Psychiatry Residents as Interdisciplinary Teachers: the PIES Process.

To the Editor:

Psychiatry residency programs have increasingly focused on developing residents’ teaching skills due to resident request and the Accreditation Council for Graduate Medical Education (ACGME) requirement that residents serve as educators. However, most resident-as-teacher models have emphasized teaching medical students on psychiatry clerkships or junior psychiatry trainees [1, 2]. As the psychiatrist shortage worsens, psychiatrists may be increasingly expected to teach non-psychiatric physicians how to administer quality psychiatric care. However, few teaching curricula or extracurricular programs have focused on psychiatrists’ roles as interdisciplinary educators [3, 4]. These two previous studies assessed cross-sectional learning outcomes of non-psychiatric physicians rather than the longitudinal process of developing psychiatry residents as educators.

We present a novel, longitudinal teaching program that both improves interdisciplinary collaboration and cultivates psychiatry residents as interdisciplinary educators. We aim to enable readers to implement the model.

PIES is developed and organized by psychiatry residents of all years interested in improving their teaching. Resident teachers create “chalk talk”–style teaching sessions, an interactive learning method that uses a visual space to construct a mental model, about common psychiatric issues encountered in medical settings. Resident teachers receive longitudinal support from a faculty mentor (who are commonly Consultation-Liaison-trained), a unique feature of the PIES process. They deliver this talk in iterations to audiences of internal medicine, family medicine, pediatrics, neurology, and obstetrics-gynecology trainees at preexisting noon conferences or didactics. They are encouraged to consider the training and needs of non-psychiatric trainees and utilize “PIES Techniques.” PIES Techniques are a list developed by consensus by the PIES resident leader and PIES faculty mentors based on the adult learning theory [5], especially problem-centered learning that draws on learners’ experiences. During the COVID-19 pandemic, resident teachers creatively adapted their previous chalk talks to virtual formats (e.g., Adobe Acrobat Reader, Google Documents, Miro, PowerPoint).

For each talk, a PIES leader (a volunteer senior psychiatry resident) facilitates three major tasks: mentorship, talk coordination, and feedback. The PIES leader periodically recruits faculty mentors known to excel at teaching.

Three months before the talk date, the PIES leader checks for talk “supply” (assessing resident teacher interest) and “demand” (assessing non-psychiatric chief resident interest). The PIES resident leader periodically surveys non-psychiatric residents and regularly coordinates with non-psychiatric chief residents to compile a running list of preferred talk topics. Alternatively, resident teachers may brainstorm topic ideas with their assigned faculty mentor that the PIES leader then runs by the non-psychiatric chief residents. Once a topic is established, the resident teacher and faculty mentors are matched with a talk date.

One to four weeks before the talk, each resident teacher practices their talk during a virtual group feedback session. The group feedback sessions may consist of up to three faculty members and 7 residents. The group delivers feedback based on PIES Techniques and their reactions as they pretend to be non-psychiatric trainees, a feature that distinguishes the PIES process from other interdisciplinary teaching models. One week before the talk, the PIES leader sends the resident teachers talk surveys (inquiring whether the learners feel equipped to manage the issue and which psychiatric skills the learners plan to use) to incorporate into their talk. One month later, the PIES resident leader distributes a survey to assess whether learners have used the skills.

Resident teachers are encouraged to incorporate feedback and deliver improved iterations of the same talk, their educational product, to different audiences.

Surveys were sent to the resident teachers (N = 5) and faculty mentors (N = 4) who piloted the PIES process. Resident teachers on average (N = 4, 80% response rate) selected “Strongly agree” that PIES has increased their knowledge about how to be an effective teacher. Faculty mentors (N = 3, 75% response rate) on average selected “Agree” that residents have improved longitudinally in their teaching skills and selected “Strongly agree” that they have observed residents improving longitudinally in their teaching. In the qualitative comments section, a faculty mentor wrote: “PIES […] brings trainees into an engaging environment where they can continually improve their teaching skillset AND have useable[sic] product for their future. It has a fantastic format and process for feedback and mentorship.” A similar sentiment was shared by another faculty member. Several residents have informally commented that teaching has increased their mastery of clinically relevant topics.

The number of resident teachers who have undergone the PIES process has increased to fourteen over the course of its two years of existence, with second- and third-year residents as the majority. As of June 2022, 38 talks had been delivered, equating to approximately 300 non-psychiatric trainees educated. These 38 talks focused on nine different topics with agitation management, delirium identification and management, functional disorder conceptualization and management, and managing challenging patient behaviors as the most common topics. Many resident teachers delivered each talk two to three times.

Non-psychiatric chief residents have proactively contacted PIES resident leaders to request specific talks and more psychiatry talks generally. Trainees from other specialties have rated PIES talks an average of 9/10, and approximately 71% of respondents used the skills taught in the month following the talk (though response rates were low). Qualitative comments included, “Such a wonderfully interactive talk and covered the main points about how varied presentations of delirium are,” and “Great audience engagement and fun presentation style!” Resident teachers have been energized by audience feedback and receiving requests for repeat talks.

The PIES process has nurtured a small group of residents into confident, effective teachers and created a community of educators dedicated to improving their teaching during extracurricular time. Peer mentorship, longitudinal relationships with teaching faculty, and experiential learning appear to be effective methods to engage residents as teachers. The PIES process is a replicable educational model that aims to instill in residents the practice of lifelong learning.

Study limitations include a small sample size for resident teacher surveys, limiting generalizability, and the absence of pre-intervention surveys.

Future directions include administering surveys to larger sample sizes and including pre-intervention surveys. We hope to invite non-psychiatric residents to deliver their own PIES-style talks to increase psychiatry residents’ exposure to interactive teaching strategies.