Faculty Bibliography

BACKGROUND:There is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education (CME). Although professional medical organizations' annual meetings play an instrumental role in CME for physicians, there are no studies describing DEI content in the annual meeting programming of professional medical organizations, including the Academy of Consultation-Liaison Psychiatry (ACLP), the primary professional organization for Consultation-Liaison (C-L) psychiatrists. METHODS:We examined the publicly available ACLP annual meeting content titles on the ACLP website from 2010 to 2021. National DEI leaders from ACLP's DEI subcommittee iteratively generated keywords that covered a broad scope of DEI-related themes. Each annual meeting content was independently coded by two members of the DEI subcommittee with discrepancies adjudicated by two additional members. Descriptive statistics were used to characterize the annual meeting content. RESULTS:Of the 2615 annual meeting titles from 2010-2021 which were analyzed, 2531 were not coded to have DEI themes. 3% (n=84) of titles were coded to have a DEI theme as follows: Culture/Diversity (n=20, 24%), Bias/Disparities (n=17, 20%), Race/Racism (n=17, 20%), Social Justice (n=12, 14%), Gender/Sexism (n=10, 12%), and LGBTQ+ (n=8, 10%). The frequency of DEI titles each year ranged from 1% (2010, 2018) to 17% (2021) with an increase in DEI content in 2021 (n=24, 17%). CONCLUSION/CONCLUSIONS:Although professional medical organizations like the ACLP are poised to leverage their CME platforms embedded in annual meeting programming to train CL psychiatrists on DEI topics, our findings suggest more work is needed to develop and promote DEI focused educational programming for their annual meetings.

Two articles recently published in this journal identified racial inequities in routine psychiatric practice. This Open Forum discusses the need for a paradigm shift in inequities research. The two articles reviewed here, one by Shea and colleagues on racial-ethnic inequities in inpatient psychiatric civil commitment and one by Garrett and colleagues on racial-ethnic disparities in psychiatric decisional capacity consultations, are examples of the new research gaze. Four topics are identified for enhancing understanding of racism and other forms of structural exclusion in psychiatric practice: medical authority and power imbalance between providers and patients, involuntary psychiatric commitment and requests for decisional capacity consultations as strategic research events, limited use of theory, and limitations of the literature on psychiatric inequities.

Psychiatry consultants are often called on by colleagues to assess a pa-tient"™s capacity to refuse medical care. These situations can expand beyond the boundaries of a decision-making capacity question to become clinically, legally, ethically, and emotionally com-plex situations. This article provides a framework for psychiatrists to navigate these complexities when asked to eval-uate a patient for the capacity to refuse medical care. We review decision-mak-ing capacity as an element of informed consent in order to clarify the psychia-trist"™s role in these consults. We dis-cuss related ethical and legal questions that can arise when a patient refuses treatment. This article also addresses other skills beyond decision-making capacity assessment that psychiatrists may utilize to support nonpsychiatrist colleagues and advance the care of the hospitalized patient.

BACKGROUND:There is a national shortage of psychiatrists with subspecialty fellowship training, and many fellowship positions are unfilled. OBJECTIVE:We conducted a survey of US psychiatry residents to better understand the motivation to pursue fellowship training and to determine any specific factors that were particularly influential in choosing a fellowship in consultation-liaison (C-L) psychiatry. METHODS:Online surveys were distributed electronically to US general psychiatry residents through the American Association of Directors of Psychiatric Residency Training list server. RESULTS:A total of 219 questionnaires were completed. Interest in fellowship declined during residency training. Most important factors in consideration of fellowship training were lifestyle (89%), finances (69%), and academic opportunities (63%). Specific influential factors were residency experiences, attending staff as a role model, and medical school experiences. Most important discouraging factors were extra training time, financial concerns, and belief that fellowship training was not necessary. Only 30% of residents had outpatient C-L psychiatry experiences. Few residents belonged to any subspecialty organization or attended any subspecialty meeting. Residents interested in C-L psychiatry fellowships had lower expectation of increased salary than other residents. Outpatient practice settings were seen as preferable over inpatient settings by most residents. CONCLUSIONS:Results of this survey suggest that enhancing consultation psychiatry exposure in medical school and residency with strong role models, outpatient C-L psychiatry experiences, facilitating subspecialty organization membership and meeting attendance, emphasizing academic opportunities of fellowship training, and improving remuneration for fellowship-trained psychiatrists might be important factors that could improve recruitment into C-L psychiatry and other psychiatric fellowships.