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Privacy and medical student information
Randy Welton, MD
So we have all heard of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), but have you heard of 1974’s Family Educational Rights and Privacy Act (FERPA)?
Whereas HIPAA protects the privacy of patients, FERPA protects the privacy of students,
including medical students. Those of us who work in medical schools and work with medical
students need to learn about the protections offered by FERPA and the additional requirements
from the National Residency Match Program (NRMP) that protect student/applicant information.
If your medical school receives funds from the federal government, FERPA probably applies.
FERPA protection commences as soon as children start attending school, but when students
reach 18 or leave high school, control of their information passes from the parents to the student.
Although there are numerous provisions, the one that typically applies to us involves protections
against disclosing, without student permission, personal information to outside interests. In
general, we must protect information such as student grades as well as reports of student conduct
and performance. When students apply for a transfer or further training (like residency training),
they agree to let their school forward information that would have otherwise been protected. This
information includes their grades, leaves of absences, and the Medical Student Performance
Evaluation (Dean’s letter) which summarizes their time in medical school, but the organizations
receiving that information need to ensure that the information stays secure and confidential.
More information about FERPA can be found here.
Once we receive this protected information regarding student applicants through the Electronic
Residency Application Service (ERAS) another set of rules kick in. These are the guidelines for
confidentiality found in the NRMP Match Agreements. Although we can obviously use the
information contained in ERAS internally to decide who to invite for interviews and will include
that information when we decide how to evaluate and rank applicants, that information needs to
stay within your organization. E-mails to fellow training directors or discussions about the
information contained in specific, identifiable applications are forbidden. This includes
information such as who has applied to your program, who has signaled your program, who has
not signaled your program, or how you have rated/ranked applicants. That information must be
I know there are a few of you who are asking, “Or what?”. What is the penalty for disclosing
this protected information?
If a college, including a college of medicine, violates FERPA it may result in an order to compel
compliance, the immediate withholding of federal funds, and the loss of eligibility for future
federal funds. If a third party, such as a residency program, has received protected information
and failed to keep it private, FERPA has a potential consequence for you as well. Third-parties
who release protected information might be deemed ineligible to receive similar information for
at least five 5 years (https://studentprivacy.ed.gov/ferpa#0.1_se34.1.99_167). That will put a
definite crimp in your recruitment plans. And don’t forget that the NRMP will want to have a
word with you. Releasing ERAS information in an unauthorized manner is a Match violation
and may imperil your programs participation in future matches. Read more
So don’t risk it. Keep your program safe by safeguarding the personal information entrusted to
you by applicants.
Organizational Equity Committee (OEC)
Ana Ozdoba, MD (guest contributor)
In the Spring of 2021, AADPRT contracted with the Eikenberg Institute for Relationships to conduct a Race, Equity, and Inclusion Organizational Assessment. The assessment helped AADPRT identify and address bias and discriminatory policies and procedures. One of the recommendations from the report was to create an Organizational Equity Committee (OEC) which occurred in 2022.
The OEC’s responsibility has been to identify ways to increase diversity, openness, fairness, transparency, equity, and inclusion within AADPRT and to forward these recommendations to AADPRT's Executive Council (EC) and Steering Committee (SC). The OEC convened for the first time in the summer of 2022 and has 12 members who meet quarterly. The focus of the OEC has been to:
Thus far, the committee has encouraged increased transparency in the organization and has worked with the EC/SC to implement structural changes to improve equity. Below are some examples of the OEC’s recommendations:
Focus Groups were held at the 2023 AADPRT Annual Meeting, where OEC gathered feedback directly from members about what the organization could do to continue to work towards a more equitable association. Areas to prioritize included:
Our committee looks forward to continuing its work as a consulting committee for AADPRT. If you want to join our committee, please email me, at email@example.com.
The Supreme Court ruling
Randy Welton, MD
There has been conversation among AADPRT members regarding the Supreme Court’s decision on race conscious admission practices and its potential impact on psychiatry residency training. The Supreme Court’s ruling prohibits colleges and universities from giving special consideration to applicants solely based on race. AADPRT had signed onto AAMC’s amicus brief supporting the University of North Carolina’s and Harvard University’s admission policies which considered race among other factors in their admissions of applicants. These policies were deemed unacceptable by the Supreme Court.
The AAMC expressed “deep disappointment” with the decision while the APA espoused concerns that the decision might impede efforts to attain health equity. ACGME’s response, which focused more tightly on the training of residents, stated that their policies “do not require race-based affirmative action to achieve diversity and this decision does not require programs and institutions to change their resident selection practices.” ACGME also does not predict that this will impact the ability of Sponsoring Institutions and programs to “ …(1) strive to eliminate discrimination and bias in the recruitment, selection, evaluation, and retention of residents/fellows and faculty members; (2) identify and nurture appropriate role models for residents/fellows; (3) establish and maintain fair and equitable learning environments; (4) support pathway programs that encourage greater diversity of the profession; and, (5) hold themselves accountable for the specific health care needs of their patient communities.”
Program directors, faculty, staff, and residents will have differing and potentially intense personal responses to these discussions, but as an organization, our primary focus is the impact on recruiting psychiatry residents. While the Supreme Court decision prohibits the use of race as a distinct assessment category, it explicitly states that “nothing prohibits universities from considering an applicant’s discussion of how race affected the applicant’s life, so long as that discussion is concretely tied to a quality of character or unique ability that the particular applicant can contribute to the university.” They encouraged universities to make their choices based on the “challenges bested, skills built, or lessons learned” by the applicants.
The Supreme Court’s decision directs us toward employing individual, holistic assessments of our applicants. With every applicant we can and should consider their performance and accomplishments in the light of the advantages they have received, the opportunities they have been granted, and the obstacles they have faced, whether those experiences are unique to them as individuals or arise from their being members of their family, community, or race. With this lens, we can continue to evaluate their potential to contribute to the welfare of their patients and the field of psychiatry.
The next public health emergency
Randy Welton, MD
Three years ago, the United States, and the rest of the world, declared a public health emergency because of the novel pathogen, COVID-19. It was a pivotal event in our personal and professional lives similar to, for those of us who are old enough to remember, how society changed on 9/11. The pandemic caused us to re-examine, and within a few weeks, fundamentally change how we select residents, train residents, and treat patients. We had almost no warning about COVID-19, but there is another public health emergency that will be striking the United States that we know is coming – a shortage of psychiatrists.
The Health Resources and Services Administration (HRSA) projects that, under their most favorable scenario, by 2035 the United States will have only 57% of the psychiatrists necessary to meet the mental health needs of the nation. If we make some reasonable assumptions such as a further reduction of barriers to receiving mental health care and an increasing need for psychiatrists, we might have as few as 43% of the required general (adult) psychiatrists. That is an insurmountable shortage of over 14,000 general psychiatrists. The picture for child and adolescent psychiatrists is nearly as bleak with the United States having only 53% of what we will need. Please take a moment to imagine that. Every place that has or needs two psychiatrists will have only one. This is not covering for someone while they are on vacation. This is not advertising for a vacant position you fully expect to fill. There is no one coming back, and there will be no one to hire. That scenario will occur within the next 12 years. We need to start thinking about how that emergency will change the training of residents and treating of patients.
How will this nationwide shortage impact training? Will we want to focus more on training residents to manage population health needs rather than the needs of the single patient in front of them? Will we shift to more flexible, competency-based training approaches? How can we better train the primary care providers who are already managing the majority of patients with depression and anxiety?
Can we expect the professional activities of psychiatrists to remain unchanged in the face of these shortages? Perhaps psychiatrists will be used more to triage and supervise rather than provide direct mental health care. We could be called upon to evaluate the patient and then determine which patients can be managed by primary care, which by advance practice mental health providers, and which need the elevated skillset of a psychiatrist. And speaking of advance practice mental health providers (APMHPs) (such as psychiatric nurse practitioners and psychiatric physician assistants), how will we train the next generation of psychiatrists to work collaboratively with APMHPs? Should psychiatrists be involved in the training of APMHPs? And more controversially, how involved should APMHPs be in the training of psychiatrists? This is especially important as HRSA predicts that staffing levels for APMHPs will be at or above 100% by 2035. In fact, sometime during 2032 the number of psychiatric nurse practitioners will surpass the number of adult psychiatrists. What will that do to public perception and the reality of mental health care in this nation?
A public health emergency is coming. What should we do?
Growing comfortable as a leader
Randy Welton, MD
"Leadership is the art of getting someone else to do something you want done because he wants to do it." —General Dwight D. Eisenhower
Excelling as a Program Director (PD) requires mastery of numerous skillsets. You need to be an administrator, an educator, a coach, and a disciplinarian. One aspect that is often forgotten is the need for you to be a leader. Very few PDs are ever trained to be a leader who challenges, develops, and inspires their team. Sometimes those skills are learned through experience. Too often they are never learned resulting in frustration with the position and an early abandonment of what could have been a rewarding career.
Developing as a leader involves administration and education, coaching and disciplining, but perhaps above all it demands that we become a role model. The best leaders lead from the front and say follow my example.
Program Directors do not need to be the most renowned clinicians, but they should always be striving to be life-long learners. Program Directors do not need to be prize winning lecturers, but they should be engaged in deliberate efforts to make themselves and their entire program more efficient and effective at conveying knowledge to the next generation of psychiatrists.
Leaders need to have integrity, honesty, and trustworthiness. Their dealings with others should be characterized by respect and fairness. The leaders’ values should be apparent. People may disagree with decisions leaders make, but they should understand the beliefs and thought process that led to the decision. Everyone associated with the PD should automatically, and correctly, assume that they are continually working for the benefit of the residency program and the welfare of their residents.
Leaders create an environment in which their team will thrive and grow. They set realistic goals and have reasonable expectations. They give their team the resources and support they need and then get out of the way and let them do their job. Program Directors, who are good leaders, will spend a considerable amount of time getting to know the interests and strengths of their team members, praising their successes, and helping them when they struggle.
Good leaders think ahead and are proactive. They anticipate obstacles and potential problems and prepare for them in advance. Although, PDs cannot predict everything that is in store for them, they should have a good feel for the annual rhythm of a residency program and be vigilant for potential difficulties to come.
Leaders strive to embody the qualities they want their team to emulate. Program Directors should model the habits they would like to see in their residents. If the PD wants residents to be thorough and prompt in their documentation, then the PD’s notes should set that example. If residents should be responsive and respectful to others, then the PD should respond quickly and politely to the requests they receive and should be diligent in meeting deadlines. Program Directors should not often settle for “barely good enough”. They should always strive to do a better job. They should ask themselves what can and should be done differently, make the necessary changes, assess what happens, and learn lessons from what they observe. The residency’s success in creating accomplished psychiatrists and their graduates’ success as future leaders in psychiatry are in part a reflection of how successfully the PD assumed the mantle of leadership.
Don’t be afraid of the Scholarly Activities Requirements
Randy Welton, MD
As a Program Director, you need to ensure that your faculty are producing a steady flow of scholarship. Many Program Directors find this a daunting requirement. How do I get faculty members to take their first tentative steps into the world of scholarly activities?
The requirements for faculty scholarly activity are found in ACGME Program Requirements for Graduate Medical Education in Psychiatry section IV.D.2. They list seven domains of scholarship but require programs to have activities within only three of those domains. Some domains are extremely time and resource intensive (e.g., research in basic science, peer-reviewed grants), but many others are probably already happening in your program. Are faculty members working with residents on quality improvement and/or patient safety initiatives? That ticks a box. Are faculty modifying the curriculum or developing tools to assess resident performance? Another box is checked. Did any of your faculty present at AADPRT (an educational organization)? That’s another domain. Have any of your faculty co-authored a paper, case report, or book chapter with a resident? If any one of them has, then your program has another domain under its belt. Faculty members also need to disseminate their scholarly activity. This can be a peer-reviewed publication, but Section IV.D.2.b lists 13 other categories of activities that can help meet the requirement. These include giving Grand Rounds, leading workshops, serving on a professional committee, or being a reviewer for a journal. The goal is to have a mix of these diverse activities.
The Background and Intent section of IV.D.2 clarifies that ACGME’s goal is to create an “environment of inquiry” that encourages a “scholarly approach to patient care”. When your program is being evaluated, the Review Committee “…will evaluate the dissemination of scholarship for the program as a whole, not for individual faculty members, for a five-year interval…with the goal of assessing the effectiveness of the creation of such an environment…” They are looking at the culture you are creating. A year or two with relatively limited scholarship is not going to sink the program. AADPRT’s ACGME Liaison Committee recently met with ACGME representatives to discuss this requirement, and they reiterated the points I have made. There needs to be scholarship within the program, but not everyone has to be constantly publishing or presenting at national meetings. They reassured us that very few programs get cited for a lack of scholarly activity, and when they are cited, the Review Committee is not looking to close the program. Rather they are looking for a plan to increase scholarship among the faculty.
Want a good resource on the Virtual Training Office (VTO) to enhance scholarly activity within your program? Go the VTO, type in “scholarly” and you will see numerous resources including a 2022 presentation on Meeting the ACGME scholarly requirements if you are from a non-research organization by Drs. Batsel-Thomas, Crapanzano, Dennis, Graham, and Hunsinger. They review several strategies including an example of “parlaying” your existing scholarly activities. A new course was created (curricular development). Pre- and post-course questionnaires were turned into a research project. The research results were turned into a poster and a publication. That is four scholarly activities stemming from one idea. They highlighted the benefits of regular faculty meetings to encourage scholarship and of partnering with the local statisticians. Programs can also informally partner with other residency programs. Each Grand Rounds given at your institution by one of your faculty can be given as a Grand Rounds at your partnering program the next year. Their faculty will similarly be presenting their work at your site. Faculty members will be regularly creating and disseminating didactic educational activities, and opportunities for collaboration among faculty members from both institutions will naturally arise. You will have converted excellent clinician / educators into legitimate scholars and partly met your requirements for scholarly activities.
Congratulations and good luck,
Envisioning a new way forward... for training
Sallie DeGolia, MD, MPH
Envisioning a New Way Forward: There couldn’t be a more fitting theme for our upcoming 2023 Annual Meeting as it relates to reconceptualizing residency training. Please join the President’s Symposium on March 4 from 10:30am-12:00pm for Turning Curriculum and Assessment Upside Down: The Future of Psychiatry Residency Training.
Mental health needs in this country are greater than ever while the shortage of providers is at crisis proportions – particularly among the subspecialties. As our nation becomes increasingly Non-White (and older) with BIPOC communities experiencing ongoing mental health care inequities, the demographics of our care providers remain relatively stable, and few providers are available for those communities most in need.
Despite the increasing mental health needs in the context of demographic shifts and provider shortages, our training programs’ structures have remained relatively unchanged for years. While curricular demands have expanded, we also manage stresses within our system by developing wellness and coaching programs and innovative mentorship programs. And we try to balance the need to meet specific requirements while allowing self-directed resident pursuits.
Since I left residency over 25 years ago, our program continues to train our residents in roughly the traditional clinical manner with two years inpatient and two years outpatient in the context of a hospital system that has remained fairly inflexible. Despite this, societal needs, population demographics, and post-residency practice trends have changed significantly.
One of my first initiatives as President was to develop a taskforce to figure out what a graduate from our programs should be able to do to meet our public mental health needs within the next 20 years. The Curriculum and Assessment Review Taskforce led by Jackie Hobbs and her taskforce members has been working hard to understand how to re-envision training to produce the kind of psychiatrist that can meet these diverse needs.
At the Presidential Symposium, the Taskforce will bring us up to date on what they have been doing. John Young will provide an overview of how we design an assessment program that simultaneously promotes development of self-regulated learners while also supporting trustworthy summative decisions. And finally, the Taskforce will lead our membership through an interactive presentation seeking member input on principles they have developed. Finally, the symposium will wrap up with a panel to field questions from the audience.
It is no easy feat to develop a more relevant curriculum that our diverse set of programs across the nation can integrate to prepare the next generation of psychiatrists to address our population’s mental health needs. Please join us at the Presidential Symposium as our Curriculum and Assessment Taskforce guides us into Envisioning a New Way Forward!
Academic Psychiatry: This is YOUR journal!
Sallie DeGolia, MD, MPH
How many of you have submitted articles to Academic Psychiatry? Maybe you have mentored a trainee who wrote for the journal or reviewed a submission? Or perhaps you were inspired by an article to create a new educational intervention in your residency program? Or maybe you simply read the journal cover to cover bimonthly. My guess is just about every one of you has experienced Academic Psychiatry. But what I’m not so sure about is whether you all realize that Academic Psychiatry is YOUR journal…
For those of you new to AADPRT or simply not familiar, ADDPRT is one of 4 parent organizations who “own” Academic Psychiatry. Along with the other 3 parent organizations (ADMSEP, AACDP and AAP), we invest a baseline amount each year with an additional amount based on the size of each parent organization to cover the cost of the journal’s office. AADPRT is the invests the most given that we are the largest parent organization. Each organization identifies a representative to sit on the Academic Psychiatry Governance Committee along with the Editor in Chief and the two deputy editors. Based on our Bylaws, the AADPRT Governance Committee representative must be an AADPRT past president. Our representative of 10 years has been Sheldon Benjamin. Shel has been an amazing advocate on behalf of AADPRT in representing our interests while promoting the health of the journal. Shel will be stepping down and welcoming Donna Sudak as our new AADPRT Governance Committee representative in 2023. We can’t be more grateful for the thoughtfulness and fierce commitment Shel has demonstrated on behalf of AADPRT over these many years. Thank you, Shel!
Founded in 1977 as The Journal of Psychiatric Education and renamed as Academic Psychiatry in 1989, our journal fills an important role by featuring scholarly work on innovative education, academic leadership, and advocacy in psychiatry and behavioral sciences. The journal aims to stimulate evidence-based advances in education and training, leadership and administration, career and professional development, ethics and professionalism, as well as health and well-being. It is the only journal that focuses specifically on education and related academic missions in psychiatry!
Starting off with only 2 editions per year, the journal has expanded to 6 per year. Since 1989, it has had 5 editors-in-chief: Jonathan Borus (1989-1995), Samuel Keith (1995-2001), Paul Mohl (2001-2002), Laura Roberts (2002-2019), and currently AADPRT member and past president, Adam Brenner (2019-present). As a result of incredibly strong journal leadership, the journal has increased its visibility and international standing through incorporation into the National Library of Medicine’s electronic database (MEDLINE) in 2001, initiated a Web-based version in 1989, moved to bimonthly publishing in 2005 thanks to the support and commitment of its then-publisher, American Psychiatric Publishing, and now has a wider distribution thanks to our-now publisher, Springers’ institutional packaging. As of 2021, Academic Psychiatry boasts an impact factor of 2.385 and 432,841 full text article downloads.
This year, the Journal’s 10-year contract with Springer is coming to an end. It has submitted RFPs for a publisher to be identified in early Winter-Spring of 2023. To ease fund flows and protect the Journal and parent organizations from liability issues, it is also in the process of establishing an LLC.
So other than staying abreast of important cutting-edge educational topics, how does your journal serve you? Dating back to editor-in-chiefs’ Jonathan Borus and William Sledge, the journal has had a strong mentorship component. The editorial team has sought to improve the “quality of writing by requiring reviewers to serve as editorial educators. Reviews were designed to be educational exercises, instructing writers on how to systematically produce better manuscripts, from grammatical style to substantial modifications of form and content.” (1). The current editorial team at the journal, including Adam Brenner (Editor in Chief) and Deputy Editors Rashi Aggarwal (AADPRT Program Chair-Elect), Richard Balon (AADPRT member), Eugene Beresin (AADPRT member and Past President), John Coverdale (AADPRT member), Anthony Guerrero, Alan Louie, and Mary Morreale, consider themselves as educators in academic writing and seeks to help all of us become better writers and educational researchers. They are also always looking for new reviewers, and, as an AADPRT member, you are indeed qualified!
Another way the journal has sought to help us is by offering workshops on writing, editing, reviewing, and mentorship topics at the annual meetings of the sponsoring organizations. As of 2020, the journal developed a Trainee Editorial Fellowship directed by Rashi Aggarwal (Deputy Editor and AADPRT’s Program Chair-elect) which offers psychiatry residents and fellows with demonstrated interest in education, and leadership to expand their skills in scholarly publication. This one-year, unfunded fellowship provides an opportunity to learn about and participate in the peer review and editing process for an academic medical journal. Although the most current due date was October 15, 2022, please refer to https://www.springer.com/journal/40596/updates/23353764 for more information about this Fellowship.
Furthermore, journal editors attend major education and psychiatry conferences each year, not only to solicit new manuscript submissions from speakers and psychiatry society leaders, but to be accessible to partner members. Adam Brenner, the Editor-in -Chief hosts open office hours twice a year for anyone in the sponsoring societies (that is us!) to discuss potential manuscript submissions and to encourage parent organizations to consider special collections of topics that are of particular interest to our members.
Finally, the journal has published several resources for readers and prospective authors and a couple of helpful articles include “How to Review a Manuscript: A ‘Down-to-Earth’ Approach” (2), “Writing the Methods” (3) and, most recently, “The Art and Science of Peer Review” (4).
You may have noticed that from time-to-time the journal publishes special editions on key topics to promote research and foster a comprehensive understanding of the topic areas. Historically, one or more AADPRT members have served as special guest editors. For example, Ann Schwartz for COVID-19 and Psychiatry Education, Bob Rohrbaugh and Sandra Dejong for the DEI collection, and Erica Shoemaker for New Paradigms for Child and Adolescent Psychiatry Training. The most recent upcoming special collection of papers is on the role of psychiatric education in addressing mass shootings and preventing violence. Deputy Editor Anthony Guerrero, MD and Guest Editor Tai-An Miao, Ph.D. lead this collection.
So, look for Adam Brenner and the deputy editors at Academic Psychiatry's table in the exhibit area at the 2023 AADPRT Annual Meeting!
For more information about YOUR Academic Psychiatry journal, please refer to https://www.springer.com/journal/40596. Please consider not only submitting your work to Academic Psychiatry, but joining the ranks of Academic Psychiatry reviewers. You can do this with a junior faculty member or a resident to mentor them in the process. You may also want to pitch a special edition topic to be considered by the editorial team. Remember, this is YOUR journal, and it is there to serve you!
1. Roberts LW et al. In celebration of the history of academic psychiatry. Academic Psychiatry 37:6, 2013.
2. Roberts LW, Coverdale J, Edenharder K, et al. How to Review a Manuscript: A ‘Down-to-Earth’ Approach. Acad Psychiatry 28:81-87, 2004
3. Coverdale J, Roberts LW, Louie A, et al: Writing the Methods. Acad Psychiatry 30:361-364, 2006
4. Aggarwal R, et al: The Art and Science of Peer Review. Acad Psychiatry 46: 151–156, 2022
Sallie DeGolia, MD, MPH
Say goodbye to the sultry days of summer as we speed into yet another frenzied period of recruitment! I would like to share a few updates.
As the hundreds of applications inundate our computers, we have the hopeful experience of navigating the ERAS Supplemental App/Signaling to help us through this process. We look forward to seeing if this new addition will ease the process of reviewing applications by helping us identify more accurately (and perhaps more efficiently?) that applicant who might fit well into our programs. Our Recruitment Committee has worked hard to keep us well-informed about the process as well as provide guidelines for yet another year of virtual interviews. This year, we have added the option of “blinded,” in person “second looks.” To further clarify this process, I am sharing our latest updated Recruitment Guidelines.
In a Spring Newsletter, I wrote about how AADPRT planned to address the new ACGME protected time directive that went into effect July 1, 2022. In addition to the useful Burnout Protected Time Resources you’ll find in our Virtual Training Office (VTO) (including AADPRT statements about PD burnout, and Talking Points to help us negotiate with our departmental leaders around protected time), AADPRT sent a strong letter to ACGME urging them to reconsider their protected time minimums. This letter was co-signed by nine other organizations including the AACAP, AACDP, CMELL and three sister organizations from Neurology, Family Practice and Emergency Medicine. Despite our efforts, ACGME responded by informing us that, at this time, they would not be revising their guidelines. However, they encourage us to participate in the 2025 Shaping GME where ACGME will review psychiatric training requirements. We are eager to participate in this process and should be well-prepared to do so! Our newly configured Curriculum and Assessment Review Taskforce chaired by Jackie Hobbs is in the early phases of defining what a psychiatrist should look like on graduation based on patient and population mental health needs in 20-30 years. It is then tasked to reconfigure training to produce psychiatrists who can more effectively address these needs. We look forward to the Taskforce’s process and encourage interested folks to participate.
Finally, the Program Committee looks forward to reviewing the 99 workshops and 45 posters submitted this year for our first-in-person-since-COVID Annual Meeting in San Diego. A huge THANK YOU goes out to this 20-member Committee representing all regions (except VII) and an international program for taking on the challenging task of carefully reviewing these submissions to ensure a high-quality meeting. From the tense elbow-bumping days of Dallas in 2020, through two plus years of remotely hearing the “you’re muted…” reframe, we will finally be able to celebrate in person 50-plus years of a terrific organization that has sought to help us succeed as training directors and find community!
I wish you all a wonderful Fall season with lots of focus power as you work through the “stack” of applications representing promising medical students who are eager to serve as the next generation of psychiatrists! It is an exciting time!
Increased focus on member input: Meet the Regional Reps
Guest Contributor L. Joy Houston, MD
Chair, Regional Representative Committee
AADPRT is an organization made up of hundreds of PDs, APDs, PAs, and other educational leaders, and membership is growing every year. Given the diverse backgrounds, practice experience, and work settings of these members, how is AADPRT leadership supposed to know what the average member needs to support them in their role or what concerns members have? That’s the role of the Regional Representatives.
Regional Representatives have existed for a lengthy period of time with their primary charge being to facilitate bi-directional communication between the regions they represent (and their component members) and AADPRT leadership. AADPRT members are divided into seven (7) geographical regions, each representing a different area of the country with its own unique attributes. To see which region your program belongs to and who your representatives are, please visit the AADPRT Committees web page at https://www.aadprt.org/meet-aadprt/committees.
Each region has two (2) representatives, one who is currently a PD or APD of a general residency program and one who is currently a PD or APD of a subspecialty fellowship. This structure is intentional and intended to ensure that the needs of both general programs and fellowships are communicated to AADPRT leadership by representatives who understand the unique attributes of different types of training programs.
In years past, the primary mechanism by which the representatives collected information was leading the regional caucuses at the AADPRT Annual Meeting. The Regional Representatives would gather information on hot-button topics and concerns unique to the region, consolidate the information to identify trends among the 7 regions, and then provide this feedback to AADPRT leadership. Periodically, the representatives might be asked to collect feedback through the regional email listservs between meetings, but communication primarily occurred at the Annual Meeting.
Over the years, as AADPRT continued to grow in membership numbers and diversity, it became clear that there was a need for greater feedback. As many members are aware, AADPRT hired a Diversity, Equity, and Inclusion consultant to help identify mechanisms for increasing equity in the organization. One item of particular note from the consultant’s report involved better utilization of the Regional Representatives. There was clearly a need for both more consistent feedback between Annual Meetings and greater transparency regarding how AADPRT leadership was utilizing this feedback.
To this end, AADPRT’s leadership has been supportive of an increasing leadership role for the Regional Representatives. The representatives have been working on increasing the frequency of regional caucuses, with virtual caucuses utilized to enhance communication between Annual Meetings. The representatives are also now being given additional opportunities to receive direct feedback from AADPRT leadership on regional concerns. This increased transparency will allow the representatives to provide more updates back to their regional members between caucuses.
The Regional Representatives have other duties in addition to enhancing communication within the organization, though. They also play a role in the Awards Committee, assisting in selecting the winners of the Ginsberg Award and Poster Competition for the Annual Meeting. They also routinely take on personal projects designed to aid their regions. Past projects include collaborating with the Recruitment Committee to develop a best practices document to aid with application review for Match season.
The most immediately recognizable project would likely be the regional Recruitment Fairs sponsored by AADPRT. These fairs were the brainchild of the Regional Representatives, based on feedback from regional members in the wake of the transition to all-virtual interviewing during the COVID pandemic. This year is the second year for the fairs and the representatives have taken on an even larger role this year, directly leading and facilitating the fairs for their regions.
So, the next time you see one of your Regional Representatives, please feel free to approach them with any concerns or needs you have. They are your direct pipeline to AADPRT leadership, a chance to have your voice be heard. And for those who’d like to consider becoming a Regional Representative, the service term for a representative is 3 years, and any upcoming vacancies are always publicized prior to the AADPRT Annual Meeting in the spring, so keep an eye out for those announcements each year to see which regions will have openings. If you have any other questions about the position, please feel free to approach the Chair of the Regional Representatives Committee (currently myself) or your region’s representatives. We look forward to continuing to serve the members of AADPRT!
Very difficult times, especially for historically marginalized populations
Sallie DeGolia, MD, MPH
The past two and a half years seem like a strange out of body experience. Our reality as we knew it vanished in a matter of days. We retreated to shelters leaving behind our freedom to move, congregate, or socialize without fear of infecting ourselves or others. Layered on top of this, many became painfully and increasingly aware of those who have not had a voice while the voiceless have become more exhausted and frustrated by the country’s pervasive blindness or deafness to their plight. Woven into this reality is the seemingly ubiquitous gun violence holding our nation hostage. And this all has played out in an increasingly divisive milieu. Some may feel overwhelmed, hopeless, and confused while others see opportunities for advocacy.
The recent Supreme Court ruling, leaving decisions about abortions up to the states, has led to more unease in our country. We harbor differing and strong feelings about this decision. Like the global pandemic, racism, and gun violence, our nation will feel the mental health impact of this decision. And unfortunately, yet again, we will see that much of the burden of the decision will disproportionately fall on historically marginalized populations including people of color, those with limited finances, and individuals living in rural communities.
As training directors of future psychiatrists, most of whom are of child-bearing age, this most recent decision, together with the national backdrop of division, may have significant impact on their personal and professional lives. It is our role as training directors to be present and support our faculty, program administrators, and trainees during these stressful times and offer opportunities for connection and conversation.
As always, AADPRT remains committed to the mental health of this nation. We support the statements put forth by many of the major medical associations regarding the recent high court decision including the American Association of Medical Colleges, the American Medical Association, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry. We are committed to helping training directors provide the best quality training possible for our future psychiatrists to meet the mental health needs of our country. We are also committed to supporting the wellbeing of our training directors, program administrators and trainees. And we will continue to advocate for these commitments on behalf of our members (most recently, in February 2022, AADPRT signed on to AAMC’s Amicus Brief in support of Harvard’s and UNC’s race-conscious admissions programs; and in June 2022 we sent a letter to ACGME, co-signed by affiliated organizations, to protest the decrease in training director and administrator protected time). I trust we will find comfort in our psychiatry community as we work our way through these challenging times. I look forward to innovative workshops at our annual meeting to help us care for and educate our trainees and each other.
I wish you all well and hope you are able to find relaxation with friends and family this summer. I’m looking forward to coming together soon – in person.
We Need you! AADPRT Strives to be Inclusive
Sallie DeGolia, MD, MPH
Many of you wonder, “but HOW?” Getting involved in AADPRT is elusive to many of our members, but there are many avenues to getting involved: join a committee, awards subcommittee, caucus, or task force; or become a mentor (or mentee!), liaison, or consultant; or present a workshop or poster at the Annual Meeting.
The best way to get started in AADPRT is to join one of our many committees or caucuses (https://www.aadprt.org/meet-aadprt/committees).
All committees, other than the Regional Representatives, Program, and ACMGE Liaison Committees, are open to all AADPRT members. For these groups, watch the listserv and Digest for calls to join! All committees have specific charges (also in link above) that seek to fulfill AADPRT’S mission: “ to promote excellence in the education and training of future psychiatrists, and to best prepare them to meet challenges by fostering a transformative environment that embraces diversity, inclusion, equity and justice.”
Many committees meet regularly and have sub-committees with designated leads to fulfill the work of the committee, and to promote inclusion and transparency in their work. There is a subcommittee for you!
Once involved in a committee, you may seek to lead a subcommittee or even become interested in chairing the committee eventually. We WELCOME that! Committee chairs serve a three-year term with the option to extend one year. How do we select chairs? This process has evolved over time -- recently resulting from the Eikenberg Institute’s Race, Equity and Inclusion Organizational Assessment Report, and likely to evolve in the near future based on any recommendations from the Organizational Equity Committee. This past year, we emailed all committee members whose committee chair was completing their term and requested nominations or self-nominations. I then consulted with the outgoing committee chair to identify a replacement based on involvement as a committee member. If no nominations were received, I turned to the general AADPRT membership to seek interest in becoming a committee chair.
Another way to get involved is through the awards committee via an award sub-committee. The awards program (https://www.aadprt.org/annual-meeting/awards-fellowships) has recently been restructured where the chair of the awards program is the president-elect (historically overseeing all awards committees). The newly formed awards committee includes all chairs of the individual awards’ subcommittees. There is a subcommittee for each AADPRT-sponsored award. We are expanding most of these subcommittees to include not only the chair, but six additional members such that each award subcommittee represents each region in our organization. Current award chairs and committee members will remain in their positions but retitled as “Awards Subcommittee Chair” and members for the specific award.
This is another way to make connections and get involved with AADPRT. Caucuses developed out of membership request and typically are based on a type of program (e.g. Small or Community Program), or job title (e.g. ATD or Vice Chair). We are also in the process of offering members the opportunity to develop affinity groups based on shared identities and interests – look for the announcement coming soon. See https://www.aadprt.org/meet-aadprt/committees.
Currently, AADPRT has two active task forces. Task forces are developed at the discretion of the president and in response to an important immediate issue facing our organization. The Burnout Task Force was developed in 2020 and recently repurposed this year to address ACGME’s new protected time minimum requirements. Recently, the Residency Curriculum and Assessment Task Force, headed by Jackie Hobbs, was developed to re-evaluate training as it has existed over many decades given our persistent psychiatric workforce issues, the changing environment of psychiatric practice, and the ongoing addiction epidemic and expanding geriatric population. You are welcome to join either task force!
The Mentorship Program offers another critical way for members to get involved – either as a mentor or mentee (or both!) (https://www.aadprt.org/training-directors/mentorship-program). We have recently developed a Mentorship Committee to focus solely on expanding this program. The committee will also be offering targeted peer mentorship virtual meetings throughout the year – ANYONE is invited! For New Training Directors (NTD), look out for NTD regular virtual forums throughout the year to help NTDs get up to speed in their new job!
Liaison & Consultant Positions
AADPRT has five Liaison positions to various organizations: Organization of Program Directors Association, AAMC, AAMC-CFAS, Governance Board AADPRT Representative for Academic Psychiatry (only Past Presidents may apply), and the American Association of Chairs of Departments of Psychiatry (reserved for Vice Chairs who attend AACDP). Two consultant positions are the Match Consultant and the GME Financing and Government Affairs Position. Look for listserv and Digest queries for new leadership as appropriate.
Clearly one of the hallmarks of our work together is learning from one another at workshops and through poster presentations. Submit innovations in programming, teaching, or methods to help each other manage the complex work that we do as program directors. If you have a great idea, but no one to present with, reach out on the listserv to find colleagues who might want to join you in developing a workshop! The expanded Program Committee has placed particular preference on new presenters and multi-site workshop/poster teams. This is a great way to showcase your work, network with members, and create life-long relationships.
AADPRT Presidential Pathway
Though this pathway will soon be under careful review by the Organizational Equity Committee, currently AADPRT has a 7-year leadership track that involves becoming AADPRT President. Each year the Nominating Committee seeks nominations from the full AADPRT membership for the Program Chair-elect position. After reviewing nomination applications, an interview process and thoughtful discussion within the expanded Nominating Committee, a Program Chair-elect is identified. This person joins the Steering Committee which includes all members who are involved in the presidential pathway in addition to the treasurer (one-year position). The seven-year progression is as follows:
So come join us! You will help lead AADPRT by getting involved and contributing while also getting to know fantastic and inspiring colleagues!
A Response to the Texas Mass Shooting
Sallie DeGolia, MD, MPH
Again, our nation is forced to endure the unthinkable pain which leaves many of us horrified, terribly sad, or perhaps even numb. With heavy hearts, AADPRT mourns the senseless loss of life - 19 children and 2 adults - at the hands of a gunman this past week in Texas.
This tragic event is the 27th school shooting just this year and only 10 days after a shooting in Buffalo, NY which claimed 10 lives. According to Gun Violence Archive, there have been 212 mass shootings (4 or more people shot or killed excluding the shooter) so far this year, and 693 in 2021 (https://www.gunviolencearchive.org/past-tolls). Furthermore, the American Psychological Association Stress in America 2019 study (https://www.apa.org/news/press/releases/stress/2019/stress-america-2019.pdf) found that 71% of adults experience mass shootings as a significant source of stress in their lives, causing 1 in 3 people to avoid certain public places.
Gun violence is a major public health crisis in this country which desperately needs attention. Despite our history of legislative neglect, it is still important to reach out to your elected representatives to pressure action (https://www.usa.gov/elected-officials). We also need to support ongoing gun violence research to better understand who is at risk, the social forces that contribute to violence, and ways to mitigate harm. These data can help guide policies governing firearm use and interventions to address the personal and societal factors that give rise to violence.
And finally, as discussed in our recent Executive Council meeting at the APA this past week, we need to identify model curricula around advocacy to help our trainees and faculty become strong champions on behalf of our patients and society. Whether we are responding to workforce issues or public health crises like gun violence or suicide, one way we can manage our numbness, sadness and rage is to act. Through advocacy, education and research, our profession can attempt to make headway in addressing this significant crisis even in the absence of legislative inaction.
And remember, you are not alone in the myriad of feelings you may be experiencing. Many of you will be supporting your patients and your families through this experience. The American Psychiatric Association has provided these vetted resources around coping with trauma which may be helpful to you: https://www.psychiatry.org/patients-families/coping-after-disaster-trauma.
Protected Time: AADPRT's efforts to preserve PD holy grail
By Sallie DeGolia, MD, MPH
As you know, the new minimum time requirements for administration of our programs will be part of the approved ACGME program requirements for adult and subspecialty psychiatry programs that go into effect July 1, 2022. One of the drivers behind these changes was ACGME’s desire to harmonize time requirements across all specialty programs. Not surprisingly, this was a potent topic of discussion during the 2022 Annual Meeting and on the AADPRT listserv.
AADPRT strongly believes these new minimum requirements are inadequate – particularly for small, under-resourced and fellowship programs. You may recall that in September 2020, AADPRT submitted a position paper to ACGME advocating for an increase in the minimum protected time for program leadership. We recommended raising “the minimum FTE training director time from 0.2 FTE to at least 0.5 FTE for all programs” and recommended a “1.0 FTE for the program coordinator role.” We strongly recommended that Residency RCs maintain the authority to increase minimum standards for protected administrative time based on program size and given the unique demands of each specialty and associated training requirements. Our reasoning for the increase was based on ACGME expansion of program requirements over the past several years including...
...without any associated decrease in other expectations or increase in time allotted to program administration. Such administrative burdens on PDs and Program Administrators/Coordinators (PAs) require administrative time while often depriving PDs of time to be role models, teachers, and mentors. Unfortunately, ACGME did not endorse our recommendations.
During the 2022 Annual Meeting, we released a survey to capture members’ reactions to the new requirements.
What’s more is that these upcoming changes come on the heels of our 2021 AADPRT Burnout Survey that reported nearly half of current PD respondents (including adult and sub-specialty PDs) already experience burnout. Of the burned-out PDs, more than three-quarters had a desire to resign their role. Even of those PDs who did not report being burned out, almost half reported a desire to resign their role. “Feeling bogged down by administrative tasks” was the most frequently reported contributor to burnout. In short, reduced time will make our jobs untenable.
So how is AADPRT responding? AADPRT has been developing strategies to address the upcoming protected time changes in order to best support our members. First, we have re-purposed the Burnout Taskforce to strategize how to advocate for appropriate protected time. The Taskforce, led by Donna Sudak, has reached out to Small Programs, CAP, and Subspecialty Caucuses to better understand their positions and is working with the Organization of Program Director Associations (OPDA) as well as reaching out to other organizations to seek a supportive coalition in addressing ACGME. The Taskforce has already been working with the Psychiatry RC to create FAQs and enhance the Background and Intent section of the CPRs to clarify how protected time should be used: for administrative duties and not teaching and supervision. The Taskforce has been charged with developing differential “talking points” targeted for small, med/large and CAP/subspecialty programs to support PDs in justifying the need for enhanced time and negotiating with their institutional leadership. Furthermore, we will develop a position statement to send to ACGME documenting our concern about the upcoming minimum requirements and the devastating impact they may have on programs – particularly small, under-resourced, and subspecialty programs. We are hopeful many of our allied partners, including subspecialty groups, will be willing to sign-on to this statement.
As many of our PDs do their best to manage trainee and faculty burnout driven by chronic, underlying, medical system drivers, and more recently, the impact of social justice issues and a global pandemic, reduction of protected time for psychiatry PDs comes at an unfortunate time. AADPRT is committed to advocating fiercely for our members to enhance their positions as program leadership and administrators for the future of well-trained psychiatrists. I encourage you to reach out to myself or Donna Sudak with your own thoughts and ideas.
Our Town Hall: my missed opportunity and reaffirming the goal
By Mike Travis, MD
On January 18th we hosted a Town Hall to discuss the Report from the Organizational Assessment. In general, there was relatively little written feedback in our online system, with only 6 responses. When wondering why there had been so few feedback responses, one of the attendees suggested that this might be the result of some members feeling uncomfortable speaking up if they disagreed with the changes we are proposing, and warned the group about potentially marginalizing a subset of AADPRT members who didn’t feel comfortable with the steps we want to take to become the diverse, equitable, and inclusive organization we aspire to be. My response as moderator of the meeting was to try to listen and explore these concerns. While these are points of tension worth recognizing, my failure to confront them directly was a missed opportunity to reiterate that we are committed to becoming a more equitable, anti-racist organization even if there are members who are uncomfortable with this change.
I realize that our slowness and hesitation to directly address these ideas may have called into question how committed we are to making meaningful change and therefore may have alienated and bewildered other people on the call. That was not my intent, but the impact was there. For anyone affected, please accept my heart felt apologies.
In discussing this interaction with colleagues and friends, I was reminded of the words of Dr. Martin Luther King Jr. and his “Letter from Birmingham Jail” written in 1963.
“I must make two honest confessions to you, my Christian and Jewish brothers. First, I must confess that over the past few years I have been gravely disappointed with the white moderate. I have almost reached the regrettable conclusion that the Negro’s great stumbling block in his stride toward freedom is not the White Citizen’s Counciler or the Ku Klux Klanner, but the white moderate, who is more devoted to “order” than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says: “I agree with you in the goal you seek, but I cannot agree with your methods of direct action”; who paternalistically believes he can set the timetable for another man’s freedom; who lives by a mythical concept of time and who constantly advises the Negro to wait for a “more convenient season.” Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection.”
I do hope and believe that we can do better in addressing these types of challenges and am grateful for colleagues and friends who shared concerns about how the conversation at the Town Hall unfolded. We, as an organization, are committed to our mission, “To better meet the nation's mental healthcare needs, the mission of the American Association of Directors of Psychiatric Residency Training is to promote excellence in the education and training of future psychiatrists, and to best prepare them to meet challenges by fostering a transformative environment that embraces diversity, inclusion, equity and justice.” If we seek to help our members become more equitable educators and equip the next generations of psychiatrists with the skills to treat all people, we must have all voices at the table. Otherwise, we stand the risk of duplicating the divisions we see in our country as a whole. We MUST listen to each other. We also must acknowledge that this is a marathon and not a sprint, that at times some people will feel heard and some marginalized, but that we share the common goals captured in our mission statement. These commonalities will, I trust, allow us to sit with the discomfort of not feeling heard at every moment, to speak for those who feel silenced or marginalized, and to help people change the attitudes and beliefs that have prevented medicine and psychiatry from being practiced in an inclusive way that is equitable for all.
We know that we’re not experts at this task. That is why we hired an outside consultant, shared our responses to his report, and are hosting specific trainings at the annual meeting. In addition, we will change many facets of the organizational structure of AADPRT over the coming years, starting with the formation of a Committee for Organizational Equity, which I hope many people will consider joining.
At our town hall, I felt encouraged by the closing comment from another participant, “We should help program directors become advocates. Advocacy work is not political. It is about equity. We should let everyone be heard, but not at the cost of silencing others. We should strive for equity within the organization”
I want to remind AADPRT members who have not yet had a chance to comment on the Organizational Report and Responses that the anonymous feedback form can be found on the right-hand side of your dashboard when you log into your account. You can also find the Organizational Assessment there.
There will be a second town hall on Tuesday February 15th 2022 from 3:00 to 4:30pm EST. This will be structured differently from the first, with questions drawn from the first Town Hall and emails we have received. This will allow us to structure the town hall more, while still giving the flexibility to allow full discussion. We look forward to seeing you there.
Uncertainty, concern lead to opportunity, momentum
By Mike Travis, MD
As we get closer to the end of 2021, we are all in an uncertain place. The discovery of the Covid-19 Omicron variant during the Winter Holiday Season has made people wonder about what form the Holidays will take. These concerns have had added poignancy as, over the Thanksgiving weekend just gone, we all mourned the three quarters of a million empty seats at family dinner tables around the country.
We face uncertainty on many fronts. What will the future look like? When will the pandemic stop? How can we prevent climate-related disasters? What can we do to address racial inequities?
From within that uncertainty, however, comes the impetus for change. For the best part of a decade many of us, myself very much included, were willing to stick to the status quo and did not attend to the inequities faced by many within our organization.
There is a saying that has been described to me as a curse, “may you live in interesting times.” I don’t think this is a curse at all. These are “interesting times”. Interesting because of changes in the science of psychiatry, certainly, but all the more interesting because we have been given an opportunity to truly break the previous status quo, hopefully once and for all, and begin the long process of continuous change for the better. By working individually, in the institutions in which we work, and within the organizations to which we belong, we can make these important changes to truly embrace inclusivity, diversity, and equity.
By doing that we will have more strength as mentors, advocates and educators, for each other, and for AADPRT as an organization. We can only do that if we work together.
I am delighted to see the feedback to our organizational review responses coming in. [Comment in virtual forum | Provide anonymous feedback] It is a testament to the strength and inclusiveness of our organization that our members are not afraid to call out what they think is going wrong and what they believe needs to change. They are also ready to highlight and advocate for the aspects of our organization that currently work well. Through the listserv each week it is inspiring to see individuals help each other with problems and questions as many and a varied as our membership.
Despite the problems we still face and the hurdles we as a society still have to overcome over the coming months and years, the last 20 months has seen a momentum gather behind an opportunity for positive change.
I do hope that you can enjoy the rest of the Winter Holiday Season. I wish for all of us that we can find time for ourselves to remember and celebrate those who are unable to join us this year and look forward to 2022 and all that it holds in store.
By Mike Travis, MD
Release of Race, Equity, and Inclusion Organizational Assessment
I wanted to write to tell you more about the next stage of AADPRT’s Diversity, Equity, and Inclusion initiatives in which so many of you have participated.
Following up from my last update, the response to the recommendations in the report have been discussed with the Executive Committee and amended accordingly.
As per the plan previously detailed and contained in the document, the full, unredacted report and recommendations will be released to the whole membership this Thursday, November 11. At the end of the report are the consultants’ recommendations repeated along with the responses of the Steering Committee (SC) and Executive Council (EC) to each point.
We want and welcome your feedback on the report, the recommendations, and the SC/EC responses.
We will schedule a town hall with Mike Travis (current President) and Sallie DeGolia (President-Elect) in January 2022. Our overarching aim in responding to these recommendations is to increase the transparency of AADPRT’s processes and procedures to its members and to broaden the opportunity for involvement and inclusion within the organization.
As detailed in the responses, we are offering two methods for member communication regarding the report. These will be our communication channels for comments on the report in lieu of the list-serve. This will allow for inclusion of all members, consolidation of comments, and an anonymous channel for feedback.
We look forward to reading and collating your comments and feedback and discussing these further at the January Town Hall and our forthcoming Annual Meeting in Minneapolis. The integration of this feedback with the existing responses and plan will drive the agenda for transparency, diversity, equity, and inclusion for AADPRT in the years to come.
By Mike Travis, MD
Randy Welton, MD
In the interests of transparency, I wanted to update you all on where we are with AADPRT’s Diversity, Equity and Inclusion initiatives in which so many of you have participated.
Last fall, because of the Executive Council’s concerns that AADPRT was not adequately addressing issues of Diversity, Equity and Inclusion within our organization, we began interviewing and eventually hiring a Diversity Consultant. While waiting for him to conduct his assessment, we took initial steps to increase the discussion of these issues within AADPRT.
We expanded the Spring Conference Program Abstract Selection Committee from 3 people to 10 people including 7 volunteers from the general membership selected based on their region and specialty training.
During the 2021 Spring Conference we had plenary speakers address – “D&I: Addressing Institutional Drivers of Mental Health Inequities: Structural Competency”, “Allyship: Becoming a More Effective Ally”, and “International Medical Graduates in Psychiatry: Elephants, Curry, and a Monsoon Wedding”, as well as numerous workshops on allyship and anti-racism topics.
In the months leading up to the conference as well as after, we offered virtual programming to all members related to anti-racism and allyship.
This past May, we began the organizational assessment process with our consultant by blindly forming seven focus groups of self-nominated members to meet with the consultant via Zoom for one-hour sessions to discuss the strengths and weaknesses of AADPRT as it related to race, equity, and inclusion within AADPRT.
In September the Steering Committee (SC) held a daylong retreat to address the findings of our Consultant’s report from the focus group meetings and to lay out an initial strategy for addressing these concerns. As a result of that process, we have come up with a series of initial responses to the content and recommendations in the report.
The Executive Council (EC) of AADPRT now has the unredacted report and the Steering Committee’s recommended initial action plan. We will be discussing this at the EC meeting on September 25th. Based on that discussion we will amend SC’s initial action plan and then share the same full report and responses with the membership as a whole after review at the Steering Committee meeting on October 14th.
I look forward to a discussion with all members about the changes to AADPRT that the coming years will bring.
By Mike Travis, MD
This morning, August 6th, I heard the StoryCorps excerpt on NPR. It was about Dr. Charles R. Drew, a graduate of McGill University who became a surgeon and was African-American. He was responsible, during World War II, for creating blood banks and preserved blood products that saved countless thousands of lives. Initially Black soldiers were unable to give blood and then when they were, their blood products could not enter the supply chain and had to be stored separately. Blood segregation. He took a stand on this and resigned his position as Director of the first American Red Cross Blood Bank. He was honored for his work with the Spingarn Medal by the NAACP and with honorary doctor of science degrees, by Virginia State College and by Amherst. He is further honored by the Charles R Drew University of Medicine and Science in Los Angeles. Sadly, this pioneer and polymath, (see his Wikipedia entry) died as a result of a car accident at the age of 45.
When I heard this StoryCorps article, I was struck by just how much of a difference Dr. Drew made in a relatively short life and how much he could have gone on to achieve had he lived. What Dr. Drew overcame to get into medical school, his accomplishments there and in the profession are singular, as is his legacy. Yet, despite his brilliance and awards, living in the District of Columbia, his local chapter of the American Medical Association would not let him join because they only allowed white doctors.
I would like to think that we have come a long way since then and I suppose by some metrics we have. Recent events, though, in politics and protecting the right to vote, in health inequalities laid bare by the covid-19 pandemic, and in the social injustice and hardship that we see day in and day out in our clinical work, make me think we have not come such a long way after all. I am sorry, as a Doctor of 30 years, to have been a part of making so little change. We still have a lot of work to do.
I want to repeat my gratitude to those AADPRT members who stepped up to be part of our recent focus groups for the AADPRT Racial Equity Organizational Assessment. In the report from Dr. Hardy, the anonymized comments from members of the groups echoed what I wrote above, there is a lot of work to do.
I wanted to write about the process of what we are intending so that you can, if you so wish, put time aside to read and respond to the report and the draft Strategic Plan. You will see this in the bullet points, but in the spirit of transparency the full report from Dr. Hardy will be released to all AADPRT members. I have detailed our plan for doing this as follows.
· Dr. Hardy’s report and recommendations were released to the AADPRT Steering committee on August 5th.
· The SC will meet for a retreat on Saturday September 11th to discuss the findings and recommendations of the report and will meet with Dr. Hardy as part of the retreat to discuss further with him and brain-storm an initial action plan.
· The SC will draft a summary of the brainstorming session and action plan that will then be shared with members of the Executive Committee (EC) along with Dr. Hardy’s report.
· The SC and EC will meet on September 25th to further refine the draft action plan and brainstorm further on actions that may need to be taken by each committee and caucus
· The SC and EC will work on the initial action plan, and from it, create a draft Strategic Plan addressing each of the areas highlighted in the report.
· This draft Strategic Plan will include changes to the Nominating Committee process as this is one of the areas highlighted in the report as requiring reform. The initial changes to this process need to be enacted well in advance of the Annual Meeting to allow a new committee to be formed and for the initial new process of the committee to be decided. This could be changed based on members’ subsequent feedback.
· We are aiming to have the completed draft Strategic Plan ready for dissemination after the steering Committee meeting on December 9th 2021, though we may have it ready earlier. The draft Strategic Plan will be disseminated to all AADPRT Members along with the full report from the Dr. Hardy’s AADPRT Racial Equity Organizational Assessment.
· The current plan is for an online form to be made available as well as a message board for AADPRT members to comment on both the report and the draft Strategic Plan. We want to use these methods to garner feedback and not the listserve. The online form will allow people to comment anonymously and without sharing their feedback with the membership as a whole. The message board allows for discussion of the report and Strategic Plan in a non-anonymized way that can be shared with all AADPRT members in real time. The message board rather than the listserve also avoids email clutter and keeps the discussion in a single place for easy reading and summation.
· Before the 2022 Annual Meeting, likely end January 2022, there will be time set aside for a Town Hall meeting chaired by the President and President-Elect. At this Town Hall, a summary of the comments and feedback will be shared along with the revisions made to the Strategic Plan as a result of the members input. There will be Q&A as part of this Town Hall.
· The final Strategic Plan will be ratified by the SC and EC at the Annual Meeting and subsequently implemented.
I hope that this will be a significant step forward for us as an organization and I thank you in advance for your thoughts and comments as we try to be as equitable and inclusive as we can.
By Mike Travis, MD
Welcome to the start of the new academic year! I have been reflecting on this as our second start to an academic year during COVID-19 and how this might be affecting the various member groups of our community differently.
For those of us that have been PDs or APDs for a few years, the continued disruption is wearing, but bearable as we have a clear idea of what “normal” used to be and what the “new normal” might look like. For those who started during the pandemic, the way forward may be less clear and I expect to see increasing threads on the listserve about new practices and revamped resources as we continue to help and support each other. The IT committee is very aware of the limitations of the listserve and is developing and sharing ideas about how we might handle and distribute information differently in the future and make it easier to navigate all the treasure house of information and experience that is represented in the thousands of emails to which we have all contributed.
In addition to our newly minted PD and APD colleagues who need and deserve our help and support, we also all have two classes of residents who have had most of their residency training post-COVID. I am sure I am not alone in struggling to understand properly the longer-term effects of the pandemic restrictions on their experience and training and how these might translate into the kind of physicians and psychiatrists they will be in the future. Trying to anticipate these potential effects and developing adaptations and potential interventions are going to be a key part of this next year. I look forward to reading and hearing about your suggestions and innovations.
In response to the ongoing COVID-19 pandemic, the leadership of AADPRT and ADMSEP have reviewed the concerns of key stakeholders and compiled the following recommendations for our trainees, faculty advisors involved in Undergraduate Medical Education, and psychiatry residency program and fellowship directors overseeing Graduate Medical Education. We have reviewed and appreciate the recommendations from the Coalition for Physician Accountability, which may also release additional guidance. Our support for the following recommendations is intended to prioritize the safety of our trainees and communities and to support a fair and equitable process for all.
Psychiatry-specific recommended standards as of June 11, 2021
Interviews for psychiatric residencies and fellowships for the 2021-2022 recruitment cycle will be virtual. We expect all programs to comply with this recommendation and we will re-evaluate for future cycles. This includes local applicants as well. Many other disciplines such as Pediatrics and Obstetrics and Gynecology have released statements on their plans to only utilize virtual methods.
- We expect that all residency and fellowship training directors will follow the recommendations set by the AAMC and the Coalition for Physician Accountability to provide away rotations preferentially to those individuals who do not have access to clinical experiences in a psychiatry residency program in their home institution. Students are not expected to do away rotations and if they choose to do so, a maximum of one away rotation should be secured.
- We recommend that faculty advisors work closely with students and encourage them to use the “Apply Smart” data and reference A Roadmap to Psychiatric Residency (updated version to be released summer 2021) when considering the number of residency programs trainees should apply to.
- We support the holistic review of applications and recognize students may have experienced non-traditional rotations during the pandemic. We recommend programs require only one psychiatry-specific letter among the letters of recommendation submitted. We recommend that programs do not require Step 2 results to be completed at the time of the initial application review.
- We recommend that programs are as transparent as possible in the interview process. For instance, program website and social media would list dates of application deadline, release dates of interview offers, and specific interview days. The anticipated structure of the interview day (e.g. number of interviews and length) can be outlined and posted publicly.
- We recommend that programs not offer more interviews than interview spots. Release of interview offers should be done as late in the day to minimize disruptions to clinical learning and allow applicants 72 hours to respond before releasing the interview offer.
- Post-interview communication should be avoided, except for the provision of significant updates (e.g., an additional publication since interviewing), asking/responding to specific necessary questions, or basic thank you notes. We will continue to follow the NRMP Match Communication Code of Conduct despite the virtual platform.
- The Interview day itself should all take place on one day, not spread across multiple days (exception would be if technology fails and rescheduling is truly needed), and no applicant interaction should be recorded.
- It is reasonable to offer optional and nonbinding “open houses” prior to the interview season process. Programs should not take attendance and ensure applicants know that these are not mandatory. All true open houses and multiprogram residency fairs should conclude by September 29, 2021. We recognize that some programs may choose to have only a few larger evening virtual gatherings instead of the classic dinner before or on the interview day. Should a program choose to do this given the reduced student exposure that may have occurred with the pandemic, attendance should not be taken, and an absence should not be considered by programs when ranking candidates. We recognize that with this deviation there may be scheduling conflicts and tension, and urge programs to keep all events applicants are expected to attend as part of the formal interview process on one day for each applicant.
- We are still exploring if in-person “second looks” will be permitted this season, pending additional information from the scientific community and balancing this with maintaining the most equitable option.
- We strongly recommend no “swag.” If programs plan to mail hard copies of materials it should not include anything of value, which includes gift cards for food.
- Data from NRMP reflect the probability of matching plateaus at >95% after 14 ranked programs for allopathic applicants. Applicants should discuss their individual circumstances with their psychiatry advisors prior to submitting applications and during the interview season.
- While we recognize that individuals may have unique circumstances, we generally recommend that applicants interview at 15 or less programs. Interview offers above this number should be declined by student, so other applicants have opportunities to interview. Similarly, this will prevent programs from unnecessarily re-reviewing applications of those who do not plan to interview.
- If cancellations are necessary, applicants should notify the program as soon as possible and at least 5 business days in advance.
- As stated above, students should only participate in one away rotation, if at all as this is not a necessary component of applying to psychiatric residency.
The above recommended standards are put forth to provide the best interview season possible and ensure a fair and equitable process.
By Mike Travis, MD
Firstly, I want to thank the Diversity and Inclusion Committee and especially Raziya Wang, Adrienne Adams and Consuelo Cagande for writing the moving and also wonderfully pragmatic letter that served as the President’s update last month. This served both to remember George Floyd and to provide practical advice about the next steps we all need to take to incorporate ally and anti-racism practices within our own programs and institutions.
As the saying has it, “everything starts from home”. As such, I am very grateful to everyone who took time out of their busy schedules in May to be part of one of the focus groups for the Racial Equity Organizational Assessment, each led by Kenneth Hardy of the Eikenberg Institute for Relationships. In the end, thanks to your commitment, we were able to convene seven groups in total; two drawn from the Diversity and Inclusion Committee, two randomly chosen from self-identified members of AADPRT, one each from the Regional Representative group and the Program Administrator group, and then a group comprising the current members of the AADPRT Steering Committee. These meetings concluded the Friday before last and we expect a report from Kenneth Hardy by the early part of July. This report will be published on the AADPRT website along with an organizational development plan which will be formed over the coming months.
It is too early to say what the focus groups have highlighted as areas upon which we, as an organization, need to work to enhance our diversity, increase equity and ensure inclusivity. The Steering Committee will meet in early September to discuss the report and then later in September we will convene the Executive Committee to develop our responses to the report and the EC and SC will subsequently lay out our proposed changes and our organizational development plan before we all gather in Minneapolis. At our Annual Meeting we will be able to reflect on, and amend, this plan together, hopefully with input from all of our members. We want this process, in itself, to be as transparent and inclusive as possible.
This time of the year is filled with milestones, though not only the ACGME kind! As we say goodbye to our graduating residents and fellows, we recognize that they have each become a part of our lives, for better or for ill, and we will be welcoming those who stay as departmental colleagues and those that leave as part of our ever-expanding specialty. We also mark the beginning of a new class; people we have come to know virtually during the recruitment season and then in-person, as they visit our cities and programs, many for the first time this year. Their arrival always fills me anew with hope and excitement for the year ahead and one of those hopes is that you feel the same.
By Raziya S. Wang, MD | Adrienne L. Adams, MD | Consuelo Cagande, MD
Members of AADPRT's Diversity and Inclusion Committee
George Floyd grew up in Houston, Texas, in the Third Ward, a historic Black neighborhood. He played football and basketball at Jack Yates High School, where he helped lead his football team to the state championship game in 1992. He then continued sports at South Florida State College before transferring to Texas A&M University - Kingsville. His college basketball coach started him as a power forward and he later remembered Mr. Floyd's athleticism and how he consistently contributed 12 to 14 points and 7 to 8 rebounds in a game (Fernandez and Burch). Returning home without a degree, Mr. Floyd began a hip-hop career as Big Floyd in the mid-1990s with two groups...
By Mike Travis, MD
Since writing last month I have been reflecting on allyship and its importance as we move forward.
I am convinced that defining what allyship means, and its different levels (from awareness, through action, to integration), seems to have led to a stronger sense of purpose in everyone and a collectiveness that is, or at least appears to be, less forced.
So much of allyship is about education; coming together and sharing ideas, reframing those that are wrong, and reinforcing those ideas that aid understanding and promote diversity, equity, and inclusion.
I am pleased to write that the Steering Committee has agreed to expand the focus groups for our Racial Equity Organizational Assessment within AADPRT beyond the original two groups, (Steering Committee and Diversity and Inclusion Committee) proposed by our consultant.
For the first of these additional groups, those of you who are regional representatives will be asked to select one of the representatives from each region for the “Regional Focus Group”. The Regional Representatives will also be asked to select a second person from within their caucus to also be a part of the focus group. This choice should be made with a special emphasis on selecting people who represent the diversity of AADPRT but have not yet taken on a formal leadership role within the organization.
On the recommendation of the Diversity and Inclusion Committee during our meeting last month, we will be forming two more focus groups drawn randomly from a stratified list of volunteers. Soon all members will receive a very brief, totally optional survey asking for name, age, position, gender, ethnicity/race, and asking you if you would be willing to serve on one of the focus groups. There will be a fuller explanation of what this would entail on the survey. We will stratify those interested persons in this self-identified group into different subgroups based on survey responses. We will then randomly select focus group participants from across the diverse segments of our membership.
In addition, we will be using a similar methodology with the Program Administrator Caucus to select 10 of their members to form the sixth focus group. This will help to ensure representatives from all parts of AADPRT are included.
We hope that you will consider putting your name forward for one of the groups!
To mark the anniversary of George Floyd’s death on May 25th , we have asked Adrienne Adams (chair) and the Diversity and Inclusion Committee to write a column in this space for next month.
I know that none of us is immune to the uncertainty we all have to bear at this time. My hope, though, is that justice will prevail, be seen to prevail, and will be accepted by all.
By Mike Travis, MD
I have been reflecting on what a great meeting we just had and how it shows that as a community we remain strong because we remain connected. On Saturday afternoon, I felt the same sense of loss at the end of the meeting that I normally have while waiting for my flight home, and this was the only time that has happened to me when attending a virtual meeting. In fact in some ways, I felt it even more so. We had all been talking and sharing, praising and cajoling, teasing and joking so much, through the chat functions, during the workshops and plenaries, that the meeting felt even more intimate. I want to reiterate my thanks to Sara and Doug, to Randy, to Melissa and to all of you for making the whole so memorable and so much greater than the sum of the parts.
As we contemplate the year ahead and the “new normal,” it is clear that we have all had experiences that have changed the way we will see the future. One of the biggest impacts is having to change the way we deal with each other. This is embodied in the ground swell towards actively and intentionally addressing issues of diversity, equity and inclusion and combating structural racism and intolerance.
These will be major components of the year ahead, both in terms of planning our 50th in-person annual meeting in Minneapolis in 2022 and in terms of the work we need to do as an organization and as individuals between now and then. As an organization, we will be engaging with an external consultant “to ascertain how AADPRT’s vision of effectively addressing issues of racial sensitivity, equity, and inclusion are being implemented throughout all facets of the Association’s structure.” To accomplish this, we will convene focus groups with participants drawn from across our membership.
These themes will be a large part of the annual meetings going forward just as they were a significant theme at this year’s Spring Conference because of your submissions and your participation.
As much as we will be reflecting on the history of the first 50 years of AADPRT over the coming year, I would also like us all to be thinking about the next 50 years of AADPRT and the changes we will need to incorporate to make us as relevant in 2070 as we are in 2021.
In previous statements we have clearly laid out AADPRT’s position as an organization committed to diversity, equity and inclusion. Part of this commitment is to deplore violence towards others based on race or culture. To see and hear about additional violence visited upon Asian-Americans and Pacific Islanders is deplorable. We are pleased to support President Biden’s statement on January 26th 2021 “Condemning and Combating Racism, Xenophobia, and Intolerance Against Asian Americans and Pacific Islanders in the United States”. We recognize the contribution made to our society at large, and our GME community in particular, by our Asian American and Pacific Islander colleagues, residents and co-workers and stand in solidarity with them against racism and violence.
President Mike Travis, MD and AADPRT Steering Committee
By Melissa Arbuckle, MD
I’m looking forward to our 2021 Spring Conference, scheduled for March 1-6! I can’t believe that almost a year has passed since we met in Dallas for our last Annual Meeting. I was just recently reviewing some of my email exchanges with colleagues last March when everything was moving to online “as a precaution.” At the time, I couldn’t imagine all that would unfold this past year. It has been a tough year to say the least. However, I’m incredibly proud with what we have accomplished as a community. Our theme for this year’s conference (Innovation, Collaboration, and Inclusion!) highlights our resiliency and our commitment to our mission: to promote excellence in the education and training of future psychiatrists, and to best prepare them to meet challenges by fostering a transformative environment that embraces diversity, inclusion, equity and justice.
As a community, we have come together to share resources for teaching online, implementing telepsychiatry, addressing systemic racism, and supporting wellness and mental health among our trainees, our colleagues, and ourselves. We have come together to work on becoming better allies, and to re-imagine recruitment as we pivoted to a virtual world.
While our new zoom reality has created a lot of challenges, it has also expanded opportunities for innovation, collaboration, and inclusion. I don’t think our community has ever been stronger or more important. I have been so grateful for the support of this community over the past year and am excited to see you soon.
By Melissa Arbuckle, MD
Over this past tumultuous year, I’ve been thinking about the many things I have taken for granted -- everyday actions and events that you can’t recognize the value of until they are gone. I have found myself especially missing those small conversations that happen when you’re standing next to someone waiting for the elevator, or while you wait in line to order lunch at the café at work. I never really thought about how important those moments were. While I’m thankful for the ability to work remotely, it’s clear that those brief interactions are an important interstitial glue that keeps a community together.
Perhaps more than anything, I have come to realize the true value of honest leadership, the value of data and science-informed decisions, and the value of civility. It’s not that I didn’t value those things before. It’s just that I really couldn’t imagine what the world could be like without them.
And last week, as I watched the insurrection attempt at the U.S. Capitol, I was reminded just how precious our democracy is. I’m grateful in that case that we do not have to learn what life might be like without it.
Watching the peaceful transition of power in our country as President Biden and Vice President Harris took office this week has given me reason for hope.
As you may recall, last fall we joined the AAMC in calling out President Trump’s executive order barring any organization receiving federal funds from participating in diversity and inclusion training that highlighted institutional racism in the United States. I was excited to learn that one of the executive orders signed by President Biden on his first day in office reverses this ban and calls for an “equity agenda” to tackle systemic racism.
The next few months are not going to be easy as we continue to face the ongoing surge in COVID-19 cases. Systemic racism is another ongoing challenge, one that will require a long-term commitment to diversity, equity, and inclusion. However, I have even greater appreciation for the value of our community and our ability to adapt and evolve in the face of such challenges and to advocate for social justice together.
I’m looking forward to connecting with all of you in the near future and wishing you all the best as we wait for spring!
The ACGME has appointed a Task Force to review its Common and Specialty Specific Program Requirements relating to duties, functions, dedicated time, and full-time equivalent (FTE) support for program directors, assistant/associate program directors, program coordinators, and core faculty members. As part of this effort, the Task Force asked us (along with other organizations) to submit a formal position statement in September.
In crafting a response, our ACGME Liaison Committee (including Melissa Arbuckle, Adam Brenner, Jessica Kovach, Alan Koike, and Chris Snowdy) reviewed the current ACGME requirements across specialties and subspecialties and conducted a survey of psychiatry program directors. Additional input was solicited at our Executive Council meeting held on 8/21/20 and our Steering Committee meeting on 9/10/20.
A final statement was compiled by the AADPRT ACGME Liaison Committee and recommended significantly increasing protected time for program leadership and administration. A full copy of the statement can be found here. We are grateful to the ACGME for taking on this issue and for the feedback provided by AADPRT members on this critical topic. As a follow up, AADPRT will present an additional testimony on this topic at the ACGME Congress on November 2nd.
By Melissa Arbuckle, MD
In June, AADPRT joined with the AAMC in calling out police brutality and racism in America. In supporting their call to action, we endorsed speaking out against all forms of racism, discrimination, and bias, and taking a lead in educating ourselves and others to address these issues head-on. We committed to employing anti-racist and unconscious bias training and to move from rhetoric to action to eliminate inequities in clinical care, research, and education.
As part of this effort, we hosted two relevant workshops in July. Sarah Mohiuddin, Michael Jibson, and Adrienne Adams presented a workshop on supporting trainees who experience patient aggression and discrimination-based aggression/harassment. A week later, Corey Williams, Jessica Isom, Matthew Goldenberg, and Robert Rohrbaugh presented their workshop on race and racism in clinical documentation. Both workshops are available on the AADPRT website.
Under the leadership of Adrienne Adams, our Diversity and Inclusion Committee reviewed our mission statement and recommended changes (which have since been approved) to underscore our commitment to “diversity, inclusion, equity and justice.”
We are not done. In recognition that real change takes time, we are committed to making this a long-standing priority in our work. As part of our pledge to educate ourselves, we plan to hire an outside consultant to help us do an in-depth review of our own organization and provide recommendations for next steps. We hope that through this process we will have an opportunity to address the role systemic racism may have in our own organization and to strengthen our commitment to diversity and inclusion.
At the same time, we are thankful for our members committed to allyship and our Committee on Diversity and Inclusion for lending their time, effort, and expertise to educating our community and supporting this work. We are excited about our upcoming spring conference and anticipate that these critical issues will be a major focus of the meeting. We are hopeful that these combined efforts will provide us all with a roadmap for how we might take on anti-racism within our home institutions and training programs.
I have never been more grateful for this community and am looking forward to seeing what we will accomplish together.
By Mike Travis, MD
President-elect and Awards Committee Chair
The AADPRT awards system opened on August 6th and closes on October 1st 2020.
In this time of social distancing, face covering, hand washing and anxiety heightening it can easily seem that awards are secondary to the daily facts of life. Yet, in the adversity we have faced over the last few months there have also been many opportunities for innovation, moments to show fortitude and circumstances that have called for superb acts of kindness and impactful feats of leadership. These are exactly the things that should be noted and lauded publicly. I therefore urge you to reflect on the many outstanding achievements of your colleagues, faculty or residents and consider submitting a nomination for one of the following AADPRT Awards.
The Annual Lifetime Service Award, which acknowledges a psychiatrist AADPRT member who has provided significant service to AADPRT, had an impact on psychiatric residency education nationally, demonstrated excellence in psychiatric residency education, provided generativity and mentoring in residency, or some combination of these. The George Ginsberg Fellowship Awards which acknowledges the excellence and accomplishments of outstanding residents interested in education and teaching who are pursuing careers as Clinician-Educators and/or Academic Administrators. The Nyapati Rao and Francis Lu International Medical Graduate (IMG) Fellowship, designed to promote the professional growth of exceptional IMG residents and fellows and facilitate their successful development as leaders in American psychiatry. The Lucille Fusaro Meinsler Program Administrator Award recognizing the outstanding skills that psychiatry residency Program Administrators possess and utilize in the day-to-day management of a residency program. Peter Henderson MD Memorial Award given for the best published or unpublished work in the area of child and adolescent psychiatry. And the Victor J. Teichner Award (deadline December 15) developed to promote and improve the teaching of psychodynamic principles to trainees in Psychiatry.
The time of Covid-19 is a time to seize on the chance of recognizing those who have continuously excelled and have really come to the fore since our last Annual Meeting. It is also a grand moment to single out those who have responded to the crisis by really stepping up their game and making a profound difference to the lives of those around them and the patients for whom they care.
By Vishal Madaan, MD, Chair, IMG Caucus
With the pandemic impact intensifying with increased morbidity and mortality, the need for physicians has never been felt more in the US. More recently, a Presidential proclamation was released on June 24th thereby suspending new applications for a number of foreign worker visas until the end of 2020. We asked Dr. Vishal Madaan, Chair of the IMG Caucus, to comment on these recent events and the potential impact on IMGs more broadly:
As the United States grapples with a grueling pandemic running concurrently with a soul-searching debate on racism, several International Medical Graduates (IMGs) have found themselves suffering collateral damage. IMGs constitute about 30% of the psychiatric workforce and 33% of our trainees. While continuing to heroically serve on the clinical frontlines during this unprecedented pandemic, they have been facing numerous unique challenges related to COVID and immigration. Slower visa processing times and lack of premium processing for 3 months have resulted in a lot of anguish. The financial downfall in many hospitals and medical institutions has resulted in several physicians being furloughed or laid off. Laid off trainees and physicians may only have 30-60 days to secure another position, which obviously entails undergoing interviews, negotiating contracts, and then going through the credentialing process; otherwise, they can’t maintain legal status. Similarly, salary cuts run the risk of requiring another formal department of labor approval, thereby, delaying the whole process. Furthermore, international travel restrictions can easily create an inability to take care of a sick family member back in their home country. For several others, administrative decisions are making it temporarily impossible for physicians to return back to the US from there countries of origin, even when they may have their homes and children here.
In addition, there are several upcoming challenges ahead. The number of IMG residency applications has steadily decreased over the past 5 years, which will have downstream effects on fellowship recruitment as well. It is unclear how the change in USMLE step 1 score reporting to pass/fail will affect IMG residency applicants---one of the concerns being that with this change, IMG applicants may lose another way to showcase their application. USMLE Step 2 CS has been postponed, and alternative pathways for IMGs are being explored since IMGs will not be eligible for residency without ECFMG certification. As virtual interviews become the norm this year, issues related to time zone differences, access to stable internet bandwidth and a secure location, and video-based interview etiquette, could become stand out issues for IMGs unlike prior years. Overt and covert pressures and implicit biases to not hire IMGs given some of the aforementioned issues will likely become more evident. And yet, IMGs, in general, are a resilient group and prior generations have faced mighty challenges in the past. Probably the most provocative question to ask ourselves as program directors is whether we can challenge ourselves and continue to recruit IMGs based solely on merit? Let us hope and strive to continue to do that!
It is hard to fathom where our country is today. For far too long, communities of color have endured unimaginable atrocities. The brutal murders of George Floyd, Ahmaud Arbery, and Breonna Taylor, all carried out with apparent immunity, provide a painful reminder of the limited value our society continues to place on Black lives. The stories have become all too familiar. They shed light on the world of racism and danger communities of color face every day.
As a community, we stand together with the Association of American Medical Colleges and support their call for action. As they outline in their statement released yesterday:
In the year ahead, we are looking forward to identifying opportunities to translate these guiding principles into specific actions. As an organization, AADPRT has made significant progress. At the same time there is a lot of work to do. Addressing racism demands that we call out violence and condemn police brutality. It will also require examining the cultural drivers that reinforce racism and white privilege in our own communities. As educators overseeing the training of future psychiatrists, it is critical that we identify concrete ways to combat health disparities and provide culturally appropriate mental health care to all communities. As academic leaders in positions of influence, we have an obligation to raise awareness about systemic racism. We cannot stay silent.
Melissa Arbuckle, MD, PhD
On behalf of AADPRT, the International Medical Graduates (IMG) Caucus advocated via letter for the Healthcare Workforce Resilience Act (S3599/HR2678). Click below to read the letters.
Letter to House Representatives
Letter to Senators
The COVID-19 pandemic has caused unprecedented disruptions to medical education. In addition to postponed medical student clerkships, lost opportunities for away rotations and sub-internship experiences, and delayed USMLE assessments, our trainees and programs will face substantial new challenges over the 2020-21 residency and fellowship application season. Recent recommendations released by the Association of American Medical Colleges (AAMC) and the Coalition for Physician Accountability, in addition to shifts in the ERAS 2021 residency timeline and the NRMP match schedule, make it more important than ever for us to come together as a community to address the challenges ahead. Continue reading...
Dear Friends and Colleagues,
I hope that you are all doing well. I can't believe that we were in Dallas just a week ago -- I already miss "bumping elbows" with you! This past week in New York City has been a blur. There is no doubt now that we are facing a global emergency with COVID-19.
Christina Girgis's post on Thursday seeking guidance for how to best navigate the challenges ahead really resonated with me. Many people may be turning to you for recommendations and you may feel unsure yourself. However, you are likely in the best position to lead your team (and dare I say, own your awesome)! The larger system is unable to make decisions quickly or at the granular level you might need given the implications and numerous unpredictable downstream consequences they're considering.
While there is no clear roadmap for how to navigate the challenges we're facing, you are part of a community that's here to help you. AADPRT and the steering committee are monitoring the situation and have reached out to several committees to help collate and disseminate information to help you manage this unprecedented crisis. Based on the number of COVID-19 cases around the country, some of us may be 1-2 weeks ahead of you. I'm hopeful that sharing our own personal experiences may help some of you better prepare for what's to come.
My program has decided to host class, process group, and group meetings over Zoom (teleconferencing software, zoom.us). We have also rearranged resident rotation schedules and increased our capacity for telepsychiatry so as many residents (and staff) as possible can be working remotely from home. Our goal is to not only minimize exposure for everyone, but to create a back-up team that can provide essential clinical services should we experience extreme staffing shortages. We have also looked at breaking up our night float schedule and encouraged residents to trade call shifts in order to limit the emotional toll for those on the front lines.
I recognize that all of this may seem like overkill, and it may not be necessary right now depending on what is happening in your own community. You should follow the recommendations coming from your own institutions. However, if you aren't doing so already, I strongly recommend that you prepare for this level of change now. The situation is rapidly evolving and is likely to escalate faster than you think. Since programs are likely to be impacted differently across the country, we are looking at tapping into our regional caucuses to help coordinate a more local response and to help you share strategies that will be most relevant in addressing your most immediate needs.
Amidst the logistical planning, know that a listening ear may still be the best thing you have to offer to your residents, colleagues, and staff. Uncertainty is anxiety provoking for all of us. Disruption is not just about work, it's about our personal lives and our families. Constant communication with words of encouragement and support is critical right now. I really appreciated Ed Kantor's posting on the listserv about the importance of staying socially connected, noting that the CDC recommendations are really about "physical" distancing.
Most of all, take time for yourself. We are all in this together. Find time to take a break from the news and your email and social media. Do those things that keep you grounded. We are going to have to adjust to a new normal, which may be here for a significant time. While there will be ongoing acute emergencies to address as training directors, this is likely to be a prolonged challenge. Now is the perfect time to join the AADPRT mentorship program-either as a mentor or a mentee! We're here to support you.
Melissa Arbuckle, MD, PhD