Faculty Bibliography

OBJECTIVE: The aging of the US population and shortage of geriatric psychiatrists mean that all medical students must be prepared to evaluate psychiatric symptoms in older patients. The authors sought to describe current geriatric psychiatry teaching practices during the psychiatry clerkship. METHODS: Psychiatry clerkship directors at 110 American medical schools were surveyed about didactic and clinical experiences of geriatric psychiatry. RESULTS: Sixty-two (56 %) of programs responded. One fifth of programs lacked specific instruction in geriatric psychiatry. Programs were more likely to include instruction on dementia than late-life depression. Increased geriatric psychiatry educational offerings were associated with the following: number of geriatric psychiatrists on faculty, presence of a geriatric psychiatrist on the medical education committee, and inclusion of geriatric psychiatry specific items in clerkship learning objectives. CONCLUSIONS: Current practices in some clerkships are inadequate to prepare medical students to care for older patients with psychiatric symptoms.

BACKGROUND: Electroconvulsive therapy (ECT) is a widely used, highly effective antidepressant treatment. Except for the most severely ill patients, right unilateral (RUL) electrode placement is the most frequent initial treatment choice. In current practice, RUL ECT is administered at several multiples of seizure threshold (ST) based on reports that lower stimulus intensity results in lower response/remission rates. Many patients, as part of an initial dose titration to determine ST, will receive a single treatment with low-dose RUL ECT and subsequent treatments with a stimulus at a multiple of ST. OBJECTIVE: To assess response to the first ECT. METHODS: A retrospective analysis of charts from clinical practice at Mount Sinai Medical Center was performed. RESULTS: A single treatment with low-dose (presumably near ST) RUL ECT had a significant and immediate antidepressant effect in our sample of patients with major depression. We determined that this response is similar to that of patients receiving a single initial treatment with high-dose RUL ECT (at a multiple of ST). CONCLUSIONS: These data suggest, contrary to commonly held belief, that RUL ECT may be effective at a low stimulus dose. This argues against restimulating at 6 times ST in the initial session, based on the belief that the near-threshold seizure has no antidepressant efficacy. Our findings suggest a need for further investigation of cases in which low-dose RUL ECT may be an effective antidepressant treatment. Further prospective studies, including larger numbers of patients who receive randomized treatment with low- or high-dose RUL with longer follow-up, are indicated.

OBJECTIVE/UNASSIGNED:The objective of this study is to examine differences between; telehealth and in-person visits during COVID-19 and in a pre-COVID-19 reference period; COVID-19 televisit completion for patients with varying engagement in treatment during the reference period. METHODS/UNASSIGNED:-tests to compare patient demographics. Generalized estimating equations for estimating the odds of outcomes were used, controlling for demographics. RESULTS/UNASSIGNED: = 15,497) to COVID-19. For patients on buprenorphine, patients with no prior in-person visits during the pre-televisit period were 2.26 more likely to complete televisits compared with patients with two or more prior in-person visits. For all patients, those with two or more prior in-person visits in the reference period were 1.27 times more likely to complete a televisit compared with a patient with no in-person visits during the pre-televisit period. There was no significant difference when comparing with patients who had only one prior in-person visit to those patients with no prior visits. CONCLUSIONS/UNASSIGNED:In this study, outpatient substance use disorder (SUD) telehealth appointments were associated with higher odds of visit completion compared with in-person visits during and prior to COVID-19. Patients receiving buprenorphine, without prior in person visits, were more likely to attend if they did not have in-person visits prior to COVID-19. Regulators should consider permanently adopting telehealth flexibilities for SUD treatment once the federal emergency status has ended.

At the beginning of a career in academic psychiatry, new attending psychiatrists do not have all the skills necessary to advance towards promotion. For instance, attendings are most likely well versed in reading and perhaps in writing medical literature, but may not have the knowledge, skills or attitudes to provide a meaningful peer review to a publication. Aside from providing an important, meaningful service to medical science, reviewing articles prior to publication can allow novice researchers and writers to gain important skills in writing for publication and critical thinking. It also allows one to keep up to date on the latest science, and build your CV. This interactive workshop will give participants the opportunity to work in small groups to review an article, present their evaluation and compare their findings with experts.Dr. Nery Diaz and Dr. Paroma Mitra will discuss the basic process of peer review, why participants should accept requests to review articles and provide a "how to" guide. Then, participants will form small groups and group review a section of an article using the guidelines discussed previously. After, the groups will report out their findings. The results from the official review of the article will be shared so that participants can compare findings. Dr. Jordan Karp will provide insights into the process of publication from the viewpoint of a member of the editorial board of the American Journal of Geriatric Psychiatry. Finally, Dr. Popeo will provide a brief summary.
Copyright

Opportunities for professional development and mentorship are vital for junior and mid-level faculty members to succeed in academic medicine. Too often, those opportunities are of short supply at institutions. In this special 2-hour, interactive workshop affiliated with the Teaching and Training Committee, learners will be exposed to several areas of professional development. Dr. Brandon Yarns will discuss providing formative feedback using the Feedback with Good Judgment Model. Dr. Scalmati will briefly address the importance of setting the stage for feedback by the establishment of clear expectations, with a description of its role in both the context of a rotation and individual tasks, and the definition ofthe concept of a "feedback bank". The second part of her presentation will consist of a practical exercise prepared by faculty involving the audience in a role play of feedback skills. Dr. Santos will discuss the need to present oneself effectively in the academic world and the value of effective CV. Finally, Dr. Popeo will discuss how strategic thinking about one's career and the judicious use of the words "yes" and "no."
Copyright

Ageism is endemic in society and in healthcare settings. It exerts both overt and subtle effects on older patients, their families, clinicians, and trainees. Ageism is defined as stereotyping or discrimination against older people based on their age. Similar to racism and sexism, ageism involves holding negative stereotypes about older adults. Unlike other "ism's", ageism is not routinely addressed in medical education settings or in discussions about the impact of implicit bias on efforts to promote diversity and inclusiveness. While there is evidence from empiric studies that negative attitudes towards older adults exist in healthcare and medical education settings, it is less clear how these attitudes can and should change. Are older adults helped or harmed by efforts to de-emphasize physiologic changes due to aging? Are they helped or harmed by efforts to highlight changes and possible limitations due to aging? How do we best help our colleagues to address ageism so we can prepare the next generation of physicians to provide excellent care to their older patients? How do we distinguish between advocacy and ageism? In this symposium, 3 geriatric psychiatrists who are also medical educators, explore the impact of ageist attitudes in three timely contexts for geriatric psychiatrists: 1) as consultants to institutional policy-making for cognitive capacity, forced retirement and related issues for physicians and others, 2) as educators recognizing and combatting ageism in the Hidden Curriculum of our medical schools, as the AAMC has launched an initiative to integrate the arts and humanities into undergraduate medical curricula, 3) as advisors to society in understanding the complexities of ageism in our current political climate. References: Bensadon BA, Teasdale T, Odenheimer GI. Attitude adjustment: Shaping medical students' perceptions of older patients with a geriatrics curriculum Acad Med 2013;88:1630-1634. Tullo ES, Spencer J, Allan L. Systematic review: Helping the young to understand the old. Teaching interventions in geriatrics to improve the knowledge, skills, and attitudes of undergraduate medical students. JAGS 2010;58(10):1987-1993 Lammando MA, Ahmed I, Ellison JM. Cognitively impaired physicians: How do we detect them? How do we assist them? Am J Geriatr Psychiatry 2018;26:631-640.
Copyright