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Geriatric Psychiatry

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International Medical Graduate Physicians

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Abstract

Older adults receive health care in various settings including, but not limited to, geriatric psychiatry practices. All graduate medical trainees, regardless of specialty, need to learn how to provide high-quality care to older adults. Residency and fellowship training programs need to take into consideration the particular clinical and psychosocial needs of this growing segment of the United States. Due to multiple factors that will be reviewed in this chapter, international medical graduate (IMG) physicians may encounter additional barriers in working with older adults. A thorough assessment of the IMG physicians’ previous geriatric educational experiences is recommended, leading to individualized learning plans designed to bridge any identified gaps. IMG physicians may need in-depth training on language and communication aspects, cultural differences in clinical presentations, interacting with families and caregivers, neurosciences and neuropsychiatry, working with interprofessional teams, and medico-legal aspects. Specific strategies for teaching IMG physicians to work effectively with older adults will also be discussed.

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References

  1. Institute of Medicine. The mental health and substance use workforce for older adults: in whose hands? Washington, DC: The National Academies Press; 2012. p. 137–70.

    Google Scholar 

  2. Bartels SJ, Naslund JA. The underside of the silver tsunami – older adults and mental health care. N Engl J Med. 2013;368:493–6.

    Article  CAS  PubMed  Google Scholar 

  3. Sumaya CV, Opara CM, Espino DV. The geriatrician and geriatric psychiatrist workforce in Texas: characteristics, challenges, and policy implications. J Aging Health. 2013;25(6):1050–64.

    Article  PubMed  Google Scholar 

  4. Bragg EJ, Warshaw GA, Cheong J, Meganathan K, Brewer DE. National survey of geriatric psychiatry fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatric Society and Association of Directors of Geriatric Academic Programs’ Geriatric Workforce Policy Studies Center. Am J Geriatr Psychiatry. 2012;20:169–78.

    Article  PubMed  Google Scholar 

  5. Brotherton SE, Etzel SI. Graduate medical education, 2008-2009. JAMA. 2009;302:1357–72.

    Article  CAS  PubMed  Google Scholar 

  6. Brotherton SE, Etzel SI. Graduate medical education, 2009-2010. JAMA. 2010;304:1255–70.

    Article  CAS  PubMed  Google Scholar 

  7. Brotherton SE, Etzel SI. Graduate medical education, 2010-2011. JAMA. 2011;306:1015–30.

    Article  CAS  PubMed  Google Scholar 

  8. Brotherton SE, Etzel SI. Graduate medical education, 2011-2012. JAMA. 2012;308:2264–79.

    Article  CAS  PubMed  Google Scholar 

  9. Brotherton SE, Etzel SI. Graduate medical education, 2012-2013. JAMA. 2013;310:2328–46.

    Article  PubMed  Google Scholar 

  10. Boulet JR, Cassimatis EG, Opalek A. The role of international medical graduate psychiatrists in the United States healthcare system. Acad Psychiatry. 2012;36(4):293–9.

    Article  PubMed  Google Scholar 

  11. Blanco C, Carvalho C, Olfson M, Finnerty M, Pincus HA. Practice patterns of international and US medical graduate psychiatrists. Am J Psychiatry. 1999;156:445–50.

    CAS  PubMed  Google Scholar 

  12. Gogineni RR, Fallon AE, Rao NR. International medical graduates in child and adolescent psychiatry: adaptation, training, and contributions. Child Adolesc Psychiatr Clin N Am. 2010;19:833–53.

    Article  PubMed  Google Scholar 

  13. Rao NR. Psychodynamic psychotherapy training as acculturative experience for international medical graduates: a commentary. Acad Psychiatry. 2012;36:271–6.

    Article  PubMed  Google Scholar 

  14. Kramer M. Educational challenges of international medical graduates in psychiatric residencies. J Am Acad Psychoanal Dyn Psychiatry. 2006;34:163–71.

    Article  PubMed  Google Scholar 

  15. Searight HR, Gafford J. Behavioral science education and the international medical graduate. Acad Med. 2006;81:164–70.

    Article  PubMed  Google Scholar 

  16. Knight BG, Sayegh P. Cultural values and caregiving: the updated sociocultural stress and coping model. J Gerontol B Psychol Sci Soc Sci. 2010;65B:5–13.

    Article  PubMed  Google Scholar 

  17. Schwartz SJ. The applicability of familism to diverse ethnic groups: a preliminary study. J Soc Psychol. 2007;147:101–18.

    Article  PubMed  Google Scholar 

  18. Powers SM, Whitlatch CJ. Measuring cultural justifications for caregiving in African American and White caregivers. Dementia. 2016;15:629–45.

    Google Scholar 

  19. Wong YJ, Nguyen CP, Wang SY, Chen W, Steinfeldt JA, Kim BS. A latent profile analysis of Asian American men’s and women’s adherence to cultural values. Cultur Divers Ethnic Minor Psychol. 2012;18(3):258–67.

    Article  PubMed  Google Scholar 

  20. Lieff S, Clarke D. Canadian geriatric psychiatrists: why do they do it? A Delphi study. Can J Psychiatry. 2002;47:250–6.

    PubMed  Google Scholar 

  21. Koder DA, Helmes E. Predictors of interest in working with older adults: a survey of postgraduate trainee psychologists. Gerontol Geriatr Educ. 2008;29:158–71.

    Article  PubMed  Google Scholar 

  22. Vaillant GE. Aging well. New York, NY: Little, Brown; 2002. p. 141–58.

    Google Scholar 

  23. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in psychiatry. Available from https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/400_psychiatry_07012014.pdf. Accessed on 25 Jul 2014.

  24. Andrew MH, Shea C. Geriatric psychiatry education in Canada: the pathway to subspecialty recognition. Int Psychogeriatr. 2010;22:919–26.

    Article  PubMed  Google Scholar 

  25. Veerbeek M, Oude Voshaar R, Depla M, Pot AM. Mental health care Monitor Older adults (MEMO): monitoring patient characteristics in Dutch mental health services for older adults. Int J Methods Psychiatr Res. 2013;22:100–9.

    Article  PubMed  Google Scholar 

  26. Park JH, Kim KW, Kim MH, Kim MD, Kim BJ, Kim SK, et al. A nationwide survey on the prevalence and risk factors of late life depression in South Korea. J Affect Disord. 2012;138:34–40.

    Article  PubMed  Google Scholar 

  27. Koenig HG, Al Zaben F, Sehlo MG, Khalifa DA, Al Ahwal MS. Current state of psychiatry in Saudi Arabia. Int J Psychiatry Med. 2013;46:223–42.

    Article  PubMed  Google Scholar 

  28. Toot S, Orrell M, Rymaszewska J, Ihl R. A survey of geriatric psychiatry training across Europe. Int Psychogeriatr. 2012;24:803–8.

    Article  PubMed  Google Scholar 

  29. Mayne DJ, Allan L, Reynish E, MacLullich AM, Vardy ER. Experience and opinions on post-graduate dementia training in the UK: a survey of selected consultant geriatricians. Age Ageing. 2014;43(2):263–6.

    Article  PubMed  Google Scholar 

  30. APA Council Reports. Am J Psychiatry. 2014;171:235–44.

    Google Scholar 

  31. Harris M, Mayo A, Balas MC, Aaron CS, Buron B. Trends and opportunities in geropsychiatric nursing: enhancing practice through specialization and interprofessional education. J Nurs Educ. 2013;52:317–21.

    Article  PubMed  Google Scholar 

  32. Dotchin CL, Akinyemi RO, Gray WK, Walker RW. Geriatric medicine: services and training in Africa. Age Ageing. 2013;42:124–8.

    Article  PubMed  Google Scholar 

  33. López JH, Reyes-Ortiz CA. Geriatric education in undergraduate and graduate levels in Latin America. Gerontol Geriatr Educ. 2015;36:3–13.

    Article  PubMed  Google Scholar 

  34. Shah N. Need for gerodontology education in India. Gerodontology. 2005;22:104–5.

    Article  CAS  PubMed  Google Scholar 

  35. Pachana NA, Emery E, Konnert CA, Woodhead E, Edelstein BA. Geropsychology content in clinical training programs: a comparison of Australian, Canadian and US data. Int Psychogeriatr. 2010;22:909–18.

    Article  PubMed  Google Scholar 

  36. Keijsers CJ, van Hensbergen L, Jacobs L, Brouwers JR, de Wildt DJ, ten Cate OT, et al. Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review. Br J Clin Pharmacol. 2012;74:762–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. EDUCAUSE Learning Initiative. Things You Should Know About Flipped Classrooms. EDUCAUSE Creative Commons (7).

    Google Scholar 

  38. Institute of Medicine. Health professions education: bridge to quality. Washington, DC: The National Academies Press; 2003.

    Google Scholar 

  39. Fulmer T, Hyer K, Flaherty E, Mezey M, Whitelaw N, Jacobs MO, et al. Geriatric interdisciplinary team program: evaluation results. J Aging Health. 2005;17:443–70.

    Article  PubMed  Google Scholar 

  40. Katon W, Unützer J, Wells K, Jones L. Collaborative depression care: history, evolution, and ways to enhance dissemination and sustainability. Gen Hosp Psychiatry. 2010;32:456–64.

    Article  PubMed  Google Scholar 

  41. Richards DA, Hughes-Morley A, Hayes RA, Araya R, Barkham M, Bland JM, et al. Collaborative depression trial (CADET): multi-centre randomized controlled trial of collaborative care for depression-study protocol. BMC Health Serv Res. 2009;9:188.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Chen AH, Youdelman MK, Brooks J. The legal framework for language access in healthcare settings: title VI and beyond. J Gen Intern Med. 2007;22 Suppl 2:362–7.

    Article  Google Scholar 

  43. Joint Commission. Hospitals, language, and culture: a snapshot of the nation. Available from www.jointcommission.org/assets/1/6/hlc_paper.pdf. Accessed on 1 Jul 2014.

  44. Cooper-Patrick L, Gallo JJ, Gonzalez JJ, Vu HT, Powe NR, Nelson C, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.

    Article  CAS  PubMed  Google Scholar 

  45. Thornton RL, Powe NR, Roter D, Copper LA. Patient-physician social concordance, medical visit communication and patients’ perceptions of health care quality. Patient Educ Couns. 2011;85(3):e201–8.

    Article  PubMed  Google Scholar 

  46. Freedman M, Alladi S, Chertkow H, Bialystok E, Craik FIM, Phillips NA, et al. Delaying onset of dementia: are two languages enough? Behav Neurol. 2014;2014:808137.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Abutalebi J, Canini M, Della Rosa PA, Sheung LP, Green D, Weekes BS. Bilingualism protects anterior temporal lobe integrity in aging. Neurobiol Aging. 2014;35(9):2126–33.

    Article  PubMed  Google Scholar 

  48. Sanders AE, Hall CB, Katz MJ, Lipton RB. Non-native language use and risk of incident dementia in the elderly. J Alzheimers Dis. 2012;29:99–108.

    PubMed  PubMed Central  Google Scholar 

  49. Zahodne LB, Schofield PW, Farrell MT, Stern Y, Manly JJ. Bilingualism does not alter cognitive decline or dementia risk among Spanish-speaking immigrants. Neuropsychology. 2014;28:238–46.

    Article  PubMed  Google Scholar 

  50. De Bot K, Clyne M. Language reversion revisited. Stud Second Lang Acquis. 1989;11(2):167–77.

    Article  Google Scholar 

  51. Low LF, Harrison F, Kochan NA, Draper B, Slavin MJ, Reppermund S, et al. Can mild cognitive impairment be accurately diagnosed in English speakers from linguistic minorities? Results from the Sydney Memory and Ageing study. Am J Geriatr Psychiatry. 2012;20:866–77.

    Article  PubMed  Google Scholar 

  52. Mendez MM, Cummings JL. Frontotemporal dementia and the asymmetric cortical atrophies. In: Dementia: a clinical approach. 3rd ed. Philadelphia, PA: Butterworth-Heinemann; 2003. p. 186.

    Google Scholar 

  53. Katz I. Mental health needs of older veterans. Am J Geriatr Psychiatry. 2014;22:527–30.

    Article  PubMed  Google Scholar 

  54. Yong HH, Gibson SJ, Horne DJ, Helme RD. Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences. J Gerontol B Psychol Sci Soc Sci. 2001;56B:279–84.

    Article  Google Scholar 

  55. Pietrzak RH, Cook JM. Psychological resilience in older US veterans: results from the National Health and Resilience in Veterans Study. Depress Anxiety. 2013;30:432–43.

    Article  PubMed  Google Scholar 

  56. Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder AM, Nadal KL, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62:271–86.

    Article  PubMed  Google Scholar 

  57. Gabbard GO. Trauma- and stressor-related disorders and dissociative disorders. In: Psychodynamic psychiatry in clinical practice. 5th ed. Arlington, VA: American Psychiatric Publishing, Inc.; 2014. p. 281–5.

    Google Scholar 

  58. Trappler B, Cohen CI, Tulloo R. Impact of early lifetime trauma in later life: depression among Holocaust survivors 60 years after the liberation of Auschwitz. Am J Geriatr Psychiatry. 2007;15:79–83.

    Article  PubMed  Google Scholar 

  59. Yehuda R, Bell A, Bierer LM, Schmeidler J. Maternal, not paternal, PTSD is related to increased risk of PTSD in offspring of Holocaust survivors. J Psychiatr Res. 2008;42:1104–11.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Seritan AL, Gabbard GO, Benjamin L. War and peace: psychotherapy with a Holocaust survivor. Am J Psychiatry. 2006;163:1705–9.

    Article  PubMed  Google Scholar 

  61. Benjamin S, Widge S, Shaw K. Neuropsychiatry and neuroscience milestones for general psychiatry trainees. Acad Psychiatry. 2014;38:275–82.

    Article  PubMed  Google Scholar 

  62. Khadilkar SV. Neurology in India. Ann Indian Acad Neurol. 2013;16:465–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Zinchuk AV, Flanagan EP, Tubridy NJ, Miller WA, McCullough LD. Attitudes of US medical trainees towards neurology education: “Neurophobia” - a global issue. BMC Med Educ. 2010;10:49.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Coverdale J, Balon R, Beresin EV, Louie AK, Tait GR, Goldsmith M, et al. Teaching clinical neuroscience to psychiatry residents: model curricula. Acad Psychiatry. 2014;38:111–5.

    Article  PubMed  Google Scholar 

  65. Kales HC, DiNardo AR, Blow FC, McCarthy JF, Ignacio RV, Riba MB. International medical graduates and the diagnosis and treatment of late-life depression. Acad Med. 2006;81:171–5.

    Article  PubMed  Google Scholar 

  66. Espinoza R. Geriatric psychiatry. In: Roberts LW, Layde JB, Balon R, editors. International handbook of psychiatry. Singapore: World Scientific Publishing Co.; 2013. p. 478–523.

    Chapter  Google Scholar 

  67. Baskys A, Hou AC. Vascular dementia: pharmacological treatment approaches and perspectives. Clin Interv Aging. 2007;2:327–35.

    CAS  PubMed  PubMed Central  Google Scholar 

  68. WHO Pharmaceutical Newsletter. 1998 No. 03&04. Regulatory actions: Sertindole: approval application withdrawn. Available from http://apps.who.int/medicinedocs/en/d/Js2256e/1.12.html#Js2256e.1.12. Accessed 25 Jul 2014.

  69. Seritan AL. Prevent drug-drug interactions with cholinesterase inhibitors. Curr Psychiatry. 2008;7:57–67.

    Google Scholar 

  70. Sienaert P, Filip B, Willy M, Joseph P. Electroconvulsive therapy in Belgium: a questionnaire study on the practice of electroconvulsive therapy in Flanders and the Brussels Capital region. J ECT. 2005;21:3–6.

    Article  PubMed  Google Scholar 

  71. Gazdag G, Takács R, Tolna J, Iványi Z, Ungvari GS, Bitter I. Electroconvulsive therapy in a Hungarian academic centre (1999-2010). Psychiatr Danub. 2013;25:366–70.

    CAS  PubMed  Google Scholar 

  72. Somoye EB, Onifade PO, OLuwaranti AO, Adeniji AA. A 10-year descriptive study of electroconvulsive therapy at the neuropsychiatric hospital, Aro, Abeokuta. J ECT. 2014;30:315–9.

    Article  PubMed  Google Scholar 

  73. Canbek O, Menges OO, Atagun MI, Kutlar MT, Kurt E. Report on 3 years’ experience in electroconvulsive therapy in Bakirkoy research and training hospital for psychiatric and neurological diseases: 2008-2010. J ECT. 2013;29:51–7.

    PubMed  Google Scholar 

  74. Lõokene M, Kisuro A, Mačiulis V, Banaitis V, Ungvari GS, Gadzag G. Use of electroconvulsive therapy in the Baltic states. World J Biol Psychiatry. 2014;15:419–24.

    Article  PubMed  Google Scholar 

  75. Waikar A, Davar B, Karhadkar C, Bansode D, Dandekar D, Kakade S, et al. ECT without anaesthesia is unethical. Issues Med Ethics. 2003;11:41–3.

    PubMed  Google Scholar 

  76. Abbas M, Masrai N, Mohanna M. Knowledge of and attitudes toward electroconvulsive therapy of medical students in the United Kingdom, Egypt, and Iraq: a transcultural perspective. J ECT. 2007;23:260–4.

    Article  PubMed  Google Scholar 

  77. Weerasekera P. Psychotherapy training for IMGs: attending to the “how to” and “what to” teach. Acad Psychiatry. 2012;36:288–92.

    Article  PubMed  Google Scholar 

  78. Karel M, Hinrichsen G. Treatment of depression in late life: psychotherapeutic interventions. Clin Psychol Rev. 2000;20:707–29.

    Article  CAS  PubMed  Google Scholar 

  79. Areán PA, Niu G. Choosing treatment for depression in older adults and evaluating response. Clin Geriatr Med. 2014;30:535–51.

    Article  PubMed  Google Scholar 

  80. Chochinov HM, Kristjanson LJ, Breitbart W, McClement S, Hack TF, Hassard T, et al. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol. 2011;12:753–62.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Morgan AC. Practical geriatrics: psychodynamic psychotherapy with older adults. Psychiatr Serv. 2003;54:1592–4.

    Article  PubMed  Google Scholar 

  82. Comas-Diaz L, Jacobsen FM. Ethnocultural transference and countertransference in the therapeutic dyad. Am J Orthopsychiatry. 1991;61:392–402.

    Article  CAS  PubMed  Google Scholar 

  83. Iosif AM, Sciolla AF, Brahmbhatt K, Seritan AL. Caregiver burden in fragile X families. Curr Psychiatry Rev. 2013;9:85–91.

    Google Scholar 

  84. Woodward-Kron R, Fraser C, Pill K, Flynn E. How we developed Doctors Speak Up: an evidence-based language and communication skills open access resource for International Medical Graduates. Med Teach. 2015;37:31–3.

    Article  PubMed  Google Scholar 

  85. Trappler B. Integrated problem-based learning in the neuroscience curriculum--the SUNY Downstate experience. BMC Med Educ. 2006;6:47.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Khan Academy. Health and Medicine modules: nervous system and sensory information. Available from http://www.khanacademy.org/science/health-and-medicine/nervous-system-and-sensory-infor. Accessed on 13 Aug 2014.

  87. American Association for Geriatric Psychiatry. Resources for educators. Available from http://www.aagponline.org/index.php?src=gendocs&ref=ForEducators&category=Tools_Resources. Accessed on 12 Aug 2014.

  88. Estus EL. Using Facebook within a geriatric pharmacotherapy course. Am J Pharm Educ. 2010;74(8):145.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Rabheru K, Wiens A, Ramprasad B, Bourgon L, Antochi R, Hamstra SJ. Comparison of traditional didactic seminar to high-fidelity simulation for teaching electroconvulsive therapy technique to psychiatry trainees. J ECT. 2013;29:291–6.

    Article  PubMed  Google Scholar 

  90. Gabbard GO. Long-term psychodynamic psychotherapy: a basic text. 2nd ed. Arlington, VA: American Psychiatric Publishing, Inc.; 2010 (DVD included).

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, University of California, San Francisco, Weill Institute for Neurosciences, 401 Parnassus Avenue, Box 0984-APC, San Francisco, CA, 94143, USA

    Andreea L. Seritan M.D.

  2. Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, Resnick Neuropsychiatric Hospital at UCLA, 300 UCLA Medical Plaza, Suite 2235, Los Angeles, CA, 90095, USA

    Randall Espinoza M.D., M.P.H.

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  1. Andreea L. Seritan M.D.
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Correspondence to Andreea L. Seritan M.D. .

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Editors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Nassau University Medical Center, East Meadow, New York, USA

    Nyapati R. Rao

  2. Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA

    Laura Weiss Roberts

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Seritan, A.L., Espinoza, R. (2016). Geriatric Psychiatry. In: Rao, N., Roberts, L. (eds) International Medical Graduate Physicians. Springer, Cham. https://doi.org/10.1007/978-3-319-39460-2_14

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