The Training Office: A conversation about mental health by trainees, for trainees.

Climate change is impacting our world in ways that can no longer be ignored. From wildfires in the west coast to flooding in the midwest, the effects of natural disasters cause communities to come part, both literally and theoretically. The systematic impact of such disasters leave fertile ground for psychological distress that is felt for generations to come. But did you know that climate change can impact mental health in a more direct, measurable way? Dr.Robin Cooper, associate clinical professor in the Department of Psychiatry at the University of California San Francisco, and a member of the steering committee of the Climate Psychiatry Alliance, discusses the intimate yet often overlooked connection between psychiatric illnesses and climate change.

Creativity is a concept that is often considered too broad, too vague and too nuanced to incorporate into the structured world of residency. But can exploring the world of the abstract help us to become more astute, caring and well-rounded physicians? Dr.Rossi, PGY4 at Cooper University Hospital, discusses his experience with exploring various avenues of creative expression, including advocacy and social media outreach. We discuss what it means to build influence during these uncertain times and how one can leverage creativity to create more agency in a designated speciality. In this episode we discuss the following: - What does creativity mean and how can it manifest within the confines of residency? - What types of outlets should trainees get involved with to further develop their creative interests? - What are the setbacks of such exposure during training and how can trainees avoid such pitfalls? - What kinds of advocacy should residents and fellow engage in to have more agency in how they practice? - How can we work to ensure that such outlets are encouraged during training?

Wellness initiatives within programs are nothing new. From structured lectures, wellness days, yearly retreats and more, programs have incorporated multiple strategies to ensure that residents and fellows are informed of how to care for themselves during training. But why do these initiatives fail to create a tangible response? And why do so many trainees still out of balance when it comes to training? Dr.Anum Baig, a PGY2 in psychiatry at Charles R.Drew University of Medicine and Science, discusses her experience of being a wellness liaison within her program and what she believes will work to enhance the wellness initiatives within training programs. In this episode, we discuss the following:  What is the definition of work-life balance and how does it differ from wellness?  What are some common initiatives that programs make to ensure that wellness is integrated within medical training?  What are some basic steps that trainees can take to ensure that they prioritize work-life-balance?  What are the common trends that seem among new vs. well-established programs in terms of wellness initiatives?  What are is a wellness liaison and how does their role differ from that of administrators?  What is the structure of such a role and how does it differ from typical wellness initiatives? 

The "B" word comes with multiple implications. From the shame associated with the lack of performance to implications about what it could mean as future obstacles present themselves, many clinicians do everything they can to avoid brining up their suffering to supervisors. How can we reframe the concept of burnout to ensure that people respond rather than react? The co-hosts of the Shrinking Burnout podcast, Dr. Andrew Wu and Dr. Varsha Radhakrishnan discuss how they breach the topic with their guests and what they have discovered is helpful in addressing the needs of trainees during times of unrelenting stress. In this episode we discuss the following: Why is burnout an essential topic when addressing physician wellness? What are the implications of burnout and how does it negatively impact physician perception? What do research trends show about how burnout impacts physician performance? What are the barriers to reframing this term to decrease negative associations? How does The Shrinking Burnout podcast address these critical physician needs?

The concept of peer mentorship is often discussed in vague, non-specific ways within the context of residency. Why is mentorship such an essential piece of the training experience and what can trainees gleam from ensuring that they gleam all they can from their mentors? Dr.Alaa ElNajjar, a child/adolescent psychiatry fellow at Albert Einstein School of Medicine, discusses Buddies Space: an innovative project aimed at connecting trainees to advisors and mentors who can give them the appropriate guidance and support based on their individual academic and personal interests. In this episode we discuss the following: How can trainees engage with their peers in a meaningful way? What are the benefits of connecting with advisors who will guide you towards the career that you want? How can the concept of peer mentorship evolve from a broad concept to one that is specific to PGY needs? What is Buddies Space and how does it contribute to the dire need for mentor engagement within the psychiatric community?

The American Psychiatric Association is the largest organization of psychiatric professionals in the world. While residents and fellows are often members of the APA, most are not aware of what kinds of opportunities for career advancement such organizations can provide. Dr.Rebecca Brendel, a psychiatrist, lawyer and advocate for organizational psychiatry, shares personal stories of how she became involved with the APA and how trainees can further invest in their futures by becoming key decision-makers in the local and national psychiatric organizations. In this episode, we discuss the following: What is the APA and what kinds of opportunities can it offer trainees? What are some introductory steps all residents and fellows can take to become involved in their local organizations? How can trainees contribute to the decision-making process within psychiatric organizations? How can psychiatric organizations further serve the needs of trainees? What are the benefits of early involvement and how can such involvement transform into a stepping stone for life beyond training?

International medical graduates (IMGs) make up nearly one fourth of the trainee work-force across medical specialties. Moving from one country to another, dealing with the nuances of a foreign language and the culture shock of working in the United States often leaves many IMGs feeling isolated and disengaged. How can training programs support the unique needs of our IMG colleagues? I speak to Dr.Souparno Mitra, a PGY2 in New York City, about his experience of immigrating to the United States for residency training. Dr.Mitra shares his challenges, triumphs and what he hopes to see programs do to support the unique needs of IMGs during such a transformative time in their lives. In this episode, we discuss the following: What are the processes IMGs go through in order to work as residents and fellows in the United States? What are some predictable adjustments all IMGs can expect to make once they start training? What are the implications of the culture shock many IMGs experience? Which demographic areas are best suited to support the needs of IMGs? What are some tangible steps that all programs to take to support the needs of a trainee who recently immigrated from another nation?

Equity in health care is a challenging and often overlooked endeavor. As trainees, we often don't realize that we can take initiative in empowering patients with resources, education and appropriate outlets to meet their needs outside of the clinical setting. Dr.Khandai, a C/L psychiatrist at the University of Illinois Chicago speaks about how we can all take steps to ensure that we are aware of biases in the clinical setting and how we can work to offset them by prioritizing equity. In this episode, we discuss the following: What is consult-liaison psychiatry? What is the definition of social justice and how can we incorporate it in the clinical setting? What are some common clinical biases attributed to patients of color? How can we work to fight against our own unconscious biases in medicine? What are some tangible steps trainees can take to ensure that they incorporate social justice in their clinical decision-making?

Program directors are the proverbial "boss" of a training program. While they may not be engaged with residents and fellows on a daily basis, their input and expertise is what makes or breaks the culture of a program. So what should trainees look for in a program director when deciding to choose or rank a program? Dr.Lindsay Poplinski, a PGY2 in psychiatry at Ohio Riverside Methodist Hospital, shares her insight into the qualities that trainees look for in a program director and what future trainees can do to ensure that they choose the program that is right for them. In this episode we discuss the following: The link between the culture of wellness within a program and the precedent set by the PD. Research-backed qualities and characteristics that trainees hold in high regard when evaluating their PD. How and why a PD can "make or break" the psychiatric training experience. What future trainees can do to ensure that their values are in line with the program of their choosing.

While our training programs often ensure that our clinical acumen is up-to-date, they often fall short of preparing us for the harsh business realities of life outside of training. What lessons should training programs breach to ensure a smooth transition from training to practice? Dr. Jenice Kim, a recent graduate of the USC psychiatry training program and new attending, shares her insights about the challenges she faced as she was thrusted into the world of independent practice after training. In this episode we discuss the following: The emotional component of the transition from training to practice. The influence of external factors on clinical decision-making. What practitioners wished they learned during training. How to bridge the knowledge gap during transition. The business of psychiatry and what programs should do to address the administrative responsibilities physicians face after training.

The concept of wellness looks very different now that it did one year ago. How has the idea of physician wellness evolved since the onset of COVID and what can trainees do to ensure they are making their own mental health a priority? Dr.Nausheen Syed, a PGY3 at the University of Maryland Medical Center, shares her insights about how her training program has handled the uniques challenges to trainee wellness that have transpired since the onset of the pandemic. In this episode we discuss the following: • How wellness is defined within the context of training programs. • How the concept of well-being has changed since the onset of the COVID-19 pandemic. • What kinds of interventions need to be in place to support physician well-being during times of potentiated stress. • How to address protocols for trainee protection during a pandemic. • Challenges in supply and demand of PPE. • What programs can do in the future to address critical needs when acute, unexpected changes occur.

Being an LGBTQ+ individual comes with its own share of joys and challenges. How are those challenges exacerbated when one decides to come out during training? Dr. William Johansen, a new attending physician, shares his personal journey of coming out during. He speaks candidly about what allowed him to thrive and what he would like to see change within training program infrastructure as it pertains to support for LGBTQ+ trainees. In this episode, we discuss the following: • The importance of training programs providing a safe, supportive environment for trainees who identify as LGBTQ+. • Ensuring that there are mentors in place who can "check in" with trainees while they are going through personal transitions. • The unique and evolving mental health needs of LGBTQ+ physicians within the context of training programs. • Strategies for supporting physicians who may be going through transitions in the way they identify. • Ways of providing mentorship for new trainees as they start the journey of becoming fully trained physicians.