Search

Mental distress in medical learners and its consequent harmful effects on personal and professional functioning, a well-documented concern, draws attention to the need for solutions. The authors review the development of a comprehensive mental health service within a large and complex academic medical education system, created with special attention to offering equitable, accessible, and responsive care to all trainees. From the inception of the service in January 2017, the authors placed particular emphasis on eliminating obstacles to learners' willingness and ability to access care, including concerns related to cost, session limits, privacy, and flexibility with modality of service delivery. Development of outreach initiatives included psychoeducational programming, consultation services, and cultivation of liaison relationships with faculty and staff. Significant utilization of clinical services occurred in the first year of the program and increased further over the course of 4 academic years (2017-2021); with a 2.2 times increase in trainees served and a 2.4 times increase in visits annually. In the 2020-2021 academic year, 821 medical learners received services (for a total 5,656 visits); 30% of all medical students and 25% of house staff and fellows sought treatment in that year. In 2021, 38% of graduating medical school students and 27% of graduating residents and fellows had used mental health services at some point in their training. Extensive use of services combined with very high patient satisfaction ratings by medical learners within this system demonstrate the perceived value of these services and willingness to pursue mental health care when offered a resource that is cognizant of, and responsive to, their unique needs. The authors reflect on potential factors promoting utilization of services-institutional financial support, outreach efforts, and design of services to increase accessibility and reduce barriers to seeking treatment-and propose future areas for investigation.

PLUS (Program to Launch Underrepresented in Medicine Success) is a 2-year cohort program at Indiana University School of Medicine providing professional development, funding and skills to produce scholarship, and a community to mitigate social and/or professional isolation for underrepresented in medicine (URiM) faculty. In year 1, scholars participate in leadership and professional development seminars and regular meetings with their mentor(s). They are assigned a PLUS Advisory Council advisor with whom they meet 2 to 3 times annually. In year 2, scholars participate in monthly seminars focused on research methods, writing productivity, and wellness. Additionally, scholars engage in a writing accountability group and practice reflective writing. Connections events, designed to combat isolation and cultivate community, occur monthly. At program completion, scholars complete a project resulting in a scholarly product for submission and dissemination in a peer-reviewed forum. To date, 3 cohorts, totaling 24 people, have participated: 20 (83%) Black, 4 (17%) Latinx; 12 (50%) females. Five scholars have completed the full program, whose pre- and postsurvey results are described. Program surveys demonstrate significant gains in scholars' confidence to secure leadership opportunities, connect with colleagues, and advocate for themselves and others. Scholars reported statistically significant increases in confidence to pursue leadership roles (t = -3.67, P = .02) and intent to submit their dossier for promotion (t = -6.50, P = .003). They were less likely to leave academic medicine (t = 2.75, P = .05) or pursue another academic appointment (t = 2.75, P = .05) after PLUS completion than at baseline. All scholars adequately met requirements for their third-year review (tenure track only), were promoted, or achieved tenure in less than 3 years since program completion. This article describes PLUS program objectives, evaluative components, and lessons learned during implementation, as a model to support URiM faculty at other institutions.

Faculty members today are bombarded with information, yet limited in time and attention. Managing communication with faculty is an increasingly important function of faculty development offices. This study explored how communication frameworks can be paired with web design principles and attention economics to increase the effectiveness of communication with faculty members. We developed and tested communication approaches designed to enhance faculty members’ identification and involvement with our programs. The advantages, disadvantages, and effectiveness of each model are presented. Ultimately, the study reframed our understanding of communication strategies, not as static tools, but rather as opportunities to engage faculty.

Women frequently benefit from focused faculty development opportunities not because they need to be “fixed,” but rather it is a means to demonstrate that success, even in chilly environments, is possible. The Stepping Stones program uses a unique design to provide participants with inspiration, time for reflection, and strategies for how to navigate one's career, through hearing about the journeys of successful women. In this article, we describe the program and evaluation results. Post-event and longitudinal follow-up surveys indicate that the program and its unique narrative format help to debunk the superwoman myth and leave participants with a sense of optimism about their future careers.

The Latino population in the United States is growing at an exponential rate. As a medically underserved population, Latinos experience many health disparities, including those related to mental health. Current research suggests that Latinos in the United States are at high risk for problems such as anxiety, depression, somatization disorders, and substance abuse, yet, often these health needs go unmet. This article suggests that an effective method of reaching and treating more Latinos is through medical family therapy. Because Latinos may be more likely to seek help from a physician for mental health complaints, and because marriage and family therapists may be most culturally congruent in their orientation to therapy, collaboration between health care providers and medical family therapists is logical.

Marital interaction and health issues exert reciprocal influences upon each other, often differing along gender lines. Research shows that couple dynamics influence the immune, endocrine, and cardiovascular systems, and self-reported health status; and medical problems can affect all areas of a couple's functioning, including communication, sexual and emotional intimacy, and role flexibility, for example. Many practicing marriage and family therapists (MFTs) are not familiar with these issues, since medical family therapy is a fairly new concept and many MFT programs do not cover such areas in depth. This paper will provide a broad overview of how medical issues affect couples and vice versa, will explore the impact of breast cancer on a couple's functioning as a disease-specific example, and will include recommendations for practicing clinicians.

Most if not all medical schools require annual performance reviews to be conducted on all or a subset of the faculty. Despite this being a common and recurring job expectation for academic leaders such as department chairs and division directors, such leaders are often poorly prepared to conduct effective reviews. Some of the difficulties stem from lack of training, avoidance of confrontation, lack of role modeling, and the time-consuming and high-stakes nature of the process itself. In addition, administrators report challenges related to insufficient methods for assessing teaching and research, variability in evaluation processes and criteria, and a disconnect between evaluation and salary. Thus, for some academic administrators, the faculty annual review can be perceived as a burden. This 2.5-hour workshop provides academic leaders an opportunity to engage with others about faculty annual reviews so they can have more confidence and resources when engaging in the evaluation process. This resource includes materials related to a leadership development workshop on this topic. The workshop is designed for academic leaders with responsibility for monitoring and assessing the performance of faculty, such as department chairs and division directors. The overall goals of the workshop are to improve the preparation of academic leaders in conducting reviews that provide constructive feedback to faculty members regarding their overall performance and to increase academic leaders' awareness of and capacity in the use of annual reviews as a means toward increased faculty vitality. Although few attendees submitted formal program evaluations, the workshop was well received when offered at our institution. Six evaluations were submitted from the 18 institutional leaders who attended the workshop. Though few in number, the comments received on the program evaluation indicate a positive response and that our objectives were met. All attendees noted that they were able to identify something they planned to act upon.

The process of the intergenerational transmission of violence is not well understood. A risk and resilience model of criminal violence against women was investigated using secondary data. The sample was composed of adolescent male juvenile delinquents who had been physically abused by their parents, and who were followed up at ages 25 and 31. A series of structural equation models were fit to investigate whether dysregulated affect mediated the effects of attachment and family chaos on the adult perpetration of violence against women. These models support the hypothesis that affect dysregulation may act as a mediator. Results raise new ideas about the mechanisms by which violence may be transmitted across generations.

Feminist principles are rare in medical education and in the practice of medicine. The authors are feminist family therapists and feminist health communication scholars who are faculty in a department of family medicine. In this paper, they present their use of a feminist perspective and feminist methods in their teaching of family physicians in training. The use of a live supervision practicum, imported from marriage and family therapy training, is described as an example of how feminist family therapists can bring a much-needed but rarely taught perspective to medical education. This perspective represents a paradigm shift away from the traditional model in medicine, one that is based on objectivity and separateness, to a more empathic and connected stance which shifts power in the physician-patient relationship.

hile completing my doctorate in marriage and family therapy, I also completed a omen's studies graduate minor. For the final exam, I as asked to reflect on themes from my omen's studies courses, and ho feminist scholarship has influenced my clinical practice of marriage and family therapy. Integrating these interdisciplinary ideas into my understanding and practice of MFT has been an important exercise in my professional development. I offer this reflection for the purpose of continued dialogue in feminist family therapy and as an example of ho interdisciplinary studies can be useful in expanding upon MFT studies.

Academic health centers (AHCs) are under unprecedented pressure, making strong leadership during these challenging times critical. Department chairs have tremendous influence in their AHCs, yet data indicate that--despite outstanding academic credentials--they are often underprepared to take on these important leadership roles. The authors sought to improve the approach to recruiting, developing, and giving feedback to department chairs at their institution, the Indiana University School of Medicine (IUSM), by reorganizing these processes around six key leadership competencies: leadership and team development, performance and talent management, vision and strategic planning, emotional intelligence, communication skills, and commitment to the tripartite mission. Over a two-year period (2009-2011), IUSM faculty and administrators developed standardized recruitment procedures to assess potential chairs based on the six leadership domains, and searches are now streamlined through centralized staff support in the dean's office. Additionally, IUSM offers a chair development series to support learning around these leadership competencies and to meet the stated professional development needs of the chairs. Finally, chairs receive structured feedback regarding their leadership (among other considerations) through two different assessment instruments, IUSM's Department Chair 360° Leadership Survey and IUSM's Faculty Vitality Survey--both of which the dean reviews annually. Strategically attending to the way that chairs are selected, developed, and given feedback has tremendous potential to increase the success of chairs and, in turn, to constructively shape the culture of AHCs.

Despite the great strides made by women in medicine and science, they still comprise a small proportion of leadership roles in academic medicine. To students, residents, and the junior or midcareer woman faculty member, the path to leadership can appear confusing, complex, and riddled with challenges. Since self-reflection plays a powerful role in the development of women leaders in academic medicine, discussing life lessons of successful women can be an important method to empower women to create and embrace their own career paths. It was for the purpose of demystifying the path to leadership that this resource was developed. Through interviews conducted in front of an audience, this resource uses the power of successful women's stories to teach audience members about leadership and career development. Rather than a formal presentation, the interview format allows the personal and professional career development story to unfold more naturally, and capitalizes on the power of reflection to stimulate learning. This workshop is unique in that it uses public interviews with successful women leaders about their personal and professional milestones. We conducted this resource 17 times between 2008 and 2013, with a total combined attendance of 377 participants. At the conclusion of each interview, attendees were asked to evaluate the session. The session format was found to be highly interesting and effective, with a mean score of 4.67 on the Likert scale; individual session means on this item ranged from 4.28 to 5. Most attendees strongly agreed that they would recommend this program to others.

Practice-based learning and improvement (PBLI) has been promoted as a key component of competency-based training in medical student education, but little is known about its implementation.This project is part of a larger CERA omnibus survey of family medicine medical student clerkship directors carried out from July to September 2012. Analyses were conducted to assess clerkship infrastructure, learner assessment and feedback, and clerkship director perceptions of PBLI curricula.The majority (69.0%, 58/82) of family medicine clerkship directors reported that PBLI is not included in their clerkship. Significant predictors of PBLI in the curriculum include: regularly scheduled centralized teaching (weekly or more versus less than weekly, OR=1.14, 95% CI=1.01--1.29) and clerkship director belief that students should achieve PBLI competency (agree in competency versus disagree in competency, OR=1.19, 95% CI=1.08--1.30). Few (20.5%, 16/78) family medicine clerkship directors reported that the amount of PBLI in their curriculum is likely to increase in the next 12 months. The duration of the clerkship was a significant predictor of reported likelihood of increasing PBLI over the next 12 months (3 weeks versus 8 weeks, OR=1.23, 95% CI=1.00--1.51).Despite increased emphasis on quality improvement activities in practice, most family medicine clerkships do not currently offer PBLI curricula. Additionally, less than one in four family medicine clerkships plan on increasing the amount of PBLI curricula in the next 12 months. Continued research in this area is needed to identify successful models for PBLI curricular offerings.

Feminists have provided invaluable critiques of traditional research methods. However, there is a difference of opinion in the social sciences as to what constitutes feminist research. Just as there is no one definition of feminism, there is no one definition of feminist research. Yet it is important that research be identified as feminist to advance feminist causes, particularly in a field such as MFT in which feminism has been more influential in clinical practice than research. In this paper, the author argues for broader parameters of feminist research than those offered by Reinharz (1992). The author also summarizes and responds to feminist critiques of traditional research and offer an example of a published research study in the MFT field that the author believes has feminist implications but would not be identified as feminist by a narrow definition of feminist research.

This article describes a pilot study to examine the usefulness of adding a couples therapy component to inpatient drug and alcohol treatment for women. The treatment model was modified from a 12-week integrative systems model that has been empirically supported in outpatient treatment settings. A team of student-therapists received intensive training and supervision in the modified version. This article discusses the ability of chemical dependency counselors to implement this model, includes pre and post treatment comparisons, and qualitative findings regarding the efficacy of the project. The treatment model promises to be usable, safe, and practical in inpatient settings, and merits a more thoroughgoing clinical trial.

Although the field of family therapy has largely embraced the notions of feminism, many family therapists seem reluctant to call themselves feminists. Nevertheless, questioning the impact of the social context of gender roles on relationships seems relatively commonplace in most family therapists' practice. The present exploratory study investigated whether American Association for Marital and Family Therapy (AAMFT) members work from a feminist perspective, and whether those who work from a feminist perspective would identify themselves or their work as feminist. A convenience sample of AAMFT members (clinical, associate, affiliate, and student) responded to a self-report survey. Results indicated that there is a small but significant difference in feminist behaviors in therapy between respondents who identified with a feminist theoretical orientation and those who did not. Despite this difference, all respondents generally had high scores on the feminist therapy scale scores. Results indicate th...

This paper is meant to broaden the concept of adolescent promiscuity to include male promiscuity and the gender bias that holds females accountable for sexual activity and ignores the role the male has in sexual activity and its consequences. The multiple systems which influence male teenage sexual behavior are examined. Communication patterns, family structure, availability and involvement of parent(s), the influence of gender stereotypes, cultural and ethnic influences, and the effects of the educational system are all examined in light of this broadened concept of male promiscuity. Family therapists possess the kind of knowledge and skills that can alter communication patterns, redefine boundaries, and promote the healthy parental involvement it takes to make an impact on the issue of male sexual promiscuity. Recommendations are made to family therapists with regard to assessment procedures and self-of the-therapist examination. Suggestions for interventions and directives in treatment are giv...

Many faculty in today’s academic medical centers face high levels of stress and low career satisfaction. Understanding faculty vitality is critically important for the health of our academic medical centers, yet the concept is ill-defined and lacking a comprehensive model. Expanding on previous research that examines vital faculty in higher education broadly and in academic medical centers specifically, this study proposes an expanded model of the unique factors that contribute to faculty vitality in academic medicine. We developed an online survey on the basis of a conceptual model (N = 564) and used linear regression to investigate the fit of the model. We examined the relationships of two predictor variables measuring Primary Unit Climate and Leadership and Career and Life Management with an overall Faculty Vitality index comprised of three measures: Professional Engagement, Career Satisfaction, and Productivity. The findings revealed significant predictive relationships between Primary Unit Climate and Leadership, Career and Life Management, and Faculty Vitality. The overall model accounted for 59% of the variance in the overall Faculty Vitality Index. The results provide new insights into the developing model of faculty vitality and inform initiatives to support faculty in academic medical centers. Given the immense challenges faced by faculty, now more than ever do we need reliable evidence regarding what sustains faculty vitality.

Since their inception in the 1970s, objective structured clinical examinations (OSCEs) have become popular and now are part of the US Medical Licensing Examination for all US medical graduates. Despite general acceptance of this method, there is debate over the value of OSCE testing compared to more traditional methods. A review of reliability and validity research does not clearly show superiority of OSCE testing. To use OSCEs in a valid and reliable way, attention must be paid to test content, test design, and implementation factors, especially when the results will be used for high-stakes decision making. While questions remain around the application of OSCE testing, there are also both known and hidden benefits to students, faculty, and organizations that use OSCEs. This paper reviews the pros and cons of the OSCE method and outlines important issues for medical educators to consider when planning to use OSCEs in their programs.

Transitions through the family life cycle can be stressful because they challenge attachment bonds between family members. Open communication and the processing of primary attachment emotions are crucial when family systems change. When family members are insecurely attached, such open communication is difficult, and people tend to get stuck in absorbing states of secondary defensive affect. Emotionally focused therapy (EFT) can be particularly helpful by encouraging family members to express primary emotions. This expression then fosters renegotiation of bonds and the clarification of attachment needs and concerns. Case examples illustrate how EFT can be applied to each family life cycle stage.

Both contextual and feminist therapy have not been given the attention they deserve in the field of MFT. We believe that not only do these approaches have undiscovered merit but also, when integrated, they provide a useful framework for conducting therapy that addresses marginalized voices and raises social consciousness. In this article, we “layer” feminist theory onto contextual therapy and argue that the constructs of contextual therapy may relate well to many women's experiences in families. We then illustrate our combined feminist-contextual therapy with two case examples. This integration broadens the scope and sensitivity of contextual therapy to address issues of gender.