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Video-Teleconferencing With Medical Students to Improve Exposure to Child and Adolescent Psychiatry: A Brief Report.

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Video-Teleconferencing With Medical Students to Improve Exposure to Child and Adolescent Psychiatry: A Brief Report.

Abstract

Objective The chronic workforce shortage in child and adolescent psychiatry (CAP) remains a germane issue that has been difficult to deal with effectively. Collaboration between medical schools without sufficient CAP resources and those with enough to share may help improve interest in the field. Method This lecture series piloted a collaborative effort between CAP residents from a Midwest academic center and student-led interest groups from two osteopathic medical schools. CAP residents led nine interactive lectures with medical students on relevant topics, using video-teleconferencing. Baseline and follow-up surveys were used to assess attitudes and responses to the lecture series. Results A group of 175 students completed the baseline survey; 43 students completed the follow-up survey; 21 of 43 (48%) reported that the lectures would positively influence their career choice toward CAP. Conclusions Interactive lectures via video teleconferencing demonstrated potential to improve medical students’ exposure to CAP, and they were well received in this initial pilot study.
Brief Report
Video-Teleconferencing With Medical
Students to Improve Exposure to Child
and Adolescent Psychiatry
Samuel J. Pullen, D.O., Jacob C. White, B.S., Carlos A. Salgado, M.D.
Sourav Sengupta, M.D., Christopher R. Takala, D.O., Sean Tai, B.S.
Cosima Swintak, M.D., Jess P. Shatkin, M.D., M.P.H.
Objective: The chronic workforce shortage in child and adoles-
cent psychiatry (CAP) remains a germane issue that has been dif-
cult to deal with effectively. Collaboration between medical
schools without sufcient CAP resources and those with enough
to share may help improve interest in the eld.
Method: This lecture series piloted a collaborative effort be-
tween CAP residents from a Midwest academic center and
student-led interest groups from two osteopathic medical
schools. CAP residents led nine interactive lectures with medical
students on relevant topics, using video-teleconferencing. Baseline
and follow-up surveys were used to assess attitudes and responses
to the lecture series.
Results: A group of 175 students completed the baseline survey;
43 students completed the follow-up survey; 21 of 43 (48%)
reported that the lectures would positively inuence their career
choice toward CAP.
Conclusion: Interactive lectures via video teleconferencing dem-
onstrated potential to improve medical studentsexposure to CAP,
and they were well received in this initial pilot study.
Academic Psychiatry 2013; 37:268270
The projected demand for services from child and ado-
lescent psychiatry (CAP) is expected to increase by
100% between 1995 and 2020, with only a small fraction
of patients expected to be evaluated by a child and ado-
lescent psychiatrist (1). The importance of addressing the
chronic shortages and maldistribution of practicing child
and adolescent psychiatrists has long been recognized, but
has proven to be a challenging undertaking (2). One area of
focus has been to develop strategies to address the relatively
low priority given to CAP in medical school curricula (3, 4).
Strategies that have successfully improved interest in CAP
have focused on increasing exposure during medical school
training (58).
Although the third and fourth year of medical student ed-
ucation represents a critical time to increase medical stu-
dentsexposure to CAP, opportunities to shape attitudes
and preconceptions about CAP during the rst and second
year of medical school training have also been considered
(3, 8, 9). Challenges to exposing rst- and second-year med-
ical students to CAP include competition with the large
amount of basic science and clinical material that must be
assimilated into a 2-year undergraduate medical school cur-
riculum and a relative under-representation of CAP medical
educators available to teach rst- and second-year medical
students (3).
In an effort to contribute to the work in this area, using ad-
ditional approaches, the authors undertook the development
of an interactive lecture series using video-teleconferencing
broadcast from a centralized teaching hospital with a CAP
residency program to reach out to other U.S. medical schools
to generate interest in and provide education about CAP to
rst- and second-year medical students. This program was
piloted with two osteopathic medical schools as part of an ini-
tiative put forth by the American Academy of Child and
Received April 10, 2012; revised September 23, 2012; accepted January 18,
2013. From the Dept. of Psychiatry and Psychology, Mayo Clinic, Roches-
ter, MN (SJP, CAS, CRT, CS), the Pacic Northwest University of Health
Sciences College of Osteopathic Medicine, Yakima, WA (JCW), Dept. of
Psychiatry and Psychology, University of Pittsburg Western Psychiatric
Institute and Clinic, Pittsburgh, PA (SS), Edward Via College of Osteo-
pathic MedicineVirginia Campus, Blacksburg, VA (ST), Child Study
Center, New York University, New York, NY (JPS). Send correspondence
to Dr. Pullen, Dept. of Psychiatry and Psychology, Mayo Clinic; e-mail:
drspullen@yahoo.com
Copyright © 2013 Academic Psychiatry
268 http://ap.psychiatryonline.org Academic Psychiatry, 37:4, July-August 2013
Adolescent Psychiatry Workforce Issues Committee (AACAP
WIC) in an effort to increase collaboration with osteopathic
medical schools. Generally speaking, osteopathic medical
schools have been underrepresented in CAP educational
initiatives.
The primary aims of this study were to pilot this educa-
tional mechanism as a potential means of increasing expo-
sure to CAP and to establish a collaborative relationship
with the two osteopathic medical schools. The secondary
aim was to establish baseline attitudes toward CAP from
rst- and second-year medical students at these two osteo-
pathic medical schools and evaluate the impact of this edu-
cational experience.
Method
This pilot educational program was exempted by our
Institutional Review Board. Child and adolescent psychi-
atry (CAP) residents at Mayo Clinic, Rochester, MN,
collaborated with rst- and second-year medical students
from Pacic Northwest University of Health Sciences
College of Osteopathic Medicine (PNWU), Yakima, WA,
and the Edward Via College of Osteopathic Medicine
Virginia Campus (VCOM), Blacksburg, VA. Faculty
members from New York University Child Study Center
(NYU), Mayo Clinic, and a CAP resident from University
of Pittsburgh Western Psychiatric Institute and Clinic
(UPMC) collaborated with CAP residents from Mayo
Clinic on curriculum and program development, and are
contributing authors. Authors from NYU and UPMC were
afliated with the AACAP WFIC and the AACAP Resi-
dent Council Medical Student Outreach Initiative, re-
spectively. This project was a voluntary effort by all
participants, and no external funding was required. A letter
on behalf of the AACAP WFIC was sent to the deans of all
accredited osteopathic medical schools to assess their in-
terest in collaborating with the authors. The student gov-
ernment president from PNWU responded rst to this
inquiry. Details of this project were subsequently dis-
seminated to student-body representatives at other osteo-
pathic medical schools. VCOM demonstrated interest,
and thus became involved with the project. We chose to
pilot this educational forum with two schools (PNWU and
VCOM) in order to demonstrate the viability of the pilot;
we believed that limiting the participants would allow us
to better address any potential problems inherent to new
initiatives. Permission to provide lectures was obtained
from the academic deans of both schools. A baseline
survey assessing general attitudes toward CAP was sent
to all undergraduate medical students at PNWU and
VCOM.
Video-teleconferencing (VTC) was used to deliver in-
teractive lectures via an encrypted and secure connection at
both sites. Mayo CAP residents presented lectures to med-
ical students in 50-minute sessions once every 36 weeks,
using a variety of forums, including live PowerPoint lec-
tures, interactive Q&A sessions, and live patient interviews.
Informed consent was obtained from patients and parents
before the live patient-interview lectures. Lectures and
topics were chosen, and afterward were vetted for accuracy
before delivery. Nine lectures were scheduled for the aca-
demic year. The lecture series with PNWU began in Sep-
tember 2011 and with VCOM in December 2011. Toward
the end of the academic year, a follow-up survey, assessing
the perceived efcacy of this program, was sent to partici-
pating undergraduate medical students. Baseline survey
data were collected in September 2011. Follow-up survey
data were collected in March 2012.
Results
A total of 175 undergraduate medical students from
both campuses completed a baseline survey. Approxi-
mately 33% (56/168) of rst- and second-year medical
students from PNWU and 32% (119/372) of rst- and
second-year medical students from VCOM completed the
baseline survey. Over half of surveyed medical students
felt that some form of exposure to CAP would inuence
their desire to consider an additional clerkship elective in
this specialty or possibly consider CAP as a career choice.
First- and second-year medical students reported that they
did not receive exposure to CAP during the rst 2 years of
training.
A range of 2025 medical students, primarily from
student-led pediatric and family-medicine interest groups
from each school, regularly attended the lectures. Approx-
imately 97% of medical students (43/44) who regularly
attended the lectures completed the follow-up survey. In-
teraction and discussion with the lecturer, a variety of lecture
formats (PowerPoint lectures, case presentations, and live
patient interviews), opportunities to interview patients, and
the convenience of an informallecture format were cited
as aspects of the lecture series that medical students enjoyed.
Nearly half of participating medical students (48%; 21/43)
reported increased interest in CAP. Logistical issues and
more opportunities for interactive discussions were the most
commonly-cited areas for improvement of the seminar
series.
Academic Psychiatry, 37:4, July-August 2013 http://ap.psychiatryonline.org 269
PULLEN ET AL.
Discussion
Delivery of this educational material via VTC seemed to be
effective. Student feedback was favorable, and although results
may not be generalizable beyond our test sites, they are con-
sistent with positive results of other educational interventions
exposing medical students to CAP (68). However, given our
small sample size, care must be taken in interpreting the results.
We intentionally chose to work with student-led interest
groups, rather than attempt to reach all undergraduate
medical students at PNWU and VCOM in a formal lecture.
Thus, audience size was relatively small at each school (20
25 students per school), and subject to selection bias,
making this a limitation in interpreting the results. Our
sample of students is likely skewed toward those with an
initial interest in CAP. Also, we are not able to say whether
the initial favorable response toward CAP would be sus-
tained among participating medical students, and, thus,
caution must be taken in drawing far-reaching conclusions
from this pilot study. The most signicant logistical chal-
lenge the authors encountered with this pilot lecture series
was periodic schedule conicts from both sites, which ne-
cessitated regular communication and exibility between
sites. Replication of this project would also have to take into
account its voluntary design; for example, lectures were
often given during lunch or after working-hours.
The teaching CAP residents participated in all lectures, and
this allowed them to expand their skill-set as educators in
addition to taking ownership of the project. Faculty members
served as mentors, helping with program/curriculum de-
velopment and reviewing lectures for content accuracy.
Students preferred live interactive sessions with the CAP
residents to other means of disseminating educational mate-
rial, such as webinars and unidirectional lectures. Live patient
interviews were particularly popular among medical stu-
dents, but were more complicated to arrange because of
ethical considerations, including obtaining informed consent
from the patients and their parents, addressing institutional
policies involving use of patients in medical student educa-
tion, and coordinating the schedules of all parties.
Conclusion/Future Directions
Early exposure to CAP appears to be critical to shaping
attitudes and developing an appreciation and interest in this
specialty. Efforts to reach out to rst- and second-year
medical students, such as this one, could also address fac-
tors affecting CAP recruitment, such as identifying students
with favorable personality traits and addressing precon-
ceived ideas about the eld (9).
This pilot program demonstrated success utilizing
a centralized teaching site to reach out to rst- and second-
year medical students from osteopathic medical schools
via VTC, and it could serve as a model for future en-
deavors. The authors plan to expand this program to other
interested osteopathic medical schools. Three sites (Mayo,
NYU, and UPMC) have begun identifying other in-
terested osteopathic medical schools for collaboration.
The actual efcacy of such a program is unknown (i.e.,
Does the initial increased interest in CAP translate to
more medical studentschoosing this specialty as a ca-
reer?),andthisquestionshouldbeaddressedinfuture
studies.
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270 http://ap.psychiatryonline.org Academic Psychiatry, 37:4, July-August 2013
VIDEO-TELECONFERENCING FOR CAP
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