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Tele-Psychiatry for College Students: Challenges, Opportunities, and Lessons Learned from the Pandemic

De Faria, Ludmila; Kring, Brunhild; Keable, Helene; Menon, Meera; Peluso, Francesco; Notman, Malkah; Ackerman, Alexandra
College students are the human capital of a nation, and their college education lays the foundation for their success as future leaders of society. However, their ability to advance is often impeded by stress. Changes in lifestyle, increased academic workload, student debt, forming interpersonal relationships, and coping with new adult responsibilities may result in clinically significant anxiety and depression that require medical attention. Left untreated, these illnesses hinder academic progress and decrease graduation rates. College students constitute a highly mobile population frequently traveling for breaks and school-related activities and, as such, at increased risk of interruption and/or discontinuation of care. The COVID-19 pandemic challenged our ability to offer consistent mental health care for students and forced us to implement public health measures that were long overdue. Temporary governmental policy changes allowing for the provision of remote care across state lines at the same reimbursement rate as in-person services were vital to student mental health recovery, retention in school, and graduation rates. The time-limited loosening of state-based medical licensure restrictions clearly demonstrated the feasibility, benefits, and dire need for widespread implementation of telehealth. These are important lessons that should inform future policies for student health. In this paper, we advocate therefore, that the temporary loosening of the licensure restrictions and equitable reimbursement rates be codified into law. The current licensing regulations have not kept pace with the lived experience of college students or modern society in general. Given more mobile lifestyles, these restrictions result in frequent inevitable transitions of care which are highly undesirable. Even if providers outside metropolitan areas were readily available,1,2 these transitions of care are fraught with considerable risk for medical error. We also advocate for a national standardization of tele-psychiatry policy and procedures, including access to electronic health care records for providers taking care of matriculated students. To date, student mental health services are a patchwork of organizational models of varying funding and efficacy.
ISSN: 2572-1801
CID: 5567982

Critical events in the lives of interns

Ackerman, Alexandra; Graham, Mark; Schmidt, Hilary; Stern, David T; Miller, Steven Z
BACKGROUND: Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities. OBJECTIVE: To evaluate the most critical events in the lives of interns. PARTICIPANTS: Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict. MEASUREMENTS: We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts. MAIN RESULTS: The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician-patient relationship. CONCLUSION: The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents' emerging professional identities.
PMID: 18972091
ISSN: 0884-8734
CID: 449052

Sex difference in the effect of puberty on the relationship between fat mass and bone mass in 926 healthy subjects, 6 to 18 years old

Ackerman, Alexandra; Thornton, John C; Wang, Jack; Pierson, Richard N; Horlick, Mary
OBJECTIVE:Understanding factors influencing bone mineral accrual is critical to optimize peak bone mass during childhood. The epidemic of pediatric obesity and reported higher incident of fracture risk in obese children led us to study the influence of fat mass on bone mineral content (BMC) in children. RESEARCH METHODS AND PROCEDURES/METHODS:Height; weight; pubertal stage; and BMC, non-bone fat-free mass (nbFFM), and fat mass (FM) by DXA were obtained in a multiethnic group of healthy children (444 girls/482 boys; 6 to 18 years old) recruited in the New York metropolitan area. Regression techniques were used to explore the relationship between BMC and FM, with age, height, nbFFM, pubertal stage, sex, and ethnicity as covariates. RESULTS:Because there were significant sex interactions, separate regression analyses were performed for girls and boys. Although ln(nbFFM) was the greatest predictor of ln(BMC), ln(FM) was also a significant predictor in prepubertal boys and all girls but not in pubertal boys. This effect was independent of ethnicity. DISCUSSION/CONCLUSIONS:FM was a determinant of BMC in all girls but in only prepubertal boys. Our study confirms nbFFM as the greatest predictor of BMC but is the first to find a sex difference in the effect of puberty on the relationship of FM to BMC. Our results suggest that, in two individuals of the same sex and weight, the one with greater fat mass will have lower BMC, especially pubertal boys. The implications of these findings for achievement of optimal peak bone mass in a pediatric population with an unprecedented incidence of overweight and "overfat" status remain to be seen.
PMID: 16855191
ISSN: 1930-7381
CID: 5230302