experiences, present themselves, wish to be perceived, and are recognized by the broader professional community. For health professional and health science educators, their ‘academic’ professional identity is situated within their academic community and plays an integral role in their well being and productivity. This study aims to explore factors that contribute to the formation and growth of academic identity (AI) within the context of a longitudinal faculty development program. Methods: Using a qualitative case study approach, data from three cohorts of a 2-year faculty development program were explored and analyzed for emerging issues and themes related to AI. Results: Factors salient to the formation of AI were grouped into three major domains: personal (cognitive and emotional factors unique to each individual); relational (connections and interactions with others); and contextual (the program itself and external work environments). Discussion: Faculty development initiatives not only aim to develop knowledge, skills, and attitudes, but also contribute to the formation of academic identities in a number of different ways. Facilitating the growth of AI has the potential to increase faculty motivation, satisfaction, and productivity. Faculty developers need to be mindful of factors within the personal, relational, and contextual domains when considering issues of program design and implementation.

The mindsets of medical education leaders: how do they conceive of their work?

Purpose How a leader perceives his or her organization affects that individuals decision making and beliefs about the best way to influence it. The goal of this study was to understand how medical education leaders conceive of their work. Method The first author interviewed 16 medical education leaders in the Faculty of Medicine at the University of Toronto from June 2005 until February 2006. The sample represented different practice contexts to ensure a diverse overview of experiences. Using the theoretical framework of Bolman and Deal, the authors examined and described the perceptual frames through which these leaders perceive their endeavors. Transcripts were analyzed and then mapped onto Bolman and Deals four cognitive lenses (i.e., frames). Results Fourteen of the 16 leaders used all cognitive frames. The human resource perspective was favored by all participants, followed closely by the symbolic (14/16) and political (14/16). Although most attended to the structural frame (14/16), only three placed any significant emphasis on it. In addition to identifying and describing the elements of this typology for medical education leadership, a new frame emerged of assessing interpersonal and work style in order to determine how to socially situate individuals. Conclusions This study uniquely contributes by supporting the utility of the Bolman and Deal typology in the medical education context and supports the value for leaders to reflect on their organizational work from a variety of perspectives (including the frames). Medical education leadership development programs need to attend to enhancing the awareness of these perspectives.

Understanding the needs of department chairs in academic medicine.

Purpose The challenges for senior academic leadership in medicine are significant and becoming increasingly complex. Adapting to the rapidly changing environment of health care and medical education requires strong leadership and management skills. This article provides empirical evidence about the intricate needs of department chairs to provide insight into the design of support and development opportunities. Method In an exploratory case study, 21 of 25 (84%) department chairs within a faculty of medicine at a large Canadian university participated in semistructured interviews from December 2009 to February 2010. The authors conducted an inductive thematic analysis and identified a coding structure through an iterative process of relating and grouping of emerging themes. Results These participants were initially often insufficiently prepared for the demands of their roles. They identified a specific set of needs. They required cultural and structural awareness to navigate their hospital and university landscapes. A comprehensive network of support was necessary for eliciting advice and exchanging information, strategy, and emotional support. They identified a critical need for infrastructure growth and development. Finally, they stressed that they needed improvement in both effective interpersonal and influence skills in order to meet their mandate. Conclusions Given the complexities and emotional burden of their role, it is necessary for chairs to have a range of supports and capabilities to succeed in their roles. Their leadership effectiveness can be enhanced by providing transitional processes and supports, development, and mentoring as well as facilitating the development of communities of peers.

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study.

Objective: To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices. Method: Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire. Results: Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential. Conclusions: The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

Proposed Geriatric Psychiatry Core Competencies for Subspecialty Training

The authors present and discuss the theoretical and practical development of proposed core competencies for subspecialty training and certification in geriatric psychiatry as required by the Accreditation Council For Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology (ABPN). Changes were derived from a concern that graduate medical education programs must do a better job of ensuring that residents completing their training are competent to practice medicine and adequately prepared to practice in a rapidly changing healthcare environment. Between July 2006 and June 2011, programs will be expected to focus on data-driven measures, both internal and national, for resident and education-program performance. After July 2011, programs will begin to focus on identifying and developing educational centers of excellence.

What do we do? Practices and learning strategies of medical education leaders

Background: Continuous changes in undergraduate and postgraduate medical education require faculty to assume a variety of new leadership roles. While numerous faculty development programmes have been developed, there is little evidence about the specific practices of medical education leaders or their learning strategies to help inform their design. Aim: This study aimed to explore what medical education leaders’ actually do, their learning strategies and recommendations for faculty development. Method: A total of 16 medical education leaders from a variety of contexts within the faculty of medicine of a large North American medical school participated in semi-structured interviews to explore the nature of their work and the learning strategies they employ. Using thematic analysis, interview transcripts were coded inductively and then clustered into emergent themes. Results: Findings clustered into four key themes of practice: (1) intrapersonal (e.g. self-awareness), (2) interpersonal (e.g. fostering informal networks), (3) organizational (e.g. creating a shared vision) and (4) systemic (e.g. strategic navigation). Learning strategies employed included learning from experience and example, reflective practice, strategic mentoring or advanced training. Conclusions: Our findings illuminate a four-domain framework for understanding medical education leader practices and their learning preferences. While some of these findings are not unknown in the general leadership literature, our understanding of their application in medical education is unique. These practices and preferences have a potential utility for conceptualizing a coherent and relevant approach to the design of faculty development strategies for medical education leadership.

The effect of age of onset on depression in the elderly.

In an attempt to examine the effects of age and age of onset on depressive illness, the records of 55 psychiatric inpatients with an average age of 77 years were reviewed. There was no correlation between age and presence of psychosis, severe cognitive impairment, positive family history, length of hospitalization, treatment, or treatment response. When the cases were grouped on the basis of age of first admission, only the rates of family history were significantly different. Although age per se may have little influence on the nature of depressive illness, age of onset may be important in distinguishing different types of depressive illness in the elderly, which suggests implications for treatment and prognosis. (J Geriatr Psychiatry Neurol 1989 ; 2:182-187).

Toward a common understanding: supporting and promoting education scholarship for medical school faculty

Education scholarship (ES) is integral to the transformation of medical education. Faculty members who engage in ES need encouragement and recognition of this work. Beginning with the definition of ES as ‘an umbrella term which can encompass both research and innovation in health professions education’, and which as such represents an activity that is separate and distinct from teaching and leadership, the purpose of our study was to explore how promotion policies and processes are used in Canadian medical schools to support and promote ES.