Research Support for C-L Psychiatry Across Wide Spectrum
Rigorous grading process selects the highest quality posters for CLP 2020
A further random selection here of posters accepted for presentation at CLP 2020 demonstrates the extent of research and studies being undertaken in support of C-L Psychiatry across a wide spectrum of subspecialties.
ACLP’s Brief Oral Presentation & Posters Subcommittee, responsible for managing poster displays at Academy annual meetings, this year received nearly 300 abstracts for consideration as posters. The subcommittee has been engaged in its rigorous grading process aimed at selecting the highest quality abstracts with a focus on scientific value, original data, and level of scholarship.
Chair of the subcommittee, Walter (Jay) Kilpatrick, DO, has added comments.
Risk Stratification of Post-Operative Morbidity and Mortality Due to an Eating Disorder in a Renal Transplant Donor
Lead presenter: Patrick Baumgart, MD
This poster study helps understanding of body dysmorphia as a potential risk factor for morbidity in organ donation.
Body image has become a particular area of interest in literature evaluating living organ donor outcomes and quality of life. As many as 13% of living kidney donors report post-donation body image concerns, and a strong correlation has been demonstrated among patients with pre-donation body dysmorphia.
As a fundamental feature of an eating disorder, distorted body image may increase the risk of both physical and psychological complications in living donors.
The poster describes the evaluation of a potential living kidney donor with an eating disorder history and discusses considerations in risk stratification. To the authors’ knowledge, this is the first case report regarding eating disorders in a living organ donor.
Presenters conclude that the evaluation of a potential organ donor with a known eating disorder must include an assessment of the patient’s perceived body image to minimize risks of harm following organ donation. Further research on post-operative morbidity and mortality due to body image is needed to optimize the transplant donor selection process.
Dr. Kilpatrick: “Here, the authors use a novel case report to highlight the need for futher examination of eating disorders as potential risk factors for living organ donors. As body image becomes a growing area of interest in literature evaluating outcomes and quality of life for living organ donors, C-L psychiatrists who perform such evaluations should be aware of such risk factors. The authors provide a compelling argument that patients with eating disorders must have their perceived body image assessed to minimize their risk of harm following organ donation. Academy members will have an opportunity to utilize this poster presentation to increase their knowledge base in this important area of our field.”
Play to Learn!—Using a Virtual Game-Based Learning Platform for Medical Education During a Consult-Liaison Psychiatry Rotation to Alleviate Burnout
Lead presenter: Rida Malick, MD
Here’s an innovative way to teach during C-L rotation. Presenters identify potential benefits of using a virtual, game-based learning platform.
Formative assessments—critical elements in medical education—are designed to provide feedback on performance and to identify areas of strength and weakness. Traditional formative assessments in clinical settings occur during rounds as the attending physician poses medical questions directly to a learner. This method, in its worst form, is referred to as ‘pimping’ and often associated with humiliation.
However, technological advances bring new and potentially improved methods of teaching and learning to mitigate learner distress and burnout. Virtual learning platforms, which apply game-based learning theories, have become more common in education—though they still remain relatively new in medical education, particularly in the clinical setting.
Users create online quizzes, surveys, jumbles, flashcards, and discussions with the goal of fostering a positive learning environment—as no student is singled out and learning becomes a game.
Two initial studies conducted with first-year medical students at the Universiti Sains Malaysia School of Medicine found that using virtual game-based quizzes motivated students to study, identified what needed to be studied, and also made learning enjoyable, suggesting that it is a promising tool in formative assessment in medical education.
In this qualitative study, presenters implemented short, virtual, game-based quizzes during C-L Psychiatry rounds at George Washington University Hospital, Washington, DC.
Dr. Kilpatrick: “Burnout in the medical community has become a national issue of importance with institutions and training programs grappling with the problem and looking for effective ways to combat it. The authors describe a qualitative study in which virtual game-based quizzes were implemented during training rounds on a C-L service. The goals of the virtual quizzes were to improve upon the learning process on rounds and decrease burnout. This unique strategy has the potential to be replicated in other institutions. Academy members who run teaching rounds, or are involved in medical student, residency, or fellowship training, can take advantage of the knowledge gained in this study.”
Life But Not As We Know It. Helping Communication About End-of-Life Decisions Between the Family and Clinicians of a Child Following Attempted Suicide
Lead presenter: Isabel Paz, MD
This poster helps us understand the complexity of end-of-life decisions after a child’s serious suicide attempt. It explores the role of the C-L psychiatrist mediating between families and physicians against a background of culture and religion, as well as past experiences of both family members and physicians.
Decisions about whether to stop life-sustaining care are challenging in the context of a serious suicide attempt. Decisions are even more complex when the patient is a child—as demonstrated by the presenter’s case report.
Multiple factors contributed to the complexity of decision-making at the end of this child’s life and, as a result, the family and physicians became polarized in their views, and communication became fraught. The C-L psychiatrist’s role was to understand and communicate with parents and physicians, challenging their preconceived ideas, and providing space for reflection. Understanding the psychological profile of the family and their cultural background, as well as previous trauma experienced by staff, played a crucial role in preserving the communication and the relationship between both parties.
Dr. Kilpatrick: “Here, the authors offer their fellow Academy members an eloquent and tragic case report that explores the complex end-of-life issues that arise in the event of a serious suicide attempt in a child. The authors take us through the multiple factors that contribute to the complexity of decision-making at the end of the child’s life, taking into the account the physician’s and family’s values and viewpoints. This poster clearly highlights the important role the C-L psychiatrist can play in these critical cases that involve incomplete suicide attempts. The case is also novel as much of the literature in this area focuses on adults. Academy members will benefit greatly from understanding both the clinical and ethical aspects of this poster presentation.”
Code Orange: Results of a Scoping Review of Hospital-Based Psychosocial Disaster Response
Lead presenter: Janet Ellis, MD
Diverse psychosocial response strategies (including various therapeutic techniques and timelines) are employed by hospitals when a disaster strikes.They need to manage psycho-social impact to patients, their loved ones, and staff, in addition to treating physical injuries and managing the media. Hospitals typically see two waves of psychosocial surges in disasters:
Family and friends searching for loved ones.
This review aims to analyze psychosocial disaster responses at hospitals, including what has or has not worked, to create psychosocial response planning suggestions for disaster scenarios.
A scoping review of papers into natural disasters and terrorism, published between 2007 and July 2018, showedinterventions included trauma-focused cognitive behavioral therapy (CBT), the most common; exposure therapy; alternative therapies; psychological first aid; general and disaster CBT; psychoeducation; and supportive counselling.
But a lack of research pertains on outlining effective psychosocial wellness strategies to prevent long-term psychological sequelae following a disaster, or real-time interventions during and immediately following a disaster.
Future research, say the presenters, should include pre-disaster psychosocial response planning, earlier intervention post-disaster, family reunification plans, and long-term follow-up.
Dr. Kilpatrick: “This is a very interesting topic that can involve the C-L psychiatrist who works in the hospital setting in various ways. The field of hospital disaster management was brought under a large spotlight after 9/11 as hospitals further learned how to prepare for such events. As the authors point out, the hospitals must manage not only the media and the physical injuries to patients, they are also responsible for managing the psychosocial impact to patients, their families, and hospital staff. This scoping review identifies current trends in the literature and areas for further exploration. Academy members will benefit from the data presented in this review and will come away with an understanding of the complexities of hospital disaster management.”
Trial of Newly Proposed Practice Guidelines for Adoption and Implementation of Psychiatric Directives with Medical Student and Resident Trainee Involvement
Lead presenter: Akshaya Selvamani, MD
A newly-proposed framework for trainee and supervisor involvement in the facilitation of Psychiatric Advance Directives (PADs) has been analyzed. Here is preliminary data on service-user attitudes and preferences.
PADs are legal means for a patient with preserved decision-making capacity to appoint a health care power of attorney and/or express preferences regarding future treatments. Despite the high patient demand for PADs, implementation in clinical practice is low. The biggest impediment, say the poster presenters, is lack of attention on the part of psychiatrists to the practice and its potential benefits.
This project seeks to identify ways to use PADs as a practical means of enhancing patient engagement and strengthening the therapeutic alliance.
“We present the data from a pilot program at a single site to encourage other programs to engage this specific practice as a part of their own efforts to destigmatize mental illness, and engage stakeholders in the provision of mental health care,” say the presenters.
Dr. Kilpatrick: “A Psychiatric Advanced Directive is a legal document that details a person’s preferences for future mental health treatment, services, and supports, or names an individual to make treatment decisions, if the person is in a crisis and unable to make decisions. As the authors point out, while PADs have been around for years, they aren’t often used in clinical settings. Here, the authors describe a newly proposed framework for trainee and supervisor involvement to facilitate PADs. They also explore service user attitudes and preferences and evaluate the need for PADs from patient and provider perspectives. C-L psychiatrists are well positioned to facilitate PADs and Academy members will gain insight and knowledge into this underutilized clinical tool.”