TEMPLE UNIVERSITY DEPARTMENT OF PSYCHIATRY
TEMPLE UNIVERSITYDEPARTMENT OFPSYCHIATRYNEWSLETTERSPRING 2019LETTER FROM THE CHAIRMANCONTENTS- Letter from the Chairman- Letter from the ResidencyProgram Director- Understanding PracticalPsychiatry: Insights- Faculty Spotlights:Dr. Natasha Dalseth- Adjunct Faculty Spotlight:Dr. Suzanne Benser- Alumni Spotlight:Dr. Jaclyn Dietzold- Resident Transition:Dr. Tiffany Clark- Residency Highlight:Psychodynamic Track- Residency Highlight:Temple as a Family- Match List 2019The issues of physician burnout andphysician well-being have becomedominant themes in healthcare over thepast several years. Credentialingagencies are beginning to focus onthese concerns. The AccreditationCouncil of Graduate Medical Education(ACGME)hasalreadymovedaggressively forward with standards forresidents and faculty. Increasingly,studies illustrate the economic cost ofburnout to the healthcare system.Burnout is described as a syndrome ofemotional exhaustion, cynicism, anddecreased efficiency at work. Incontrast to burnout, there is also a greata great deal of emphasis on physicianand resident well-being. The AmericanMedical Association published amonograph entitled Creating theOrganizational Foundation for Joy inMedicine with the goal of healthsystems building a more engaged,satisfied physician workforce which inturn will provide better, safer, and morecompassionate care to patients.Clinical departments at Temple havebeen tasked with developing wellnessprograms for both residents and facultyin order to promote well-being andminimize burnout. Under the directionof Dr. Jessica Kovach and a residentcommittee, a robust wellness programis evolving in the Department. BeckyWu, M.D. was the Chair of thecommittee last year and had a majorrole in the implementation of theprogram. This year Allison Loudermilk,D.O. is the Chair and continues to helpguide the growth of the program. Iwould like to list all of the residentsthat have contributed in many ways tothe outstanding program that we nowhave, but that would include listingalmost all of the residents in theDepartment. They all have participatedin making this a successful effort.The types of programs recommendedfor wellness are extensive and varied.In our Department, the approach tionprocess occurred over the past twoyears. A resident and faculty WellnessCommittee was formed. First, wesurveyed residents and created acommittee mission statement. Themission of the wellness committee is todecrease overall burnout and increasewellness and resilience in our residentsby examining and addressing factorsspecific to our program whichcontribute to resident burnout.- Residency in PhotographsTemple PsychiatrySpring 2019Page 1
LETTER FROM THE CHAIRMAN, CONT.We conducted a needs assessment via focus group at ourannual resident retreat and anonymous resident survey.Using data from the survey we created a "priority list" ofitems which our residents feel contribute most to burnoutin the residency and items which would help protectthem from burnout.Completed items of the Committee included: creation ofa Didactic Revision Committee to decompress our moststressful day of the week; increasing team-building andbonding activities such as brunch and book club;decreasing stress through low-cost yoga and mindfulness(attended by both faculty and residents); environmentalimprovements in the call room; creation of monthly,voluntary process group space for discussion ofdifficulty clinical cases; discussion of our nationalACGME resident and faculty wellness data. Next goalsinclude creation of a resident lounge area adjacent to thecall room, monitoring progress of ongoing items, andmonitoring and addressing what we anticipate will beannual ACGME wellness data. There have been fourGrand Rounds presentations in the past two years relatedto wellness issues with outside speakers.Several initiatives for the faculty were implemented aswell. Faculty members are encouraged to participate innational meetings related to their areas of interest inorder to develop a more global view of academicpsychiatry and to learn what successful programs otherDepartments have implemented. Each year the facultyand residents celebrate together in a social setting at thefollowing events: Intern welcome barbeque Residency graduation The annual holiday celebration The Benjamin Rush Reception which is anannual reception held by the PhiladelphiaPsychiatric Society. Temple always has thelargest turnout with almost the entire facultyand almost all residents attending.There is a small faculty committee constantlyexploring ways to minimize the stress of theelectronic medical record EPIC and to simplify thework process. Suggestions are always solicited anddiscussed at faculty meetings. A number ofchanges have been effective, and currently facultymembers are adding Dragon voice recognitionsoftware to their computer as this significantlydecreases the amount of documentation time.Faculty members were recently invited toparticipate in a stress reducing Yoga class with theresidents, and 1/3 of the faculty participated. TheDepartment produces a newsletter three times ayear which celebrates the successes of the facultyand the residents. This newsletter goes out theTemple faculty, Departmental alumni, and toDepartment volunteer faculty.Over the next several years the Department willcontinue to expand these programs and focus onwell-being. The widespread participation ofresidents and faculty members has been gratifying.William Dubin, M.D.Chair, Department of PsychiatryTemple PsychiatrySpring 2019Page 2
LETTER FROM THE PROGRAM DIRECTORFirst and foremost, Iamexcitedtoannounce the Class of2023! We are veryhappytohavematchedeightexcellentapplicantsfrom a variety ofschoolsandbackgrounds. Our newinternclassiscomprised of CaesarImperio M.D. Ph.D.,Holly Jordan M.D.,Janet Lee M.D., Terry Lok M.D., Ashby MammenM.D., Divya Patel M.D., Jeremy Sharma M.D., andJacob Weiss M.D.While residency recruitment is an important and excitingaspect of any program directors’ job, recent years haveproven to be very exciting for Psychiatry ResidencyDirectors. Over the last five years, the popularity ofpsychiatry among US students has skyrocketed. Thenumber of US MD students who match into psychiatryhas increased from 685 in 2014, or 4.2% of graduates, to1,054 in 2019, representing 5.9% of graduating students.The number of psychiatry positions in the match hasincreased but not at the same pace (1353 in 2014 to 1740in 2018). In 2018, among students who applied to onlyone specialty, psychiatry was the specialty with thehighest rate of unmatched US students (13.6% did notmatch). This, coupled with rising average specialtyboard scores, has prompted many to ask “Is psychiatrythe new dermatology?” And, more importantly, why ispsychiatry “the new dermatology”?The data we have associate certain factors with a higherlikelihood of choosing psychiatry. Those factors arefemale sex, personal or family history of mental illness,early exposure to the field of psychiatry, longerTemple Psychiatrypsychiatry clerkships, and a positive perception ofpsychiatry by other disciplines at one’s medicalschool. A 2017 study by Goldenberg, Williams, andSpollen looked at data from the Association of AmericanMedical Colleges’ (AAMC) medical school entrance andgraduation questionnaires. This study showed thatstudents who planned to go into psychiatry on enteringmedical school had the highest stability of career choicethroughout their school years and continued to pursuepsychiatry as their career choice through graduation.Psychiatry also showed the second highest increase inpopularity as a future specialty choice over the course ofmedical school (behind only urology).Factorsassociated with choosing psychiatry as a future careerincluded rating the psychiatry clerkship as excellent, anundergraduate major in psychology, reporting work-lifebalance as a strong influence, being 27 or older atmedical school matriculation, reporting educational debtas having no influence, having substantial undergraduateinteraction with LGBT individuals, and having takenpsychology and English literature for personal interest.Students who took undergraduate biochemistry oradvanced general chemistry for “personal interest” wereless likely to choose psychiatry.While we know certain factors are associated with thechoice of psychiatry as a future specialty, what we donot know is why students are choosing psychiatry overother specialties. One possibility is that students aremore likely to choose a specialty that they feel isconducive to a balanced lifestyle. Certainly they mustnotice that psychiatrists tend to be less burnt out andmore satisfied with work-life balance than the averagephysician. However, I think the situation is morecomplex. The AAMC began requiring medical schoolsto pay attention to mission-appropriate diversity over 10years ago. The AAMC’s admissions holistic reviewproject began around the same time. It is possible thatSpring 2019Page 3
LETTER FROM THE PROGRAM DIRECTOR, CONT.this process led to the recruitment of more students withpsychology and other liberal arts backgrounds, who thenin turn may have been more inclined towards psychiatry.During this same time period, stigma towards psychiatryhas decreased in popular press and in many (but not all)subcultures and regions, recognition of the nationwideshortage of psychiatrists has increased, and excitingadvances in neuroscience promise better futurepsychiatric treatments. Finally, we frequently hear fromstudents who say that they entered medical schoolthinking that they would go into primary care, “but thenI realized that family practitioners, pediatricians, andinternists do not have any time with their patients.”Students often will report a version of “In otherspecialties, I realized that talking to patients is ahindrance to the physician’s day, and in psychiatry, it isthe heart of it.”Regardless of the associated factors, reasons, anddownstream results of the increase in psychiatryrecruitment, I am overjoyed with the success of ourrecruitment season and match. Our recruitmentrepresents an energetic effort by our entire department.We could not be successful without the contributions ofour own residents and faculty. Thank you!The results of this increase in recruitment remain to beseen. Certainly, program directors are struggling withscreening large numbers of applications, and applicantsare struggling with the expense and time needed to applyto an average of around 40 programs per applicant.Declining numbers of international medical graduatesapplying to and matching into psychiatry means moreuncertainty for both fellowships and communitypsychiatry agencies, since international medicalgraduates are more likely to work in those settings aftercompleting residency. Certainly, with a surplus ofapplicants and a nationwide psychiatry workforceshortage, our specialty would do well to address thecomplex financial and political factors that prevent anadequate increase in the number of residency trainingslots.NRMP. (2019). Advance Data Tables. 2019 MainResidency Match [PDF file]. Retrieved from le PsychiatrySources:Goldenberg MN, Williams DK, and Spollen JJ. (2017).Stability of and Factors Related to Medical StudentSpecialty Choice of Psychiatry. Am J Psychiatry, 174(9),859-866.Jessica Kovach, M.D.Director of Residency TrainingSpring 2019Page 4
UNDERSTANDING PRACTICAL PSYCHIATRY:INSIGHTSThe power of words— amazing! As achild is beginning tomatchsounds(words)withactions, intentions,andthebodylanguage of theperson who utteredthosewords,positive or negativeimpressionscanform. For example,taketheword“hug.” If a child associates “hug” with an angry,threatening, immobilizing event, there will always be adichotomy as to the meaning of that word in the distantmemory banks of that individual. For most of us,happily, the association to “hug” is one of affection,safety, warmth, and caring.history in depth, his or her failures and successes,traumas lived through successfully or not, will assist usin developing insight into the words that we choose.As we all know, words can start and end wars, lead toviolence or to love, cause security or fear, and even trustversus paranoia. All of us can remember when wordsbrightened our day, gave us a sense of pride, encouragedus to go forward or deflated our self-esteem, led toshame or embarrassment, or may have even caused us toflee.I read somewhere that English has the most words ofany language.As therapy progresses, are we using words to confront,soothe, educate, confuse, or desensitize our patient? Ifone would ask me how trust is formed in general and intherapy specifically, I would say that it is based uponconsistency over time. Trust may be positive or negative— are we helpers or “hurters?”If one subscribes to the above, it puts a burden — but Ithink a positive one — upon the therapist. We must tryto understand the words we are using and the effect weare hoping to achieve. To use words to bolster our ownego, minimize the patient, or make them submissive is amistake. Patients demonstrate to us why they need ourhelp. The words we choose can be welcoming, sincere,anxiolytic, or the opposite. They can drive patientsaway, increase their dysphoria, or do the opposite. Thesame is true in our private lives, as well.Choose wisely.In all of medicine, but I believe more so in psychiatry,words are one of our most important tools. As we take ahistory, we must look at how the words that we arechoosing influence our patient. In addition, we must becognizant of our vocal tone and volume, facialexpressions, and body language — all of which caninfluence how our patient interprets the meaning —overt and covert — of our words. Knowing the patient’sTemple PsychiatryRoy Steinhouse, M.D., LFAPA, FCPPAssociate Chair and ProfessorSpring 2019Page 5
FACULTY SPOTLIGHT:NATASHA DALSETH, M.D.The first class of Temple University’s Physician Assistant (PA) program graduated in August 2018. Dr. NatashaDalseth provided the students with the opportunity to translate their didactic experiences into clinical learningduring their psychiatry rotation at Episcopal Hospital. Dr. Dalseth has used her experiences with Temple medicalstudents to create role-specific learning objectives for our collaborative allied health professionals in training. Shecommunicates that “It is important for PA students to recognize the importance of psychiatric symptoms and themedications in all of their patients.” She emphasizes a focus on medication interactions and side effects. Clinicalexperiences are guided to help PA students identify blind spots in terms of experience with psychiatric care andtreatments.Dr. Dalseth notes that building trust with patients with severe mental illness comes with its own challenges, andshe wants to provide her students with various approaches so that they never feel at a loss. As such, she guides herstudents through seeing a psychiatric patient, figuring out how to diagnose medical issues, and building a rapportwith the patients that they see regularly. With improved communication, medical complications are not missed,and the patients will receive excellent care. Her hope is that this opportunity will promote cognizance amongstudents, so they will give their full attention to the medical complaints and needs of patients with psychiatricdiagnoses.Physician Assistant students, in turn, have been able to give time to patients, and this has had a good responsefrom Dr. Dalseth’s patients. The patients report that the students are able to listen to them for a long time and talkto them about topics other than symptoms. These conversations have led to an increased depth in understandingthe patients’ needs which has resulted in out-of-the-box thinking and novel suggestions during treatment teams!Written by Kalvin Foo, M.D.Temple PsychiatrySpring 2019Page 6
ADJUNCT FACULTY SPOTLIGHT:SUZANNE BENSER, M.D.Dr. Suzanne Benser has 26 years of clinical experience in the private practice ofpsychiatry, psychotherapy, and psychoanalysis, and she has been using her vastexperience as a Clinical Assistant Professor with the Department of Psychiatry toeducate and supervise residents since 2011. She has multiple recent publications inthe field of psychoanalysis, and she is immersed in teaching and supervisingpsychotherapy and psychoanalysis in the greater Philadelphia region as a facultymember of the Psychoanalytic Center of Philadelphia (PCOP). As someone who isdeeply interested in social justice issues, she is also spearheading the YouthPsychotherapy Program to provide psychotherapy in Philadelphia high schools forat risk youths (students from multiple foster home placements, students whodropped out and re-entered the school system). She is happy to report the programis thus far showing statistically significant results in symptom reduction andinterpersonal functioning for these youths. She received PCOP’s OutstandingService Award last summer for her work overseeing and developing the program.As the daughter of an engineering consultant, Dr. Benser grew up moving to a new city (and often a new country!)nearly every year in her youth, but now calls Philadelphia her home. Dr. Benser believes her early travels led to herinterest in understanding the human mind and ultimately to her interest in psychiatry. She constantly asks "how weget to be who we are, what do we have in common, what makes us different, and how do we connect?" She read avast array of books as a young person that helped to shape her interest in the human mind, from Freud and otherpsychoanalysts to Victorian literature by Charlotte and Emily Bronte. She received her undergraduate degree inbiology from the University of North Texas and continued on to receive her medical education at Texas TechUniversity. She moved to Philadelphia to complete her psychiatry internship at Pennsylvania Hospital and herresidency training at the Institute of Pennsylvania Hospital, where she remained as Medical Staff for several yearswhile establishing her private practice. Although Dr. Benser teaches many residents and fellows through hercommitments to PCOP, Einstein, and Temple, she notes of her work with Temple psychiatry residents, "I love thatTemple residents are truly persistent in their efforts to grow. I work with Temple residents every week who aregenuinely committed to learning psychotherapy.” She is also very pleased to have been recently appointed as areferral psychiatrist for the Temple Housestaff Wellness Program through the Graduate Medical Education office.Dr. Benser hopes to impart her enthusiasm for psychiatry and psychoanalysis to the residents and fellows withwhom she works. She notes that it is a privilege to "know that you're doing meaningful and deep work with yourpatients. It’s amazing how people can change when they are understood and accepted. And there's always more forall of us to understand about the human condition!” In her private life, Dr. Benser is married with 2 children, one ofwhom is in college and the other who is currently pursuing an MPH at Columbia University. In her free time sheenjoys cooking with her husband, traveling, and kettle bell workouts.Written by Jenny Lugo, M.D.Temple PsychiatrySpring 2019Page 7
ALUMNI SPOTLIGHT:JACLYN DIETZOLD M.D.When I entered into my psychiatry residency at Temple University Hospital, I had a wide range of interests withinthe field, but I was largely unsure of what I wanted my career to look like post-graduation. Over the course of mytraining, I was exposed to many rich clinical experiences, although I found my calling during my second year onmy Child and Adolescent rotation at Horsham Clinic. After this initial exposure, I tried to incorporate as manyrelated experiences as possible into my training. I treated an increased number of child and adolescent outpatientsand became involved with Mich
Department produces a newsletter three times a year which celebrates the successes of the faculty and the residents. This newsletter goes out the . Chair, Department of Psychiatry Temple Psychiatry Spring 2019. Page 3 LETTER FROM THE PROGRAM DIRECTOR psychiatry clerkships, and a positive perception of .
section five: speciality psychiatry 29. child and adolescent psychiatry 159 30. women and mental health 169 31. geriatric psychiatry 173 32. emergency psychiatry 177 33. psychotherapy 181 34. forensic psychiatry 189 35. community psychiatry 193 36. mental health legislations in india 195 37. neuroimaging, eeg and evoked potentials 197 38.
About Temple University 2.1 Temple University—of the Commonwealth System of Higher Education Founded in 1884 by Dr. Russell Conwell as an informal adult-education outgrowth of his Baptist Temple ministry, Temple College was chartered in 1888 and incorporated as Temple University in 1907. In 1965, Temple became a member of the Commonwealth
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DEPARTMENT OF PSYCHIATRY DIVISION OF CHILD & ADOLESCENT PSYCHIATRY UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES PSYCHIATRIC RESEARCH INSTITUTE Psychosis in Children and Adolescents Written by: Jody L. Brown, M.D. Assistant Professor D. Alan Bagley, M.D. Chief Resident Department of Psychiatry Division of Child & Adolescent Psychiatry
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Jagannath Temple was built in the city of Puri by King Chodaganhadeva in 12th century. He also built the Sun temple of Konark. His grandson Ananga Bhimadeva completed the construction of the temple in 12th century. There are three main deities in the temple who are put into the temple cars during the festival of Rath Yatra and these deities are
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