Acad Psychiatry DOI 10.1007/s40596-015-0317-x
FEATURE: LETTER TO THE EDITOR
A Call for Better Methodology for Global Mental Health Educational Program Reviews Carla Marienfeld & Robert Rohrbaugh
Received: 17 December 2014 / Accepted: 6 February 2015 # Academic Psychiatry 2015
To the Editor: Academic Psychiatry has become a leader in publishing articles related to the promotion and responsible development of global mental health programs in psychiatric residency training [1–9]. Without this vital academic discourse, the quality of training and experience for US residents may suffer, and the impact of the program on the collaborating country may be diminished. Van Dyke et al. outlined both the justification for and value of global mental health programs in US training, as well as important components in developing such programs [1]. In the August 2014 volume of the Academic Psychiatry, Tsai and colleagues published a paper titled “Global Health Training in US Graduate Psychiatric Education” [2] that provides additional important insights into global mental health training. Despite the authors’ explicit intention to “systematically assess” current training opportunities, we believe the methodology available for this type of evaluation and the methodology employed limited the yield of important information relevant to the accurate characterization of current global mental health programs. Additional considerations include funding, collaborating countries, international collaborations and program values, and preparation before going abroad, as follows: Funding: Several programs are noted to provide a travel stipend. However, funding to cover salary, malpractice, and benefits during these experiences or funding for any research or educational activities that are completed is not assessed beyond mention of some programs that utilize
C. Marienfeld (*) : R. Rohrbaugh Yale University School of Medicine, New Haven, CT, USA e-mail: [email protected]
R25 funded “research tracks.” Funding is a critical factor affecting the ability of the program to provide enriching and viable opportunities. Collaborating countries: Representative collaborative sites are listed for programs based, presumably, on available information from website review and Google searches. However, our website at the time of the search listed several countries where residents had global mental health experiences though the article only mentioned one site. Our own publication from 2013 (which would not have been found through this paper’s methodology) also listed several other sites [3]. We suggest that website review may not be the best source of information for this level of program data. International collaborations and program values: The article outlines limitations of programs that promote psychiatry resident participation in preestablished clinical elective programs administered by other medical departments or through the medical school. Although the ease of having a “single infrastructure” is appreciated, treatment of most psychiatric illness requires deep understanding of the cultural context and system of care and must attend to the longitudinal course of most psychiatric illness. Although 1-month clinical electives in international settings are easily cataloged on a website, the benefits of international experiences that promote scholarly work, capacity building, and sustained collaboration are harder to capture using this methodology. Preparation before going abroad: The authors acknowledge the importance of “…specific didactic training, mentored scholarly activity, and field experiences …
Acad Psychiatry
organized clinical experiences with marginalized populations in the US,” as does the Van Dyke article [1], and reference two examples of these elective opportunities. The Yale Global Mental Health Program has also promoted this ideal and offered seminars to increase knowledge of global mental health and better prepare residents for experiences that might be encountered abroad, including ethical considerations. Defining a national global mental health curriculum structure and implementation process would be difficult from a website review. Overall, this paper makes an important conceptual advance in assessing what is actually happening in GMH education programs nationally. As the authors of the study point out, web-based searches have been utilized to explore global health education opportunities in US medical training (including by one of the authors of this letter) and may yield more complete information than the historically low response rate of surveying programs directly. However, reports of web-based program review should accurately characterize data available on websites, even while acknowledging limitations in conveying the potential richness and true experience within these programs. We are proud of our current website (globalmentalhealth.yale.edu), but fully acknowledge it does not capture the entirety of our program.
Disclosures On behalf of all authors, the corresponding author states that there is no conflict of interest.
References 1. Van Dyke C, Tong L, Mack K. Global mental health training for United States psychiatric residents. Acad Psychiatry. 2011;35(6):354–9. 2. Tsai AC, Fricchione GL, Walensky RP, Ng C, Bangsberg DR, Kerry VB. Global health training in US graduate psychiatric education. Acad Psychiatry. 2014;38:426–32. 3. Marienfeld C, Rohrbaugh RM. Impact of a global mental health program on a residency training program. Acad Psychiatry. 2013;37(4):276–80. 4. Alem A, Pain C, Araya M, Hodges BD. Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia: the Toronto Addis Ababa Psychiatry Project (TAAPP). Acad Psychiatry. 2010;34(6):424–32. 5. Ballas P. “Don’t be a pig:” advice on doing an international elective as a resident. Acad Psychiatry. 2011;35(6):388–90. 6. Belkin GS, Yusim A, Anbarasan D, Bernstein CA. Teaching “global mental health:” psychiatry residency directors’ attitudes and practices regarding international opportunities for psychiatry residents. Acad Psychiatry. 2011;35(6):400–3. 7. Bourgeois JA. Academic psychiatry: an international, innovative specialty. Acad Psychiatry. 2011;35(6):349–53. 8. Morse MD, Raviola G, Fricchione G, Berger E. Telesupervision for medical student rotations in global health psychiatry. Acad Psychiatry. 2011;35(6):415–6. 9. Song SJ. An ethical approach to life-long learning: implications for global psychiatry. Acad Psychiatry. 2011;35(6):391–6.
FEATURE: LETTER TO THE EDITOR
A Call for Better Methodology for Global Mental Health Educational Program Reviews Carla Marienfeld & Robert Rohrbaugh
Received: 17 December 2014 / Accepted: 6 February 2015 # Academic Psychiatry 2015
To the Editor: Academic Psychiatry has become a leader in publishing articles related to the promotion and responsible development of global mental health programs in psychiatric residency training [1–9]. Without this vital academic discourse, the quality of training and experience for US residents may suffer, and the impact of the program on the collaborating country may be diminished. Van Dyke et al. outlined both the justification for and value of global mental health programs in US training, as well as important components in developing such programs [1]. In the August 2014 volume of the Academic Psychiatry, Tsai and colleagues published a paper titled “Global Health Training in US Graduate Psychiatric Education” [2] that provides additional important insights into global mental health training. Despite the authors’ explicit intention to “systematically assess” current training opportunities, we believe the methodology available for this type of evaluation and the methodology employed limited the yield of important information relevant to the accurate characterization of current global mental health programs. Additional considerations include funding, collaborating countries, international collaborations and program values, and preparation before going abroad, as follows: Funding: Several programs are noted to provide a travel stipend. However, funding to cover salary, malpractice, and benefits during these experiences or funding for any research or educational activities that are completed is not assessed beyond mention of some programs that utilize
C. Marienfeld (*) : R. Rohrbaugh Yale University School of Medicine, New Haven, CT, USA e-mail: [email protected]
R25 funded “research tracks.” Funding is a critical factor affecting the ability of the program to provide enriching and viable opportunities. Collaborating countries: Representative collaborative sites are listed for programs based, presumably, on available information from website review and Google searches. However, our website at the time of the search listed several countries where residents had global mental health experiences though the article only mentioned one site. Our own publication from 2013 (which would not have been found through this paper’s methodology) also listed several other sites [3]. We suggest that website review may not be the best source of information for this level of program data. International collaborations and program values: The article outlines limitations of programs that promote psychiatry resident participation in preestablished clinical elective programs administered by other medical departments or through the medical school. Although the ease of having a “single infrastructure” is appreciated, treatment of most psychiatric illness requires deep understanding of the cultural context and system of care and must attend to the longitudinal course of most psychiatric illness. Although 1-month clinical electives in international settings are easily cataloged on a website, the benefits of international experiences that promote scholarly work, capacity building, and sustained collaboration are harder to capture using this methodology. Preparation before going abroad: The authors acknowledge the importance of “…specific didactic training, mentored scholarly activity, and field experiences …
Acad Psychiatry
organized clinical experiences with marginalized populations in the US,” as does the Van Dyke article [1], and reference two examples of these elective opportunities. The Yale Global Mental Health Program has also promoted this ideal and offered seminars to increase knowledge of global mental health and better prepare residents for experiences that might be encountered abroad, including ethical considerations. Defining a national global mental health curriculum structure and implementation process would be difficult from a website review. Overall, this paper makes an important conceptual advance in assessing what is actually happening in GMH education programs nationally. As the authors of the study point out, web-based searches have been utilized to explore global health education opportunities in US medical training (including by one of the authors of this letter) and may yield more complete information than the historically low response rate of surveying programs directly. However, reports of web-based program review should accurately characterize data available on websites, even while acknowledging limitations in conveying the potential richness and true experience within these programs. We are proud of our current website (globalmentalhealth.yale.edu), but fully acknowledge it does not capture the entirety of our program.
Disclosures On behalf of all authors, the corresponding author states that there is no conflict of interest.
References 1. Van Dyke C, Tong L, Mack K. Global mental health training for United States psychiatric residents. Acad Psychiatry. 2011;35(6):354–9. 2. Tsai AC, Fricchione GL, Walensky RP, Ng C, Bangsberg DR, Kerry VB. Global health training in US graduate psychiatric education. Acad Psychiatry. 2014;38:426–32. 3. Marienfeld C, Rohrbaugh RM. Impact of a global mental health program on a residency training program. Acad Psychiatry. 2013;37(4):276–80. 4. Alem A, Pain C, Araya M, Hodges BD. Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia: the Toronto Addis Ababa Psychiatry Project (TAAPP). Acad Psychiatry. 2010;34(6):424–32. 5. Ballas P. “Don’t be a pig:” advice on doing an international elective as a resident. Acad Psychiatry. 2011;35(6):388–90. 6. Belkin GS, Yusim A, Anbarasan D, Bernstein CA. Teaching “global mental health:” psychiatry residency directors’ attitudes and practices regarding international opportunities for psychiatry residents. Acad Psychiatry. 2011;35(6):400–3. 7. Bourgeois JA. Academic psychiatry: an international, innovative specialty. Acad Psychiatry. 2011;35(6):349–53. 8. Morse MD, Raviola G, Fricchione G, Berger E. Telesupervision for medical student rotations in global health psychiatry. Acad Psychiatry. 2011;35(6):415–6. 9. Song SJ. An ethical approach to life-long learning: implications for global psychiatry. Acad Psychiatry. 2011;35(6):391–6.
