Toi Blakley Harris

A Systematic Review of Stress-Management Programs for Medical Students.

ObjectiveBecause medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.MethodsThe authors searched the published English-language articles on PsycINFO and Pub Med, using a combination of the following search terms: stress-management, distress, burnout, coping, medical student, wellness. Both randomized, controlled trials and controlled, non-randomized trials of stress-management programs were selected and critically appraised.ResultsA total of 13 randomized, controlled trials or controlled, non-randomized trials were identified. Interventions included self-hypnosis, meditation, mindfulness-based stress-reduction, feedback on various health habits, educational discussion, changes in the length and type of curriculum, and changes in the grading system. Only one study was identified to be of very high quality, although several had described group differences at baseline, used blinding, had good follow-up, and used validated assessment tools. There was a wide heterogeneity of outcome measures used. Interventions that were supported by a reduction in stress and anxiety in medical students included mindfulness-based stress-reduction or meditation techniques, self-hypnosis, and pass/fail grading.ConclusionsSignificant opportunities to advance educational research in this field exist by developing more high-quality studies with particular attention to randomization techniques and standardizing outcome measures.

Evaluation and treatment of acute psychosis in children with systemic lupus erythematosus (SLE): consultation–liaison service experiences at a tertiary-care pediatric institution

Background Neurological and psychiatric manifestations of systemic lupus erythematosus (SLE) are prevalent in children with SLE. There are few data on the evaluation and management of psychotic features in children with this systemic autoimmune disorder. Objective The authors describe contemporary Child and Adolescent Psychiatry Consultation and Liaison service management of acute psychosis in children with lupus. Method The authors reviewed the records (2003–2008) of all pediatric SLE inpatients who were administered a traditional or atypical antipsychotic agent. They describe clinical features, initial and discharge mental status examinations, and inpatient psychotropic medication usage. Results Ten pediatric SLE patients (age 10–19 years) required psychiatric management for psychosis during the review period. Paranoid delusions (70%), visual hallucinations (60%), and auditory hallucinations (60%) were the most common psychotic symptoms documented. All children were initially treated with an antipsychotic medication. Seven children were maintained on an atypical antipsychotic during their hospitalization. Two children had extrapyramidal signs, but no other adverse events were documented. All children were improved at discharge, and 40% had complete resolution of psychosis; 8 of the 10 patients were discharged on a psychotropic medication. Discussion Psychotic manifestations associated with severe disease presentations were successfully treated by child psychiatrists. Atypical antipsychotics were well-tolerated and used as an adjunct to immunosuppressive regimens in these patients. Prospective studies are necessary to improve the care of children and adolescents with SLE and severe psychiatric manifestations.

Teaching the psychosocial aspects of pediatric surgery.

The optimal care of children with surgical diseases requires acquiring skills in the psychosocial assessment and therapy of children. Developing and implementing a curriculum to teach these concepts to pediatric surgery trainees should result in decreased perioperative stress for the child and improved patient outcomes and family satisfaction.

A Structured End-of-Life Curriculum for Neonatal-Perinatal Postdoctoral Fellows.

Death in tertiary care neonatal intensive care units is a common occurrence. Despite recent advances in pediatric palliative education, evidence indicates that physicians are poorly prepared to care for dying infants and their families. Numerous organizations recommend increased training in palliative and end-of-life care for pediatric physicians. The purpose of this study is to develop a structured end-of-life curriculum for neonatal–perinatal postdoctoral fellows based on previously established principles and curricular guidelines on end-of-life care in the pediatric setting. Results demonstrate statistically significant curriculum effectiveness in increasing fellow knowledge regarding patient qualification for comfort care and withdrawal of support (P = .03). Although not statistically significant, results suggest the curriculum may have improved fellows’ knowledge of appropriate end-of-life medical management, comfort with addressing the family, and patient pain assessment and control.

Saturday Morning Science programs: a model to increase diversity in the biosciences.

PURPOSE To examine a pathway program for middle and high school students from underrepresented backgrounds designed to foster career interest in the biomedical sciences. In 2002, the Institute of Medicine released a report entitled Unequal Treatment, which examined the racial and ethnic disparities in health and health care within the United States and encouraged the development of a diverse health care workforce as a means to reduce health care disparities. PROCEDURES Saturday Morning Science (SMS) is a program model presented as a pipeline strategy that addresses this specific recommendation. SMS is a 10-week program that emphasized the importance of science and math. Post-SMS evaluations were conducted to assess biomedical career knowledge, attitudes regarding future career plans, and the effectiveness of the program. FINDINGS A total of 87.5% of middle and high school students who were enrolled in SMS completed the program (113 of 130). Seventy percent of SMS participants were underrepresented minorities. Snapshot program evaluation data exposed new ideas about science (strongly agree/agree, 98%; 64 of 65), exposed new ideas about medicine (strongly agree/agree, 97%; 63 of 65, and increased desire to enter science related field (strongly agree/agree 82% (53 of 65). CONCLUSIONS SMS was designed to motivate students of underrepresented ethnic backgrounds from middle through high school to attend college and prepare for careers in the health sciences. SMS students had the opportunity to interact with scientists, physicians, medical and graduate students, and other academicians. They provided direction and guidance to ensure that students had meaningful experiences specifically designed to expose them to opportunities in the biosciences.

Students versus faculty members as admissions interviewers: Comparisons of ratings data and admissions decisions

Purpose To explore variations both in interview ratings data and in medical school admissions decisions when current medical students do and do not participate in interviewing applicants. Method The research team conducted this randomized controlled trial by performing identical analyses for each of six independent cohorts of applicants (n = 3,868) to Baylor College of Medicine for the academic years 2005–2006 through 2010–2011. A pair of randomly selected interviewers—either two faculty members or a faculty member and a student—interviewed each applicant in a one-on-one interview. Results Interviewer pairs randomly structured to include either two faculty members (n = 1,523) or one faculty member and one student (n = 2,345) produced ratings of similar means as well as homogeneity across ratings. The structure of the rater pairs, as expected, was not predictive of the final admissions decisions after the authors took into account Medical College Admission Test scores and grade point average. Conclusions These results, showing that student involvement does not compromise the ratings of interviewed applicants, support the continued involvement of students in medical school admissions interviews.

Trauma and Diverse Child Populations

It has been estimated that as many as two-thirds of American youth experience a potentially life-threatening event before 18 years of age and that half have experienced multiple potentially traumatic events. Race, ethnicity, and culture influence the frequency and nature of these traumas and also the ways in which children react to traumatic events. The authors discuss the varied influences of cultural background on these reactions to trauma, the varying presentations of diverse children experiencing troubling reactions, and the need to provide treatment to children and their families in a fashion that is culturally sensitive and acceptable to diverse families.

Lessons Learned: A "Homeless Shelter Intervention" by a Medical Student

ObjectiveThe authors explored the process of implementing a medical student-initiated program designed to provide computerized mental health screening, referral, and education in a homeless shelter.MethodsAn educational program was designed to teach homeless shelter staff about psychiatric disorders and culturally-informed treatment strategies. Pre- and post-questionnaires were obtained in conjunction with the educational program involving seven volunteer shelter staff. A computerized mental health screening tool, Quick Psycho-Diagnostics Panel (QPD), was utilized to screen for the presence of nine psychiatric disorders in 19 volunteer homeless shelter residents.ResultsShelter staffs’ overall fund of knowledge improved by an average of 23% on the basis of pre- /post- questionnaires (p=0.005). Of the individuals who participated in the mental health screening, 68% screened positive for at least one psychiatric disorder and were referred for further mental health care. At the 3- month follow-up of these individuals, 46% of those referred had accessed their referral services as recommended.ConclusionMedical student-initiated psychiatric outreach programs to the homeless community have the potential to reduce mental health disparities by both increasing access to mental health services and by providing education. The authors discuss educational challenges and benefits for the medical students involved in this project.

The Texas Regional Psychiatry Minority Mentor Network: A Regional Effort To Increase Psychiatry’s Workforce Diversity

As highlighted by the Surgeon General’s 2001 report, there is a need to eliminate mental health disparities among ethnic minorities that are underserved (1). Healthcare disparities have resulted in decreased access to bilingual services for underrepresented and underserved minorities, increased risk for misdiagnosis, more inpatient hospitalizations, and less follow-up after hospitalizations (2, 3). The current mental-health workforce is also deficient with respect to diversity. In 2007, 16% of psychiatry trainees were from underrepresented groups such as African American, Hispanic American, Native American, or of Pacific Islander descent. Also, 24% were of Asian descent. Even smaller proportions of the membership of the American Psychiatric Association (APA) (4) or of psychiatric faculty (5) belong to the underrepresented ethnic groups. Although the need for mentoring has been described as an important part of academic medicine, fewer than 50% of medical students and, in some fields, less than 20% of faculty are reported to have a mentor (6). Members of underrepresented groups and women have been shown to have more difficulty in establishing a mentoring relationship (7). Many models have been implemented to improve the recruitment, retention, and promotion of minorities in medical school and academic departments across the country (8–12), although there is only generally limited evidence to support the efficacy of mentorship (13). In this article, we describe the development and implementation of a program of mentorship and cultural-competence education that targets the elimination of mentalhealth disparities. This program, the Texas Regional Psychiatry Minority Mentor Network (TRPMMN), has three goals: 1) to interest minority medical students in psychiatry as a profession; 2) to increase the cultural competence of mental-health providers; and 3) to increase retention through mentorship and support of the minority faculty. We also report data on some academic accomplishments of the medical students, residents, and juniorfaculty program participants from the first 18 months of the program’s implementation.

Use of aripiprazole in adolescents with a history of lupus-associated psychosis and refractory psychiatric manifestations

Neurologic and psychiatric manifestations are prevalent in children and adults with lupus (labeled by convention neuropsychiatric systemic lupus erythematosus or NPSLE). However, there is a paucity of data on the evaluation and management of NPSLE in youth, with only a few publications describing the use of atypical antipsychotics in children and adolescents with lupus. In children, aripiprazole, a D2/5-HT1A partial agonist, appears to cause less prominent metabolic derangements than other second-generation antipsychotics. This agent may be an important tool in the treatment of pediatric patients with lupus who are at risk for weight gain and dyslipidemia due to disease and corticosteroid effects. The authors present two cases in which psychiatric symptoms associated with treatment-refractory lupus responded to aripiprazole pharmacotherapy.