Psychiatry Clinical Extender Program: The community feedback period for this project began on 8/9/18 and ended on 10/9/18

What is the problem that needs to be addressed? Please describe how it is related to mental health.

Psychiatry Medical Residency Programs consistently attract the lowest or next to lowest performing medical students as measured by USMLE Step 1 and USMLE Step 2 CK scores (National Residency Matching Program  Charting the Match Annual Report).  NRMP data also shows that Medical Students entering Psychiatry have some of the lowest participation rates in Abstracts, Presentations, and Publications.

Mental Health and Psychiatric Organizations are late in attracting future healthcare providers to an interest in Mental Health/Psychiatry.  While other medical specialties/organizations utilize Clinical Care Extender and Volunteer Programs, Psychiatry typically does not.  The first time for such an opportunity in Psychiatry is the MS-3 year when medical students do a required rotation in Psychiatry.  Until the MS-3 year, medical students do not have much interaction with Psychiatric Patients, unlike most other medical specialties.

The informal interactions between practicing physicians, allied health professionals, future physicians in medical school, premedical students and high school students help form future career interests and business opportunities.  Psychiatry has some of the largest opportunities for discovery, but does not adequately attract the human resources required to find those discoveries. The difference in age between a high school and MS-3 Medical Student is at least 7 years.

Why is this a concern for Orange County? What can Orange County and other counties learn from this project?

Currently, the only route to Board Certification in Psychiatry is through a Psychiatry Residency Program listed in the National Resident Matching Program (NRMP).  NRMP data shows that the pool of future Psychiatrists has some of the lowest key performance indicators compared to other medical specialties. There is also a spillover effect.  The cohort of young people that volunteer don’t necessarily enter the industry, career or medical specialty where they initially invest their time.  Experiences are carried over to future opportunities and can provide a base of common knowledge for future collaboration.

What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?

What is being done?  Unknown. Is it Working?  NRMP Charting the Match Annual reports over the last decade suggest whatever strategy is being used hasn’t impacted NRMP key performance indicators.

What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.

Historically,  Psychiatry operates on the fringe of medicine, law and society.  Mental health has a history of locked wards, security issues, and a different standard of rights for patients. Introduction of volunteers or the “non-initiated” to a mental health setting has risks of disruption to healthcare operations and shock to the volunteer.  Orange County – possibly other jurisdictions -has previously made investments that enable a volunteer or Clinical Care Extender program in Psychiatry/Behavioral Health.

What is the project idea? Please describe how this project will operate.

Orange County has invested in Wellness Centers and other facilities that are unlocked and do not have the security risks historically experienced in mental health.  These facilities can initiate Volunteer & Clinical Care Extender Programs.

Additional Information

  • Examples of Clinical Care Extender/Volunteer Programs include:
  • Hoag (https://www.hoag.org/about-hoag/volunteer/health-scholar-program-pre-med-nursing-program-/)
  • St. Jude (https://www.stjudemedicalcenter.org/st-jude-memorial-foundation/volunteer/)
  • VITAS  Medicare Requirement for Hospice Volunteers (https://www.vitas.com/resources/volunteers/hospice-volunteers-and-medicare-law)

 

July 30, 2018

10 comments

What would the learning objectives be?

Orange County can set any learning objectives deemed appropriate. It is assumed that OC will administer the program and thus will comply with all applicable laws and policies.

If OC needs help with talent or creativity to develop learning objectives for a program that is modeled elsewhere then an RFP for consulting help would be appropriate to ensure all parties are satisfied with the messaging used.

Thank you for your reply. The INN Team will explore learning objectives as the proposal is developed. However, the community forum is designed to gather input from the community regarding goals, key learnings and questions to be answered as a result of piloting this project. We appreciate any input you or other community members have in exploring this with our team. We will keep this question open for continued input.

I attend wellness center central in orange county and I really do enjoy coming here and learning and really wish there was more places around the community and closer to home since I live in Santa Ana boarder line Fountain Valley. Mental health services do need to be more expose to the community and have more people involved by talking about it from the start of high school.

Any results obtained from this type of program will take many years to witness. How will we know if it was successful within Innovation’s limited 3 to 4 year timeframe?

The short- term success metric will be volunteer hours contributed. Typical success metrics for mental health and poverty initiatives involve conservation of jurisdictional resources or more efficient deployment of resources. The innovation program would merely need to cite the total of volunteer hours to claim success.

The future physician pipeline has a long lead time. Innovations of merit that do not fit the short term goals of this program should be forwarded to entities that seek long term development goals with long term impact.

It is mentioned that OC has, “previously made investments that enable a volunteer or Clinical Care Extender program in Psychiatry/ BH.” Can you give examples of specific programs and how would this program differ from those programs?

“Enable” means that something is made possible. It doesn’t mean that the something exists.

I am not aware of Orange County – or any other jurisdiction – deploying volunteers in a psychiatric clinical setting.

Being a unique program isn’t required. The demand from pre-med/pre-health professionals exists for these programs.

Examples were provided in the initial submission. Programs of this type that already exist are typically based in medical hospitals or hospice programs.

Thank you for your response. HCA will review the information initially submitted to determine the viability of this proposal. Please feel free to add any additional information throughout the community engagement period for this submission.

I personally attend Wellness Center run by Pathways in Orange California and I believe the help of younger volunteers would help reduce the stigma of mental illness and encourage them to pursue careers in the field. I have felt that physicians that I have encountered in the past have taking my bi polar diagnosis and had a predetermined assumption of how I felt on a daily basis. I think their experience at a younger age with patients with the disease will give them first hand experience with how it affects a patients life.

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