Spotlight: Stanford Psychiatry at the 2024 Annual Meeting of AADPRT

Between February 27 and March 2, members of the American Association of Directors of Residency Training gathered at the Hilton Austin to share expertise and celebrate the national community of residency training program directors and administrators. The theme of this year’s meeting was “Our Time is Now: Changing Psychiatry Residency Training.”

Several department faculty members and administrators attended the meeting and participated in talks and sessions with colleagues from around the nation during their time in Austin:

The Disciplinary Process: Navigating the Evolving Landscape in Residency Training

Speakers: Ann Schwartz, Adrienne Bentman, Deborah Spitz, Sallie De Golia

For all program directors, the disciplinary process is challenging. Initial faculty assertions of problematic behavior or incompetence may evaporate, arrive after submission of a passing evaluation, or become lost in the shuffle among rotations and sites. When confronted, the resident may be scared, misrepresent the issues, or be entirely unaware of the concerns. Despite guidelines that seem clear, implementing the disciplinary process can leave the program director in a “grey zone” of confusion, surprises and difficult choices which can challenge even the most seasoned among us. The workshop explored how to think through perceived problematic resident performance, discussed solutions, and shared techniques and experiences that have been helpful. The role of mentorship and coaching was emphasized as helpful for trainee development. The workshop explored pitfalls and collateral damage including managing the challenging and complicated feelings of vulnerability and fear that may arise in the context of remediation or dismissal of a fellow resident. Generational differences and expectations in the process and how the Covid experience impacted resident expectations and performance were also discussed.

Understanding and Improving Trends on the ACGME Resident/Fellow Survey

Speakers: Silvina Tonarelli, Edwin Williamson, Isheeta Zalpuri, Yasin Ibrahim, Alma Liliana Monroy Tijerina

Since 2004, the ACGME has required all accredited programs participate in the annual resident/fellow and faculty survey to monitor graduated medical clinical education. The survey asks trainees about their compliance with duty hours and their opinions of faculty, the feedback they receive, the educational content and resources of the program, professionalism, teamwork and overall experience with the program among other areas. In 2018, questions about resident’s wellness were added reflecting a concern about physician burnout. A National Multi-Specialty Panel of Residents and Fellows discussed current resident attitudes toward the ACGME and its accreditation role, and concluded that the resident population at large misunderstands the organization's mission, character, and goals. A clear message to residents about why the survey is important is needed despite many controversies about it. Although it can be painful to see a low score, the anonymity of the survey may allow the program director to learn about problems and concerns before they reach a crisis point. In addition, low scores can be the leverage a program director needs to negotiate with the institution on behalf of their residents. In the spirit of foreseeing a new way forward, training directors will benefit from not only learning about the areas covered by the ACGME survey, but also learning how other programs facing the challenges of this annual evaluation.

Mid-career: Should I Stay or Should I Go? Strategies to Keep Mid-career Program Directors Engaged and Professionally Fulfilled

Speakers: Isheeta Zalpuri, Consuelo Cagande, Shirley Alleyne, Benedicto Borja, Sallie De Golia

Being a mid-career Program Director (PD) can feel like a “mid-life crisis,” especially when you begin to ask yourself “Is this still the right role for me?” or “Do I want to continue to be a PD?” Aside from the clinical and teaching responsibilities, the administrative workload can make it challenging to juggle the taxing personal responsibilities of midlife. Burnout is a common experience among Psychiatry PDs and is associated with a desire to resign as well as a struggle to find meaning in this highly demanding position. The academic culture often expects and reinforces the need to say “yes” to requests to demonstrate being a “team player” and enhance one’s CV.  This pressure is especially felt by women and under-represented faculty. The workshop focused on strategies shown to enhance wellbeing and professional fulfillment as a way to reflect and mitigate what may seem a “mid-life malaise.” We discussed opportunities for professional and leadership development, how to balance and prioritize various opportunities as their career advances including converting non-promotable taskto promotable tasks when appropriate using mentorship and innovative techniques.  We also explored how to delegate, another important leadership skill to sustain a mid-career PD’s well-being.

Lifer Gathering: Embracing "Senior" Titles with Hope and Anticipation

Speakers: Shashank Joshi, Geri Fox, David Kaye, Josepha Cheong, Sheldon Benjamin

“To know how to grow old is the master-work of wisdom, and one of the most difficult chapters in the great art of living.” Henri Amiel (1874) This experiential workshop focused on the impact of becoming the “Senior______(Educator, Consultant, Faculty)” on our professional, personal, and spiritual lives. Drawing from the works of Erik Erikson and George Vaillant as the primary framework for the discussion, participants reflected on significant events and experiences that shape them and the ways they face the aging process.

Thalamus: Lessons Learned for Success Moving Forward

Speakers: Debra Bibeau, Tara Brock, Jennifer Laflin, Sarah Watson, Ola Golovinsky, Sandy Chan

The Program Administrator’s (PA’s) Communication Committee presented a discussion on Thalamus, the scheduling program that has partnered with ERAS in response to PA queries.  The workshop provided a space for discussion and information-sharing session.

Developing and Implementing Public/Community Psychiatry Tracks Within Child and Adolescent Psychiatry Fellowship Programs

Speakers: Caitlin Costello, Shashank Joshi, Emily Troyer, Chuan-Mei Lee

While adult-focused public psychiatry fellowship (PPF) training programs have been in existence for over 40 years, child and adolescent public and community psychiatry training is much newer. Several institutions have developed innovative “tracks” within child and adolescent psychiatry (CAP) fellowship programs focused on public/community psychiatry which serve to train CAPs to be future leaders of public/community health systems for youth and provide clinical and educational opportunities to work with youth in such settings. The workshop presented three examples of public/community psychiatry tracks within CAP fellowship programs, identifying key similarities and differences, with attention to program curricula, funding structures, and public-academic partnerships. Participants created a public/community psychiatry track mission statement, identified opportunities at their home institution to enhance teaching public/community psychiatry topics, and brainstorm ways to collaborate with local public sector agencies and community partners.

Plenary: How to Bring Oxygen to the Top of the Ivory Tower: The Role of Program Directors in Influencing Their Leader

Speakers: Tanya Keeble, Kari Wolf. Moderator: Isheeta Zalpuri

There is a saying in business: The higher you climb, the thinner the air. This concept implies that leaders are often operating in an oxygen-starved environment—making decisions based upon the limited information before them while being, themselves, far-removed from what is really going on in the front lines.

PDs, in particular, are in a unique position, straddling the fence between front-line worker and leader/manager. Through either their own direct involvement or through the involvement of their residents, PDs are aware of almost everything going on in the department. Yet, they also lead others—the learners, the coordinator(s), and sometimes other faculty. What is often lacking from the PD’s repertoire, however, is the leadership of the people above them in the hierarchy. As a result, PDs need to learn to “manage upwards.” To be effective at managing upwards, PDs must understand the competing interests their leader is trying to balance. Few faculty really grasp the politics, interconnectedness, and environment in which departmental leaders make decisions—both those that affect only their own departments as well as those with broader reach.

The plenary presented a look “behind the curtain” to expand understanding of how departmental leaders function within their own hierarchies, politics, and the broader organizational landscape. Participants were presented with strategies to help influence decisions made above them in their organization.

More Information

For more information about this meeting, please visit AADPRT's website.