Brief Report

Video-Teleconferencing With MedicalStudents to Improve Exposure to Child

and Adolescent Psychiatry

Samuel J. Pullen, D.O., Jacob C. White, B.S., Carlos A. Salgado, M.D.

Sourav Sengupta, M.D., Christopher R. Takala, D.O., Sean Tai, B.S.

Cosima Swintak, M.D., Jess P. Shatkin, M.D., M.P.H.

Objective: The chronic workforce shortage in child and adoles-cent psychiatry (CAP) remains a germane issue that has been dif-ficult to deal with effectively. Collaboration between medicalschools without sufficient CAP resources and those with enoughto share may help improve interest in the field.

Method: This lecture series piloted a collaborative effort be-tween CAP residents from a Midwest academic center andstudent-led interest groups from two osteopathic medicalschools. CAP residents led nine interactive lectures with medicalstudents on relevant topics, using video-teleconferencing. Baselineand follow-up surveys were used to assess attitudes and responsesto the lecture series.

Results: A group of 175 students completed the baseline survey;43 students completed the follow-up survey; 21 of 43 (48%)reported that the lectures would positively influence their careerchoice toward CAP.

Conclusion: Interactive lectures via video teleconferencing dem-onstrated potential to improve medical students’ exposure to CAP,and they were well received in this initial pilot study.

Academic Psychiatry 2013; 37:268–270

The projected demand for services from child and ado-lescent psychiatry (CAP) is expected to increase by

100% between 1995 and 2020, with only a small fractionof patients expected to be evaluated by a child and ado-lescent psychiatrist (1). The importance of addressing thechronic shortages and maldistribution of practicing childand adolescent psychiatrists has long been recognized, buthas proven to be a challenging undertaking (2). One area offocus has been to develop strategies to address the relativelylow priority given to CAP in medical school curricula (3, 4).Strategies that have successfully improved interest in CAPhave focused on increasing exposure during medical schooltraining (5–8).Although the third and fourth year of medical student ed-

ucation represents a critical time to increase medical stu-dents’ exposure to CAP, opportunities to shape attitudesand preconceptions about CAP during the first and secondyear of medical school training have also been considered(3, 8, 9). Challenges to exposing first- and second-year med-ical students to CAP include competition with the largeamount of basic science and clinical material that must beassimilated into a 2-year undergraduate medical school cur-riculum and a relative under-representation of CAP medicaleducators available to teach first- and second-year medicalstudents (3).In an effort to contribute to the work in this area, using ad-

ditional approaches, the authors undertook the developmentof an interactive lecture series using video-teleconferencingbroadcast from a centralized teaching hospital with a CAPresidency program to reach out to other U.S. medical schoolsto generate interest in and provide education about CAP tofirst- and second-year medical students. This program waspilotedwith two osteopathicmedical schools as part of an ini-tiative put forth by the American Academy of Child and

ReceivedApril 10, 2012; revised September 23, 2012; accepted January 18,2013. From the Dept. of Psychiatry and Psychology, Mayo Clinic, Roches-ter, MN (SJP, CAS, CRT, CS), the Pacific Northwest University of HealthSciences College of Osteopathic Medicine, Yakima, WA (JCW), Dept. ofPsychiatry and Psychology, University of Pittsburg Western PsychiatricInstitute and Clinic, Pittsburgh, PA (SS), Edward Via College of Osteo-pathic Medicine–Virginia Campus, Blacksburg, VA (ST), Child StudyCenter, New York University, New York, NY (JPS). Send correspondenceto Dr. Pullen, Dept. of Psychiatry and Psychology, Mayo Clinic; e-mail:drspullen@yahoo.comCopyright © 2013 Academic Psychiatry

268 http://ap.psychiatryonline.org Academic Psychiatry, 37:4, July-August 2013

Adolescent PsychiatryWorkforce IssuesCommittee (AACAPWIC) in an effort to increase collaboration with osteopathicmedical schools. Generally speaking, osteopathic medicalschools have been underrepresented in CAP educationalinitiatives.

The primary aims of this study were to pilot this educa-tional mechanism as a potential means of increasing expo-sure to CAP and to establish a collaborative relationshipwith the two osteopathic medical schools. The secondaryaim was to establish baseline attitudes toward CAP fromfirst- and second-year medical students at these two osteo-pathic medical schools and evaluate the impact of this edu-cational experience.

Method

This pilot educational program was exempted by ourInstitutional Review Board. Child and adolescent psychi-atry (CAP) residents at Mayo Clinic, Rochester, MN,collaborated with first- and second-year medical studentsfrom Pacific Northwest University of Health SciencesCollege of Osteopathic Medicine (PNWU), Yakima, WA,and the Edward Via College of Osteopathic Medicine–Virginia Campus (VCOM), Blacksburg, VA. Facultymembers from New York University Child Study Center(NYU), Mayo Clinic, and a CAP resident from Universityof Pittsburgh Western Psychiatric Institute and Clinic(UPMC) collaborated with CAP residents from MayoClinic on curriculum and program development, and arecontributing authors. Authors from NYU and UPMC wereaffiliated with the AACAP WFIC and the AACAP Resi-dent Council Medical Student Outreach Initiative, re-spectively. This project was a voluntary effort by allparticipants, and no external funding was required. A letteron behalf of the AACAPWFIC was sent to the deans of allaccredited osteopathic medical schools to assess their in-terest in collaborating with the authors. The student gov-ernment president from PNWU responded first to thisinquiry. Details of this project were subsequently dis-seminated to student-body representatives at other osteo-pathic medical schools. VCOM demonstrated interest,and thus became involved with the project. We chose topilot this educational forumwith two schools (PNWU andVCOM) in order to demonstrate the viability of the pilot;we believed that limiting the participants would allow usto better address any potential problems inherent to newinitiatives. Permission to provide lectures was obtainedfrom the academic deans of both schools. A baselinesurvey assessing general attitudes toward CAP was sent

to all undergraduate medical students at PNWU andVCOM.

Video-teleconferencing (VTC) was used to deliver in-teractive lectures via an encrypted and secure connection atboth sites. Mayo CAP residents presented lectures to med-ical students in 50-minute sessions once every 3–6 weeks,using a variety of forums, including live PowerPoint lec-tures, interactive Q&A sessions, and live patient interviews.Informed consent was obtained from patients and parentsbefore the live patient-interview lectures. Lectures andtopics were chosen, and afterward were vetted for accuracybefore delivery. Nine lectures were scheduled for the aca-demic year. The lecture series with PNWU began in Sep-tember 2011 and with VCOM in December 2011. Towardthe end of the academic year, a follow-up survey, assessingthe perceived efficacy of this program, was sent to partici-pating undergraduate medical students. Baseline surveydata were collected in September 2011. Follow-up surveydata were collected in March 2012.

Results

A total of 175 undergraduate medical students fromboth campuses completed a baseline survey. Approxi-mately 33% (56/168) of first- and second-year medicalstudents from PNWU and 32% (119/372) of first- andsecond-year medical students from VCOM completed thebaseline survey. Over half of surveyed medical studentsfelt that some form of exposure to CAP would influencetheir desire to consider an additional clerkship elective inthis specialty or possibly consider CAP as a career choice.First- and second-year medical students reported that theydid not receive exposure to CAP during the first 2 years oftraining.

A range of 20–25 medical students, primarily fromstudent-led pediatric and family-medicine interest groupsfrom each school, regularly attended the lectures. Approx-imately 97% of medical students (43/44) who regularlyattended the lectures completed the follow-up survey. In-teraction and discussionwith the lecturer, a variety of lectureformats (PowerPoint lectures, case presentations, and livepatient interviews), opportunities to interview patients, andthe convenience of an “informal” lecture format were citedas aspects of the lecture series that medical students enjoyed.Nearly half of participating medical students (48%; 21/43)reported increased interest in CAP. Logistical issues andmore opportunities for interactive discussions were the mostcommonly-cited areas for improvement of the seminarseries.

Academic Psychiatry, 37:4, July-August 2013 http://ap.psychiatryonline.org 269

PULLEN ET AL.

Discussion

Delivery of this educational material via VTC seemed to beeffective. Student feedbackwas favorable, and although resultsmay not be generalizable beyond our test sites, they are con-sistent with positive results of other educational interventionsexposing medical students to CAP (6–8). However, given oursmall sample size, caremust be taken in interpreting the results.We intentionally chose to work with student-led interest

groups, rather than attempt to reach all undergraduatemedical students at PNWU and VCOM in a formal lecture.Thus, audience size was relatively small at each school (20–25 students per school), and subject to selection bias,making this a limitation in interpreting the results. Oursample of students is likely skewed toward those with aninitial interest in CAP. Also, we are not able to say whetherthe initial favorable response toward CAP would be sus-tained among participating medical students, and, thus,caution must be taken in drawing far-reaching conclusionsfrom this pilot study. The most significant logistical chal-lenge the authors encountered with this pilot lecture serieswas periodic schedule conflicts from both sites, which ne-cessitated regular communication and flexibility betweensites. Replication of this project would also have to take intoaccount its voluntary design; for example, lectures wereoften given during lunch or after working-hours.The teachingCAP residents participated in all lectures, and

this allowed them to expand their skill-set as educators inaddition to taking ownership of the project. Faculty membersserved as mentors, helping with program/curriculum de-velopment and reviewing lectures for content accuracy.Students preferred live interactive sessions with the CAPresidents to other means of disseminating educational mate-rial, such aswebinars and unidirectional lectures. Live patientinterviews were particularly popular among medical stu-dents, but were more complicated to arrange because ofethical considerations, including obtaining informed consentfrom the patients and their parents, addressing institutionalpolicies involving use of patients in medical student educa-tion, and coordinating the schedules of all parties.

Conclusion/Future Directions

Early exposure to CAP appears to be critical to shapingattitudes and developing an appreciation and interest in this

specialty. Efforts to reach out to first- and second-yearmedical students, such as this one, could also address fac-tors affecting CAP recruitment, such as identifying studentswith favorable personality traits and addressing precon-ceived ideas about the field (9).This pilot program demonstrated success utilizing

a centralized teaching site to reach out to first- and second-year medical students from osteopathic medical schoolsvia VTC, and it could serve as a model for future en-deavors. The authors plan to expand this program to otherinterested osteopathic medical schools. Three sites (Mayo,NYU, and UPMC) have begun identifying other in-terested osteopathic medical schools for collaboration.The actual efficacy of such a program is unknown (i.e.,Does the initial increased interest in CAP translate tomore medical students’ choosing this specialty as a ca-reer?), and this question should be addressed in futurestudies.

References

1. Thomas CR, Holzer CE 3rd: The continuing shortage of childand adolescent psychiatrists. J Am Acad Child Adolesc Psy-chiatry 2006; 45:1023–1031

2. Kim WJ: Child and adolescent psychiatry workforce: a criticalshortage and a national challenge. Acad Psychiatry 2003; 27:277–282

3. Sawyer MG, Giesen F, Walter G: Child psychiatry curricula inundergraduate medical education. J Am Acad Child AdolescPsychiatry 2008; 47:139–147

4. Dingle AD: Child psychiatry: what are we teaching medicalstudents? Acad Psychiatry 2010; 34:175–182

5. Gough JK, McCallum Z, Bevan C, et al: Undergraduate childpsychiatry teaching in Melbourne, Australia. Acad Psychiatry2010; 34:190–194

6. Martin VL, Bennett DS, Pitale M: Medical students’ interest inchild psychiatry: a clerkship intervention. Acad Psychiatry2007; 31:225–227

7. Malloy E, Hollar D, Lindsey BA: Increasing interest in childand adolescent psychiatry in the third-year clerkship: resultsfrom a post-clerkship survey. Acad Psychiatry 2008; 32:350–356

8. Kaplan JS, Lake M: Exposing medical students to child andadolescent psychiatry: a case-based seminar. Acad Psychiatry2008; 32:362–365

9. Shaw JA, Lewis JE, Katyal S: Factors affecting recruitment intochild and adolescent psychiatry training. Acad Psychiatry 2010;34:183–189

270 http://ap.psychiatryonline.org Academic Psychiatry, 37:4, July-August 2013

VIDEO-TELECONFERENCING FOR CAP