Spirituality and religion in Canadian psychiatric residency training.

OBJECTIVE: Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. METHODS: We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. RESULTS: We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. CONCLUSION: Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.     

A comparison of the performance of for-profit and nonprofit U.S. psychiatric inpatient care providers since 1980

OBJECTIVE: The authors synthesized evidence from a systematic review of the literature reporting substantiated performance differences between private for-profit and private nonprofit psychiatric inpatient care providers in the United States since 1980. They also compared reported differences in performance between nonprofit and for-profit inpatient psychiatric care providers with reported differences between nonprofit and for-profit providers of other types of health care. METHODS: Studies were located by means of computerized bibliographic searches and follow-up searches of studies cited in the articles located in the computerized search. The analysis included peer-reviewed studies that compared the performance of for-profit and nonprofit health service providers, including inpatient psychiatric services, in the areas of access, quality, cost-efficiency, and amount of charity care on the basis of quantitative data collected after 1980. The studies were classified in one of three categories according to the study conclusion: for-profit superiority, nonprofit superiority, or no difference or mixed results. RESULTS: Almost all studies (with one exception) found that the nonprofit psychiatric providers performed as well as or better than their for-profit counterparts. The proportion of studies reporting performance superiority of nonprofit versus for-profit psychiatric inpatient providers was greater than the proportion of studies reporting the same conclusion for providers of all other types of health care taken together. CONCLUSIONS: On the basis of data collected since 1980, nonprofit psychiatric inpatient care providers in the United States had superior performance on access, quality, cost-efficiency, and amount of charity care, compared with for-profit providers. Caution is warranted in pursuing public policies that permit or encourage the replacement of nonprofit psychiatric inpatient care providers with for-profit providers of these services.     

Predictors of psychiatrist-reported treatment-compliance problems among patients in routine U.S. psychiatric care

Characteristics associated with psychiatrist-reported treatment-compliance problems were investigated using the 1999 Study of Psychiatric Patients and Treatments from the Practice Research Network of the American Psychiatric Institute for Research and Education (n=1,843). Logistic regression was used to study characteristics associated with compliance problems as perceived by treating psychiatrists. Among the 22 potential predictors of interest, all but three (age, gender, and problems with primary support group) were found to be significantly associated with treatment-compliance problems in bivariate analyses. A predictive model was developed consisting of eight independently significant predictors from diagnostic, clinical, psychosocial, and treatment-history domains. These predictors included substance use disorder diagnosis, medication side effects, moderate to severe psychotic symptoms, personality disorder diagnosis, economic problems, prior hospitalization, current Global Assessment of Functioning scale score, and duration of treatment with current psychiatrist. This predictive model correctly identified the presence or absence of treatment-compliance problems in 91% of patients in a sample randomly drawn from the dataset before model construction. These findings may be useful to clinicians, researchers, and program planners interested in addressing the important issue of treatment-compliance problems in psychiatric care settings.     

A model for reintegrating couples and family therapy training in psychiatric residency programs.

OBJECTIVE: The authors propose a family-systems training model for general residency training programs in psychiatry based on the couples and family therapy training program in Stanford's Department of Psychiatry and Behavioral Sciences.METHODS: The authors review key elements in couples and family therapy training. Examples are drawn from the family therapy training curriculum in a general psychiatric residency program. RESULTS: Conceptual and practical skills taught over the span of a psychiatric residency training program are described, focusing on: joining with the couple or family; seeing systemic patterns, recognizing the family's developmental stage, history, and culture; identifying family structure; and intervening systemically. CONCLUSION: This family-systems training model can serve as a resource for residency programs interested in integrating the couples and family therapy model more fully into their curricula.     

The educational objectives of a psychiatric residency program.

The authors present a statement of the specific educational objectives of their psychiatric residency program. This statement is designed to help residents keep in focus the central tasks of their training and to provide the faculty with an organizing matrix for curriculum development. Through such specific delineation of their objectives, residency programs can also contribute to a clarification of the specialty.     

Volunteer case aides in the U.S.A.

Mrs. Jeanne Lewington was awarded a 1973 Winston Churchill Fellowship to visit the U.S.A. and look at the way volunteers are used, particularly in the field of mental health. She studied projects at State and Private Mental Hospitals and Community Health Centres. She was particularly impressed with the contribution of Volunteer Case Aides in one to one work with psychiatric patients and describes this principle in some detail. On her return Mrs. Lewington approached the King's Fund London and has been given a grant to finance the establishment of a two year Volunteer Case Aide Programme based at St. Crispin Hospital, Northampton, England, evaluation of which will take place during 1975.     

Interviewing skills in relation to psychiatric residency

A review of the literature suggests that the teaching of interviewing skills in psychiatry residency programs has been largely ignored. The consequences of poor interviewing, the characteristics of good interviewing, and what is known about effective training techniques for the mastery of clinical interviewing are reviewed. The relevance of psychiatric training is discussed. Issues which warrant further research are presented.     

Mastering CanMEDS roles in psychiatric residency: a resident's perspective.

Postgraduate trainees in psychiatry are being evaluated on their proficiency at competencies that comprise the physician roles identified by the CanMEDS 2000 Project. This paper provides an overview of each CanMEDS role and its associated competencies and suggests strategies to help residents prepare for the new format of the Royal College of Physicians and Surgeons (RCPSC) certification examination in psychiatry.