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Background: The coronavirus disease 2019 (COVID-19) pandemic brought an unprecedented shift in health care toward telepsychiatry. This worldwide phenomenon was necessary to meet community health needs while prioritizing patient and provider safety. This study explored the impact of changes in delivery of mental health care services during the pandemic on patient and provider satisfaction with care. Methods: Providers and patients at an academic outpatient psychiatric clinic completed an electronic, cross-sectional, anonymous survey. Items probed perceived convenience and comfort with in-person and telehealth visits, COVID-19–related depression and anxiety, and visit modality preferences. Results: The response rate was 80.0% for providers and 21.0% for patients. Providers found telehealth more convenient than in-person visits during the pandemic, t(11)=1.66, P=0.024. Patients reported no differences in convenience (P=0.497) or comfort (P=0.535) ratings. As the pandemic continues, 83.3% of providers and 50.0% of patients indicated they would prefer telehealth visits. Only 16.7% of providers and 25.0% of patients would prefer telehealth visits continue after the pandemic. Preferred appointment type during the pandemic was not significantly correlated with pandemic-related anxiety or depression. Conclusion: Providers showed a strong preference for telehealth visits during the pandemic, whereas patients felt equal convenience and comfort with care in both telehealth and in-person visits. Fewer participants preferred to use the telehealth modality after the pandemic ends. Higher COVID-19–related depression or anxiety did not impact preference toward visit type. These results suggest that telepsychiatry is an acceptable, although not always preferred, modality for psychiatric care during the global pandemic.

My story illustrates how a power dynamic altered my own behaviors, how gender biases about sexual misconduct contribute to inequities within academia, and the importance of providing safety and validation to victims of sexual misconduct. As faculty now, I pay attention to power dynamics with trainees, colleagues and patients, recognizing that even voicing differences of opinions can be difficult from a disempowered position. The powerlessness I experienced, freezing then yielding, can occur in any setting that does not provide safety and support for the expression of diverse and contrasting perspectives. Changing cultural norms related to power within academia requires all of us to think differently about ourselves and others continuously as we all carry implicit biases [11]. From a women’s mental health perspective, all physicians should recognize that emotional pain often derives as much from sociocultural narratives that invalidate lived experiences as from the actual traumatic events. Sexual aggression from my supervisor rendered me powerless as a trainee; this common experience limits both professional successes and damages the health of women in our society.

Purpose: Health care disparities are an important but sometimes underrepresented topic in graduate medical education. In this study we measured the impact of educational and behavioral interventions on resident knowledge about and attitudes toward health care disparities. Methods: Faculty from 6 residency programs designed and presented an hour-long educational intervention to emphasize the importance of and increase resident knowledge about health care disparities. Selected residents then helped design a month-long behavioral intervention to engage their peers in conversations about disparities with patients. Surveys were administered pre- and post-educational intervention as well as post-behavioral intervention in order to measure the impact each intervention had on resident knowledge and attitudes. Results: Paired-samples t-tests showed that residents were more knowledgeable about health care disparities issues following didactic teaching (P < 0.001) and felt such issues were more important (P < 0.001). Furthermore, presence of these feelings significantly predicted the frequency of engaging in the behavioral intervention (r = 0.44, P < 0.01). Conclusions: Two brief, simple interventions produced significant changes in resident knowledge, attitudes and behaviors regarding health care disparities. The educational intervention was most effective at increasing knowledge of disparities in general and encouraging participation in the behavioral intervention, while the behavioral intervention was useful in increasing knowledge of specific patients’ barriers to care.

Background: Burnout is a major problem among physicians in the United States. Women physicians experience higher rates of both burnout and sexual harassment than their male counterparts. Some studies from Asia and Europe have shown a correlation between sexual harassment at work and burnout in women physicians, but no studies on this topic have been done in the United States. Methods: For this study, women physicians with active Louisiana licenses were invited to complete a cross-sectional self-report survey to assess burnout and sexual harassment. Burnout was assessed with the 2-item Maslach Burnout Inventory, and sexual harassment was assessed with a questionnaire adapted from the Sexual Experiences Questionnaire and a series of follow-up items. Results: The survey response rate was 13% (129 of 970 invitees). Of the 129 participants, 36% reported feeling burned out from their work at least once a week and 38% reported having experienced at least one inappropriate sexual incident in their career. Ninety-six percent of respondents reported having experienced gender harassment from their colleagues, while 69% had experienced unwanted sexual attention from the same. Additionally, 69 (53%) participants reported experiencing some form of sexual harassment from patients or their families. Colleague gender harassment was significantly correlated with burnout scores. Conclusion: This study found that reports of burnout and gender harassment from colleagues were significantly correlated. The results also align with previous findings of high rates of sexual harassment in medical school and residency. More research should be done in this area, especially focusing on women in training, women of color, and sexual and gender minority individuals.

Stigma towards people with substance use disorders is pervasive and imbedded in our US culture. Prejudicial attitudes that are part of a health care practitioner’s value system are a barrier to people accessing health care and substance use treatment. This study aimed to reduce stigmatizing attitudes of graduate health care professional students by implementing an innovative curriculum combining multiple teaching methods. Physician assistant students received a 3-h educational intervention that consisted of lecture and discussion sessions, direct interaction with a recovering substance user, viewing a film portrayal of addiction and addiction treatment, and written self-reflection. Changes in student attitudes were measured using a subscale of the Attitudes to Mental Illness Questionnaire (AMIQ) instrument and analysis of coded written reflections. A follow-up focus group resulted in additional qualitative insight into attitudes. Post-intervention scores for the “heroin” AMIQ vignette significantly improved compared to pre-test scores (p

Introduction There is growing interest in delivering patient-centered care in all areas of medical practice, yet acquiring the requisite attitudes, skills, and behaviors simply by observing or participating in current systems of care that employ a medical or physician-centric model is challenging. Patient centeredness involves an understanding of patients’ perspectives on their illness and treatment, the impact that health and illness have on the lives of patients, and the values and goals patients have for themselves, while also encouraging patients and health care professionals to engage in a shared decision-making model of health care. That model aspires to result in increased trust between providers and patients, as well as better patient outcomes. Methods This 90-minute workshop utilizes three different approaches to help the learner develop patient-centered care and communication skills in a mental health setting: a video of a patient sharing her experience with the mental health system, a narrative model of appreciating patient experience (first-person memoir), and an exercise using patient-centered language in a medical record documentation. Results This workshop was presented at the American Association of Psychiatric Directors of Residency Training (AADPRT) Annual Meeting in March 2016. Approximately 21 people attended. Feedback was received from 11 participants and demonstrated a high degree of agreement (4.5 out of 5) with the following statements: the speakers met the stated educational objectives; the content was educationally useful; the information in this presentation will inform my educational practices; the presentation advanced my knowledge of the subject. Discussion While these three pedagogical exercises do not cover the entirety of the skills required for patient-centered care and communication, they do provide a useful starting point for hearing and appreciating the experience of the patient. Despite the focus on mental health settings and treatment, other medical specialties could derive useful ideas from this workshop format or adapt the materials to their own needs.

Medical professionals' negative attitudes toward patients with mental illness and substance abuse disorders can have negative consequences, and these attitudes are not rare. In surveys, patients have reported discrimination in mental health settings in the 16% to 44% range and 17% to 31% in physical health settings.1 More concerning than the perceived stigma experienced by patients is the potential for bias in medical decision making. For example, health care providers are less likely to refer people with mental illnesses for a mammogram, less likely to admit them for hospitalization after a diabetic crisis, and less likely to perform a cardiac catheterization.2 Stigmatizing beliefs also affect clinical decisions through diagnostic overshadowing, attributing physical symptoms to the mental condition and consequently not investigating or treating them.3 Although evidence suggests that patients with mental illnesses are no less likely to be adherent to treatment recommendations than others, health care professionals who endorsed more stigmatizing attitudes about mental illness were more likely to be pessimistic about the likelihood of patients adhering to treatment, and this contributed to impaired decision making.4