The modified curriculum was built around six one-hour lectures in the residency program’s core didactics. Three postgraduate year-four resident lecturers worked with the investigators to retain the original emphasis on differential diagnosis, risk assessment and psychopharmacological management while adding a dedicated psychotherapy segment to each session. That segment introduced a psychological model for the illness category, techniques associated with that model and a sample dialogue intended to demonstrate how the concepts might appear in conversation. The design deliberately placed psychotherapy within an established course, reflecting a broader problem in residency education: early trainees may have little time for separate instruction, even though acute inpatient work is an important setting for developing relational and psychological skills.

For psychotic disorders, residents were introduced to the aberrant salience model of psychosis and cognitive behavioral therapy for psychosis. The model links delusions and hallucinations to altered attention and salience, offering a framework for examining the evidence a patient uses to sustain a belief. Instruction emphasized an inquisitive, nonjudgmental stance, careful inquiry into perceptual experiences, alliance building and assessment of safety. For depression, the curriculum combined cognitive therapy with behavioral activation: residents learned to identify automatic thoughts involving hopelessness, unworthiness or self-inefficacy, use Socratic questioning to examine them and encourage engagement in physical and social activity. These approaches give junior clinicians a way to discuss psychological patterns while preserving the central psychiatric tasks of diagnosis, safety assessment and medical management.

The anxiety lecture used the same cognitive framework to address catastrophic thinking and exaggerated estimates of risk, alongside distress-tolerance techniques for somatic anxiety. For substance use disorders, residents were taught motivational interviewing rather than a confrontational model of change. They learned to recognize ambivalence as a normal feature of substance use, ask rather than dictate, elicit the patient’s own arguments for change and use those “change talk” to strengthen motivation. This orientation is particularly relevant in acute care, where patients may be medically unstable, ambivalent or asked to engage in treatment before they are ready to commit. Rather than treating resistance as a character defect, the method gives clinicians a way to explore what matters to the patient and connect that perspective with possible change.

Other sessions tackled interpersonal and personality dimensions of acute illness. A psychodynamic model of mania was used to explain how an acutely manic patient may exploit another person’s vulnerabilities to support grandiosity, test limits and shift responsibility onto the clinician. Residents were also taught to monitor countertransference and set boundaries. For borderline personality disorder, the curriculum presented both Marsha Linehan’s biosocial model and a brief introduction to Otto Kernberg’s object relations account of borderline personality organization. Dialectical behavior therapy skills included distress tolerance and emotion regulation, while transference-focused psychotherapy concepts included countertransference monitoring, gentle clarification and confrontation. Clinical vignettes from acute settings were used to make the more abstract concepts clinically legible, including the dynamics of splitting and projective identification.

Ten postgraduate year-one residents took part in the course. Because residents missed some sessions while covering vacation, night float or other duties, the investigators distributed optional, anonymous surveys before and after individual lectures, producing 90 survey sets. A five-point Likert scale measured confidence in understanding psychological features, comfort using psychotherapeutic interventions, likelihood of applying those interventions and the perceived helpfulness of the lectures. Six patient vignettes with multiple-choice questions assessed competency. The researchers used one-tailed Welch’s t-tests to compare average pre- and post-lecture ratings and a Fisher exact test for competency. The institutional review board determined that the curriculum evaluation did not constitute human-subjects research, while the dataset was made available from the corresponding author on request.

After the lectures, residents reported substantially greater comfort with the psychological features of psychiatric conditions, rising from a mean of 3.57 to 4.33 on the five-point scale. Comfort using psychotherapeutic techniques increased from 2.82 to 4.17, and the reported likelihood of using those techniques rose from 3.09 to 4.48. Each change was statistically significant at p less than 0.001. Participants also generally rated the lectures as very to extremely helpful for improving their psychotherapeutic technique. These findings are consistent with a familiar challenge in medical education: a short, structured intervention can increase learners’ confidence and intention to apply a skill, even when a small test cannot demonstrate that their actual performance has improved. The particularly large shift in reported willingness to intervene may be practically important, because a technique a resident does not feel able or willing to use cannot affect patient care.

Objective competency results did not improve significantly. Residents answered 92 percent of the multiple-choice questions correctly before the sessions and 96 percent afterward, a difference that the investigators did not regard as statistically significant. The authors noted that the near-ceiling baseline score suggested the test lacked discriminatory power. The result also illustrates why validated performance assessments are needed: vignettes may test recognition of concepts, but they do not necessarily show whether a resident can conduct an alliance-building interview, regulate countertransference or apply motivational interviewing with a real patient. The pilot therefore establishes feasibility and a promising signal of engagement, not proof that the curriculum changes long-term clinical competence or patient outcomes.

The teaching approach also suggests that psychotherapeutic expertise need not be concentrated entirely in experienced faculty. The course was delivered by several senior residents who were not described as psychotherapy experts, using prepared material, clinical examples and established models. Its success may reflect the accessibility of structured techniques that can be linked directly to a psychiatric condition: cognitive methods for depression and anxiety, motivational interviewing for substance use, alliance-focused CBTp for psychosis, and interpersonal or attachment-related frameworks for mania and borderline personality disorder. Future studies should test the curriculum across multiple residency programs, use larger and more diverse cohorts, track whether the changes persist after the lectures and measure performance with more demanding assessments. Even so, the pilot makes a clear case for a simple proposition: psychotherapy is not confined to outpatient clinics or the final stage of training, and acute care can become a deliberate classroom for learning how to understand and respond to the mind in distress.

Subject of Research: Pilot psychotherapy education for first-year psychiatry residents in acute psychiatric settings

Article Title: A Pilot Psychotherapy Curriculum for Early Psychiatry Residents in Acute Settings

Article References: Greenberg, N. R., Levit, J., & Gorun, A. (2026). A Pilot Psychotherapy Curriculum for Early Psychiatry Residents in Acute Settings. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02458-x

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02458-x

Keywords: psychiatry residency, psychotherapy training, acute mental health, medical education, cognitive behavioral therapy, motivational interviewing, psychodynamic therapy, resident education, clinical competence, Pilot, Psychotherapy, Curriculum

The research team, led by Nicole Sheridan and Katherine M. Matheson of the Children’s Hospital of Eastern Ontario Research Institute and the University of Ottawa, with collaborators including Sara Citron, Lara Postl, and Blair Hammond, set out to map exactly how IECMH education is delivered within Canadian residency programs. Between August and December 2023, program directors and associate program directors from every Royal College of Physicians and Surgeons of Canada accredited general psychiatry residency program and every child and adolescent psychiatry subspecialty program were invited to complete an anonymous survey. The questionnaire probed teaching practices, curricular structure, clinical exposure, perceived resident competence, and the barriers and facilitators that shape whether formal IECMH curricula can take root.

Nine program directors ultimately participated, four representing general psychiatry and five representing child and adolescent psychiatry. The numbers are small, but the population is finite and the response pattern is telling. Not a single general psychiatry program reported a mandatory rotation in infant and early childhood mental health, and most reported no dedicated IECMH teaching at all. In practical terms, a psychiatrist completing a five year general residency in Canada could graduate without any structured exposure to the assessment of infants, toddlers, and preschoolers, or to the parent child relationships that shape early emotional development.

The picture brightens somewhat in the subspecialty stream. Child and adolescent psychiatry programs reported greater clinical exposure, with most requiring an IECMH focused rotation. Yet even here, formal didactic teaching, the classroom based instruction that anchors most medical curricula, remained limited. No program of either type reported using e learning modules, a notable gap at a time when digital education has become a standard vehicle for spreading specialized content across geographically dispersed training sites. The result is a patchwork in which clinical exposure varies by institution and structured teaching varies by the enthusiasm and expertise of individual faculty.

When asked how well their programs educated residents in IECMH, the two groups diverged sharply. General psychiatry program directors commonly rated their programs as teaching the material not very well, while child and adolescent psychiatry directors generally selected moderately well. Both groups, notably, pointed to the same primary obstacle: limited faculty expertise. Infant and early childhood mental health sits at the intersection of developmental psychology, attachment theory, neuroscience, and clinical psychiatry, and clinicians with deep training in this area remain scarce. A program cannot teach what its faculty have not themselves been taught, and the survey suggests that bottleneck is now propagating through the training pipeline.

The scientific case for closing that gap is substantial. Decades of research, from John Bowlby’s foundational work on attachment onward, have established that the earliest relational environment exerts lasting effects on psychopathology and health across the lifespan. Adverse childhood experiences are strongly linked to poorer developmental and health outcomes in young children, and disruptions to parenting, including those driven by parental mental illness, are a well documented pathway of intergenerational risk. Neurobiological research on fetal and infant development shows that the brain’s early architecture is shaped by caregiving relationships, making the first years a period of unusual plasticity and unusual vulnerability. Canadian bodies, including the Royal College itself, have increasingly emphasized linking early brain and biological development to psychiatric practice.

Why does this matter for general psychiatrists who will never see a patient under the age of five? Because their adult patients were all once infants, and many of them are parents. Parental mental health disruptions affect parenting quality and child outcomes, meaning every psychiatrist treating an adult with depression, psychosis, or substance use disorder is, implicitly, also in a position to influence that adult’s children. A psychiatrist who cannot recognize early relational disturbance, who is uncomfortable advising a new parent, or who misses the developmental context of a family’s distress is working with an incomplete clinical toolkit. The survey’s authors frame IECMH competence as relevant to psychiatric practice broadly, not as a niche subspecialty concern.

The contrast with parallel fields is instructive. In pediatrics, a related national survey by an overlapping research group examined early relational health training in Canadian paediatric residency programs, part of a growing effort to quantify how well trainees are prepared to support the earliest caregiver child relationships. In reproductive psychiatry, American researchers demonstrated that a national standardized curriculum could effectively set common educational standards across programs. And within child and adolescent psychiatry, prior studies have argued explicitly that all child psychiatrists need infant mental health training and have proposed comprehensive models for delivering it. The Canadian survey extends this movement by documenting, from the program directors’ own perspective, how far psychiatry still has to go.

There is also an encouraging signal buried in the findings. All respondents endorsed IECMH training as important or very important, and all expressed strong interest in scalable, self directed educational approaches. That combination of acknowledged importance and appetite for flexible formats suggests the barrier is not conviction but infrastructure. Existing resources point toward what is possible: the American Academy of Child and Adolescent Psychiatry has developed online curriculum modules on infant and preschool mental health, and the Keystones of Development program has shown that online curricula can successfully teach residents to promote positive parenting in primary care settings. Adapting such models to Canadian psychiatry training, aligned with Royal College competency requirements, could bypass the faculty scarcity problem by delivering expert content consistently across every program.

The study’s limitations warrant honest framing. Nine respondents cannot represent every program with statistical precision, and self reported survey data reflect directors’ perceptions rather than direct measurement of resident competence. The authors note that the underlying data cannot be shared publicly because they contain potentially identifying information, though deidentified data may be available from the corresponding author under research ethics approval. Funded by the Happy Roots Foundation and approved by the CHEO Research Ethics Board, the study was published on 2 October 2026. Its central conclusion, however, is difficult to dispute: IECMH education in Canadian psychiatry residency is variable and inconsistently structured despite widespread recognition of its relevance. For a specialty whose interventions can echo across generations, the survey is less an indictment than a roadmap, identifying exactly where feasible, competency aligned curricula could transform how the next generation of psychiatrists understands the beginnings of the mind.

Subject of Research: Infant and early childhood mental health education in Canadian psychiatry residency training programs

Article Title: Infant and Early Childhood Mental Health Training in Psychiatry Residency: National Program Director Perspectives in Canada

Article References: Sheridan, N., Zarb, S., Citron, S., Postl, L., Hammond, B., & Matheson, K. M. (2026). Infant and Early Childhood Mental Health Training in Psychiatry Residency: National Program Director Perspectives in Canada. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02449-y

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02449-y

Keywords: infant mental health, early childhood mental health, psychiatry residency, medical education, program directors, Canada, curriculum development, child and adolescent psychiatry, attachment theory, early relational health, residency training, faculty expertise

The study, led by Adela-Georgiana Buciuc of the University of Miami Health System and Jackson Health System, together with Heidi Linden Kiziah and Zelde Espinel, set out to measure a problem that medical educators have flagged repeatedly over the past decade but rarely quantified at the earliest stage of psychiatric training. The researchers administered a voluntary, anonymous 19-item questionnaire to 43 junior psychiatry residents at a single academic institution. Twenty-nine residents completed the survey, a response rate of 67 percent, including nine first-year residents, twelve second-year residents, and eight third-year residents. The instrument, adapted from a needs assessment previously developed by Medina and colleagues, asked residents to rate their confidence across twelve clinical neuroimaging tasks and to describe their attitudes toward imaging in psychiatric practice, using a five-point Likert scale ranging from strongly disagree to strongly agree. The study was approved as exempt by the participating institution’s Institutional Review Board, and participation was fully anonymous.

The headline numbers are sobering. Baseline self-efficacy averaged just 2.18 out of 5.0 across all cohorts, well below the midpoint of the scale. Confidence was lowest for the modalities and skills that sit furthest from routine psychiatric work: residents reported the least confidence in interpreting positron emission tomography and single-photon emission computed tomography reports, with a mean score of 1.69, followed by recognizing functional neuroanatomy at 1.83 and independently interpreting brain magnetic resonance imaging studies at 1.86. These are not exotic skills. Functional neuroanatomy underpins nearly every conversation psychiatrists have about mood, psychosis, and cognition, and brain MRI is ordered routinely in the workup of first-episode psychosis and suspected dementia. The fact that trainees feel barely equipped to engage with these reports suggests a widening gap between what modern psychiatric practice demands and what residency curricula deliver.

Perhaps the most consequential finding is what the data reveal about the trajectory of learning over time. A one-way analysis of variance found no statistically significant difference in self-efficacy across training years: first-year residents averaged 2.00, second-years 2.35, and third-years 2.10, with F(2,26) equal to 0.83 and a p-value of 0.45. In other words, confidence did not grow with seniority. Three years of clinical rotations, call nights, and informal exposure to radiology reports produced no measurable gains in how equipped residents felt to interpret neuroimaging. The authors interpret this null result as evidence that unstructured clinical exposure alone is insufficient to build this competency, a conclusion with significant implications for how residency programs allocate teaching time.

Residents themselves appear acutely aware of the problem. Satisfaction with current neuroimaging knowledge was lowest among first-year residents, with a mean of just 1.22 out of 5.0, and levels of neurophobia, the well-documented anxiety that medical trainees experience when confronted with neurology and neuroscience content, remained elevated across all three training levels, with an overall mean of 2.86. Neurophobia is not a trivial phenomenon. Decades of medical education research have linked it to avoidance of neuroscience-heavy specialties and to superficial learning strategies that prioritize memorization over mechanistic understanding. The finding that imaging-related anxiety does not attenuate with seniority in the absence of deliberate instruction suggests that the problem is self-perpetuating: trainees who feel incompetent avoid the material, and avoidance prevents the competence from ever developing.

What makes the study particularly striking is the contrast between competence and motivation. While self-efficacy languished at 2.18 out of 5.0, composite attitude scores averaged 3.69, with broad agreement among respondents that a dedicated neuroimaging curriculum should be part of residency education. Residents, in short, want to develop this competency but do not feel equipped to do so. The authors argue that this dissociation indicates the barrier is primarily institutional rather than attitudinal. This distinction matters for program directors and educators, because interventions aimed at motivating learners are likely to miss the mark when the learners are already motivated. What is missing instead is structured instruction: dedicated didactic time, supervised reading of actual scans, and a curriculum that builds functional neuroanatomy and imaging interpretation progressively across the years of training.

The new data also sharpen a question left open by earlier work. Medina and colleagues, in a 2020 needs assessment published in the same journal, identified neuroimaging education as a meaningful gap in psychiatry training and called for a dedicated curriculum, but surveyed residents across all postgraduate years without specifying when such instruction should begin. The Miami findings indicate that the gap is already established at the very start of residency and does not narrow with seniority, providing a rationale for introducing neuroimaging instruction early rather than deferring it to elective or advanced years. Calls for structured neuroimaging and clinical neuroscience curricula have recurred throughout the past decade, including recent contributions in Neuropsychopharmacology and the Harvard Review of Psychiatry, yet the gap persists. The authors argue that the field now needs to move from repeated documentation of the problem toward actual implementation.

The study is not without limitations, and the authors are candid about them. The sample comes from a single institution, and 29 respondents is a modest number that limits statistical power and generalizability. The cross-sectional design captures a snapshot rather than a trajectory, so the flat self-efficacy curve across training years is inferred from comparing different cohorts rather than following the same individuals over time. Self-reported self-efficacy is also an imperfect proxy for actual interpretive skill, and a resident who underestimates their abilities is not the same as one who misreads a scan. Multisite studies that pair self-efficacy measures with objective assessments of interpretation would substantially strengthen the evidence base. Still, the consistency of the findings with a decade of prior literature lends them credibility, and the pattern of low confidence, high motivation, and no growth over time is difficult to explain away as an artifact of one institution’s culture.

Informed by these findings, the authors’ institution has already developed and implemented a structured, longitudinal neuroimaging curriculum, the design and evaluation of which will be reported separately. The study’s broader message extends beyond psychiatry. As imaging, genetics, and computational neuroscience reshape the biological understanding of mental illness, the psychiatrists who treat patients will need to engage with these tools confidently, not as spectators to a radiology report but as informed interpreters who can integrate imaging findings into clinical reasoning. The Miami data suggest that this engagement will not happen by osmosis. If neurophobia takes hold early and clinical exposure alone fails to build competence, then deliberate, early, and sustained instruction is not an educational luxury but a necessity. The residents, it turns out, are already asking for it.

Subject of Research: Neuroimaging self-efficacy and neurophobia among junior psychiatry residents

Article Title: Neuroimaging Self-Efficacy and Neurophobia Among Junior Psychiatry Residents: A Cross-Sectional Needs Assessment

Article References: Buciuc, A.-G., Kiziah, H. L., & Espinel, Z. (2026). Neuroimaging Self-Efficacy and Neurophobia Among Junior Psychiatry Residents: A Cross-Sectional Needs Assessment. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02442-5

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02442-5

Keywords: neuroimaging, psychiatry residency, neurophobia, self-efficacy, medical education, MRI, PET/SPECT, clinical neuroscience, curriculum design, residency training, functional neuroanatomy, needs assessment

The core of her argument is a structural one. Psychodynamic teaching, in many programs, is concentrated in outpatient psychotherapy clinics, where patients are stable and carefully selected for suitability. That placement is valuable for learning psychotherapy as a treatment modality, but it carries a hidden message: psychodynamic thinking matters only when you are conducting psychodynamic psychotherapy. Everything else—emergency calls, inpatient rounds, consultation-liaison work—appears to belong to a different, more scientific psychiatry. The result is a perceived split between the biological and the psychological that residents internalize early, and that curricula inadvertently reinforce by the geography of their own schedules.

Gorun contends that this split is illusory. Acute care settings, she argues, demand psychodynamic concepts just as much as the consulting room does. Understanding unconscious meaning, defenses, attachment patterns, transference and countertransference can help a psychiatrist make sense of crises, ruptures in the therapeutic alliance, impasses over medication, conflicts within the treatment team, and the varied ways patients respond to hospitalization or to a new diagnosis. On an inpatient unit, a patient’s sudden hostility toward a resident or an inexplicable refusal of medication may be legible only when read through these lenses. The psychodynamic framework, in this view, is not a niche skill reserved for selected cases but a general-purpose interpretive instrument for all of clinical psychiatry.

The timing of instruction matters as much as its location. Gorun proposes introducing psychodynamic principles in the first two postgraduate years, precisely when residents are caring for the most acutely ill patients and are most likely to be flooded by intense emotional reactions. Demoralization, helplessness, anger, rescue fantasies and avoidance are among the experiences she names—reactions that residents often interpret as personal failings or as evidence of unprofessionalism. When supervisors model how countertransference can be used as clinical information rather than suppressed as embarrassment, residents gain a vocabulary for experiences that otherwise feel isolating. Framing these reactions as data about the patient and the relationship, rather than as noise to be managed, may also reduce shame and burnout, a claim with obvious appeal in a profession struggling with trainee wellbeing.

Attitudes, however, are not shaped by timing alone. Gorun draws on Gabbard’s earlier warnings about how psychotherapy should not be taught: in ways that devalue other modalities, lean on jargon, separate psychotherapy from the rest of psychiatry, or handle the research evidence poorly—either neglecting it or overemphasizing it at the expense of clinical usefulness. Her prescription is to lead with the evidence base. Psychodynamic psychotherapy is an empirically tested treatment, and residents should learn early which patient groups benefit most, including those with complex or chronic depression, histories of childhood trauma, or comorbid personality disorders. Presenting psychodynamics as a modality with defined indications, rather than an unfalsifiable worldview, directly addresses the common assumption that it is not evidence-based.

A further barrier is the perception that psychodynamics is outdated and socially narrow. Some residents arrive in training believing it is unhelpful and inaccessible to patients from certain socioeconomic backgrounds. Gorun responds that the field’s contemporary landscape is considerably broader than its stereotype: community psychoanalysis has developed in recent years, and short-term, manualized, problem-focused psychodynamic psychotherapies have brought structure and brevity to a tradition once associated with open-ended treatment. Teaching this range of applications, she argues, is part of correcting the impression that psychodynamic work belongs only to a particular class of patient or a particular kind of practice.

The most substantive revision she proposes concerns theory itself. Contemporary psychodynamic theories describe how discrimination and structural inequalities contribute to symptom formation. Relational psychoanalytic theories emphasize that treatment always unfolds within a social and cultural context, and that the identities of both therapist and patient can powerfully influence what happens between them. Armed with this background, residents can examine—with what Gorun calls humility and curiosity—how a patient’s perception of similarities or differences in race, gender, sexuality or class, together with the resident’s perceived position of authority, shapes the therapeutic relationship. Exploring these dynamics openly with the patient, rather than leaving them unspoken, becomes a practical route to stronger alliances.

Gorun also addresses the discipline’s history directly. She notes that there is evidence the failure to acknowledge sociocultural bias within psychodynamic theory has turned promising residents away from engaging with the field altogether. Confronting that history, rather than defending against it, is presented as a necessary condition for recruiting a new generation of clinicians. She extends the point to systems: racialized dynamics in groups and institutions inevitably surface in training clinics, and a psychodynamic lens can help make them speakable, turning uncomfortable observations into opportunities for active change rather than silent attrition.

The argument, taken whole, is less a defense of classical doctrine than a rebranding of an interpretive method. What Gorun asks educators to do is make psychodynamic relevance visible: integrate psychodynamic formulation across every clinical setting rather than ghettoizing it in the psychotherapy clinic, teach concepts in experience-near language instead of technical jargon, tie theory to the real clinical dilemmas residents face with complex and challenging patients, and present contemporary theories that deepen understanding of identity and social context in the treatment relationship. Framed this way, psychodynamics becomes two things at once—a practical clinical lens that strengthens residents’ relationships with their patients, and an essential analytic tool embedded in formulation and treatment. Whether the reframing succeeds will depend on whether programs are willing to move the subject out of the clinic and into the emergency room, the inpatient ward and the supervision hour where residents actually live. The correspondence, published on 31 August 2026, arrives as a pointed challenge to the assumptions embedded in psychiatric curricula worldwide.

Subject of Research: Integrating psychodynamic concepts into contemporary psychiatry residency training

Article Title: Reframing Psychodynamics for Contemporary Psychiatry Training

Article References: Gorun, A. (2026). Reframing Psychodynamics for Contemporary Psychiatry Training. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02426-5

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02426-5

Keywords: psychodynamics, psychiatry residency, psychotherapy training, countertransference, biopsychosocial formulation, therapeutic alliance, relational psychoanalysis, medical education, evidence-based psychotherapy, trainee burnout, cultural bias, acute care psychiatry

The stakes of the question are considerable. Burnout and depression among resident physicians are among the most consistently documented problems in graduate medical education. A widely cited 2015 meta-analysis in JAMA found that more than one in four resident physicians screened positive for depression or depressive symptoms, and more recent work published in JAMA Network Open in 2024 has tracked the duration of new-onset depressive symptoms during residency, showing that the burden is not merely transient. Research in the New England Journal of Medicine has also linked long work hours to depression in first-year physicians. Against this backdrop, residency programs have experimented with a dizzying array of wellness initiatives, from resilience workshops to mindfulness sessions, often with disappointing results. Critics have argued that many such programs place the burden of coping on the individual trainee while leaving the underlying structure of work untouched, a mismatch captured in prior studies of wellness curricula that concluded that one size does not fit all.

The Toronto team approached the problem from a different angle. Rather than adding another wellness activity on top of an already saturated schedule, they asked what would happen if residents were simply given back a recurring, protected block of flexible time each week, time that could be used for learning, reflection, administrative catch-up, or recovery, according to each resident’s own needs. The idea, credited in the paper’s acknowledgements to Dr. Susan Abbey, was dubbed A&P time, and it was embedded into the routine operations of the residency program rather than offered as an optional extracurricular. The design principle was that the time had to be genuinely protected: shielded from clinical duties, pages, and the ambient pressure to be perpetually available.

This framing draws on a growing body of theory in medical education around what researchers call adaptive expertise. In contrast to routine expertise, which allows clinicians to perform familiar tasks efficiently, adaptive expertise is the capacity to handle novel, ambiguous, and complex situations, to reason through problems that do not map neatly onto prior experience. Scholars including Mylopoulos and colleagues have argued that medical education systems tend to optimize for routine competence while systematically underdeveloping the habits of reflection, experimentation, and self-directed inquiry that adaptive expertise requires. Unstructured time, paradoxically, may be one of the few reliable incubators of those habits. When every hour of a resident’s week is scheduled, there is no room for the exploratory, self-directed learning that turns knowledge into judgment.

There is also a practical precedent. A 2020 study in JAMA Otolaryngology–Head & Neck Surgery examined weekly protected nonclinical time in a surgical residency and found associations with lower burnout and improved well-being among residents. The Toronto case study extends this line of inquiry into psychiatry, a specialty where the emotional demands of the work are distinctive and where the boundary between professional and personal depletion can be especially porous. By treating the intervention as a program evaluation rather than a formal experiment, the researchers were able to capture rich, contextualized feedback from the residents who actually lived with the schedule change, analyzing their responses using established thematic analysis methods.

The regulatory environment matters here as well. Both the Accreditation Council for Graduate Medical Education in the United States and the Royal College of Physicians and Surgeons of Canada, which accredits the Toronto program, have general standards that require programs to protect time for education and to attend to trainee well-being. In practice, however, those requirements often collide with the relentless arithmetic of clinical service coverage. Education time is frequently the first casualty of staffing shortfalls, and wellness programming is frequently layered on top of unchanged workloads, producing what earlier researchers have described as mixed messages about wellness and work. The Toronto intervention is notable precisely because it attempts to reconcile the two: the protected block is framed simultaneously as learning infrastructure and as a well-being measure, on the theory that the two functions reinforce each other rather than compete.

The findings of the case study, as reported in the article, highlight how residents used and experienced the flexible time in ways that varied widely from person to person, echoing the earlier lesson that uniform wellness offerings fail because trainees’ needs are heterogeneous. Some residents directed the time toward scholarly projects or targeted study; others used it to catch up on the administrative backlog that otherwise bleeds into evenings and weekends; others treated it as recovery time. The unifying thread was not the specific activity but the experience of autonomy and protection, the knowledge that a defined portion of the week belonged to the resident rather than to the service. That sense of ownership, the authors suggest, is what converts a scheduling change into a support for both learning and well-being.

The study also engages with a deeper tension in medical training, one articulated in a 2024 New England Journal of Medicine perspective on distinguishing necessary from unnecessary discomfort in training. Medical education has traditionally valorized hardship, operating on the assumption that enduring difficulty is itself formative. But the evidence on resident depression and burnout has steadily eroded the case for indiscriminate suffering. The Toronto team’s intervention occupies a thoughtful middle position: it does not remove the genuine challenges of clinical work, which remain the core of learning, but it removes a specific and arguably unnecessary form of discomfort, the chronic scarcity of self-directed time. In doing so, it reframes well-being not as a set of coping skills to be taught but as a structural property of the training environment itself.

Methodologically, the work is a case study, and the authors are appropriately measured about what that means. It describes a single program’s experience, evaluated as exempt from review by the University of Toronto Research Ethics Board, with data and evaluation materials available on request from the corresponding author. The qualitative approach, grounded in Braun and Clarke’s thematic analysis, prioritizes depth and transferability over statistical generalization. The researchers acknowledge the residents who participated and note that their feedback directly shaped ongoing program development, an iterative quality that distinguishes program evaluation from one-off research. Funding was provided in part by an Academic Scholars Award from the Department of Psychiatry at the University of Toronto, awarded to Dr. Chaukos, and the authors report no conflicts of interest.

For residency programs elsewhere, the takeaways are likely to resonate well beyond psychiatry. The intervention is cheap, requiring no new curriculum, no additional faculty, and no novel technology, only the political will to defend a recurring block of time against the constant encroachment of service demands. The evidence base, spanning the otolaryngology burnout study, the broader literature on adaptive expertise, and now this Toronto case study, converges on a common insight: time is not a neutral container for training but an active ingredient in it. How a program structures a resident’s week sends a signal about what it values, and programs that protect flexible, self-directed time may be making a measurable investment in both the competence and the durability of the physicians they produce. As graduate medical education continues to grapple with a mental health crisis among trainees, the simplest interventions, giving residents back a few protected hours and trusting them to use them well, may prove among the most powerful.

Subject of Research: Weekly protected flexible time in a psychiatry residency as an intervention to support resident learning and well-being

Article Title: Unstructured Time, Structured Support: Weekly Protected Flexible Time to Support Resident Learning and Well-Being

Article References: Stergiopoulos, E., Berseneva, M., Tan, A., Mylopoulos, M., & Chaukos, D. (2026). Unstructured Time, Structured Support: Weekly Protected Flexible Time to Support Resident Learning and Well-Being. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02430-9

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02430-9

Keywords: residency training, physician well-being, burnout, medical education, adaptive expertise, protected time, psychiatry, graduate medical education, program evaluation, mental health, thematic analysis, University of Toronto

The distinction between role-play and real play may sound like a matter of semantics, but the research team argues it cuts to the psychological core of how therapy skills are actually acquired. Traditional role-play asks a resident to simulate a depressed patient while a colleague improvises therapeutic techniques at them. Both participants know the exercise is artificial, and that knowledge shapes behavior. The trainee-therapist may perform techniques mechanically, focused on hitting checklist items rather than responding to a human being. The trainee-patient, meanwhile, must fabricate distress, which can flatten the emotional texture that real clinical conversations demand. Real play attempts to close that gap. By inviting participants to discuss actual, self-selected experiences of a mild or moderate nature, the exercise preserves emotional authenticity while staying within safe boundaries, since no participant is asked to expose anything they are not willing to share.

The theoretical rationale for this approach draws on a substantial body of prior work. Reviews of clinical role-play in mental health education have documented both its value and its limitations: learners appreciate the opportunity to rehearse therapeutic communication, but they frequently report that simulated encounters feel stilted, unconvincing, or even embarrassing. Studies comparing peer counseling with role-playing in clinical psychology training have explored whether working with real, non-simulated material improves skill acquisition, and mixed-methods systematic reviews of cognitive behavioral therapy training have repeatedly flagged the emotional intensity of the learning process as a barrier for trainees. The Alberta team positioned their case study within this conversation, asking whether the emotional weight that residents carry into CBT training could be reduced by changing not the curriculum but the format of practice itself.

Methodologically, the study is a case study with a qualitative backbone, and the authors are transparent about that scope. The interventions were designed and delivered by Fu and Hibbard, while Pazderka contributed to the data analysis, and the team analyzed learner experiences using thematic analysis, the widely used method introduced by Virginia Braun and Victoria Clarke for identifying patterns of meaning across qualitative data. Their reporting follows established standards for qualitative research in medical education, which emphasize transparency about data collection, analysis, and the position of the researchers. Ethics approval to share the findings was granted by the human research ethics review board at the University of Alberta under protocol Pro00154080. The authors reported no conflicts of interest, and the data underlying the study are available upon request.

What emerged from the analysis, according to the study’s title and framing, are two linked outcomes: enhanced authenticity and reduced stress. The authenticity finding speaks to the felt quality of the practice sessions. When the conversation in a training exercise is anchored to a real experience rather than an invented one, the therapeutic micro-skills being taught, such as open questioning, reflective listening, guided discovery, and the collaborative shaping of a cognitive formulation, are exercised against genuine material. Learners reportedly found that this made the practice feel truer to what actual therapy demands, narrowing the notoriously difficult transfer gap between the classroom and the clinic. The stress reduction finding is equally consequential, because anxiety during supervised practice can itself interfere with learning, narrowing attention and encouraging defensive performance rather than open experimentation with new techniques.

The emotional dimension of CBT training is not a peripheral concern. Prior qualitative work with psychiatry residents has documented the lived experience of learning CBT as demanding and at times destabilizing, with trainees describing doubts about their competence and discomfort at being observed while attempting an unfamiliar therapeutic stance. Broader literature on impostor syndrome among physicians and physicians in training suggests that these feelings are common and can erode well-being across the trajectory of medical education. A scoping review published in 2025 extended that picture across medical undergraduates and postgraduate professionals, linking impostor feelings to measurable impacts on well-being. Against this backdrop, a training format that measurably reduces stress while preserving rigor has an obvious appeal, particularly in psychiatry, where national surveys as far back as 2007 have documented uneven and sometimes ambivalent resident perceptions of psychotherapy training.

The clinical context also matters. Cognitive behavioral therapy occupies a central position in evidence-based guidelines for major depressive disorder, including the 2022 clinical practice guidelines from the United States Department of Veterans Affairs and Department of Defense and the 2023 update from the Canadian Network for Mood and Anxiety Treatments. Teaching it well is therefore not an optional enrichment but a guideline-anchored obligation for residency programs. Yet the standard textbook accounts, exemplified by the widely used Beck and Beck volume now in its third edition, describe a sophisticated set of conceptual and technical skills that take years to integrate. If the rehearsal format itself adds avoidable anxiety, programs may be paying a hidden cost in both trainee well-being and skill consolidation. Real play offers a candidate for reducing that cost without diluting the material being practiced.

The authors are careful about the limits of what a case study can establish. Published as a case study in Academic Psychiatry, the work reports the experience of a specific educational intervention at a single institution rather than the results of a controlled comparison across cohorts. Thematic analysis captures patterns of meaning in participants’ accounts, not effect sizes, and the findings are shaped by the local curriculum, the facilitators, and the group involved. The team’s own reference list includes a systematic review of therapist resilience, underscoring that the well-being of clinicians in training is an active research field in its own right. What the case study contributes is a concrete, low-cost modification with a plausible mechanism, one that other programs can pilot, adapt, and evaluate rather than a definitive prescription for psychotherapy pedagogy everywhere.

Even so, the implications reach beyond a single residency seminar. Medical educators have long wrestled with the tension between simulation, which protects patients and allows safe repetition, and authenticity, which is what makes practice transfer to real encounters. Communication skills teaching in medicine has accumulated decades of guidance on maximizing the benefits of role-play, and interprofessional and counselor education have explored affective and relational pedagogies that engage learners’ genuine emotional lives. The Alberta findings align with a broader movement in health professions education that treats emotional authenticity not as a hazard to be managed but as a resource to be harnessed. If real play continues to show benefits in larger and more controlled studies, the humble swap of a fabricated patient for a real, carefully bounded personal experience could become a small but meaningful fix in one of psychiatry training’s most persistently stressful corners.

For now, the study stands as an invitation to experiment. Its authors suggest, through their design and framing, that the emotional architecture of skills training deserves the same careful engineering as the curriculum content itself. Residents learning CBT are being asked to do something genuinely difficult: to think in a new structured way while simultaneously attending warmly and flexibly to another person’s distress. Reducing the artificiality of the practice environment appears to lighten that double load, allowing trainees to be more fully present and, in the authors’ terms, more authentic. As psychotherapy remains a guideline-recommended treatment for depression and allied conditions, the question of how to train its practitioners humanely and effectively will only grow in importance. This case study offers an early, thoughtfully documented answer: make the play real, and the learning may follow.

Subject of Research: Real play versus role-play methods for reducing stress and enhancing authenticity in psychiatry residents' cognitive behavioral therapy training

Article Title: Real Play Enhances Authenticity and Reduces Stress in Learning Cognitive Behavioral Therapy

Article References: Fu, T., Hibbard, K., & Pazderka, H. (2026). Real Play Enhances Authenticity and Reduces Stress in Learning Cognitive Behavioral Therapy. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02427-4

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02427-4

Keywords: cognitive behavioral therapy, real play, role-play, psychiatry residency, medical education, psychotherapy training, qualitative research, thematic analysis, trainee stress, impostor syndrome, authenticity, University of Alberta

The term clinician scholar covers a spectrum of roles in which physicians combine clinical practice with scholarly activity, whether that activity is laboratory science, health services research, quality improvement, or education scholarship. In psychiatry, the stakes are unusually high. Mental illness accounts for an enormous share of the global burden of disease, yet psychiatric treatments often rest on an evidence base that is younger and thinner than that of many other medical specialties. The researchers point to earlier work, including a 2024 report in Academic Psychiatry by Bastidas-Bilbao, Ho, Sockalingam, and Sheehan, arguing that research training in psychiatry residency needs transformation to create a new pipeline of interdisciplinary researchers. The new study is the empirical groundwork for that transformation.

Methodologically, the project was designed as a quality improvement initiative rather than a conventional research study. The Office of Research Ethics at the University of Toronto deemed it a quality improvement project, and it was therefore exempt from formal research ethics review. That designation matters because it shaped how the team could gather information quickly and responsively from trainees. The investigators used two complementary data collection strategies: an online environmental-scan questionnaire distributed to psychiatry residents and fellows, and qualitative semi-structured interviews with a subset of trainees. The interviews were then subjected to thematic analysis, guided by the conceptual and design thinking framework for thematic analysis published by Virginia Braun and Victoria Clarke in Qualitative Psychology in 2022.

The analytical approach deserves attention because it reflects a broader shift in medical education research. Rather than treating thematic analysis as a mechanical coding exercise, the Braun and Clarke framework emphasizes reflexive, conceptually informed decisions at every stage of design, from how questions are phrased to how themes are constructed. The University of Toronto team also acknowledged the assistance of Drs. Song Min Lee, Christina Truong, and Nikhita Singhal in preparing and analyzing the qualitative interview data. Within the project itself, the authors describe a clear division of labor: Ho and Sheehan designed and directed the project, Sockalingam served as a mentor, and Ananya Garg and Eulaine Ma carried out the resident interviews and the thematic analysis that underpins the findings.

The study did not emerge in a vacuum. The University of Toronto’s Department of Psychiatry operates a dedicated Clinician Scholar Program, and the new needs assessment was explicitly framed as an evaluation of residents’ interests, experiences, and needs in relation to that kind of training infrastructure. Elsewhere in Canada, research-track programs for psychiatry residents have been described at three institutions in a 2014 review in the Canadian Journal of Psychiatry by Bhat, Leong, Lee, Voineskos, Daskalakis, Lam, and colleagues, and a 2017 report in Clinical and Investigative Medicine by Yin, Steadman, Apramian, and colleagues charted a path for training the next generation of Canadian clinician-scientists more broadly. Parallel efforts in family medicine, such as the fifteen-year outcome analysis of Canada’s first clinician scholar program published by Workman, Albert, and Norman in Canadian Family Physician in 2019, and the enhanced-skills clinician scholar program described by Lacasse and colleagues in the Canadian Medical Education Journal the same year, demonstrate that the model has been tested across disciplines.

What distinguishes the Toronto approach is its insistence on listening to trainees before building or expanding programming. Needs assessments of this kind serve a specific technical function in curriculum development: they establish the gap between the current state of training and the competencies residents will need, so that educational resources are directed at demonstrated deficits rather than assumed ones. By combining a broad questionnaire, which functions as an environmental scan of the entire training population, with in-depth interviews, the design captures both the distribution of interests across the residency cohort and the textured reasons behind individual choices. That mixed qualitative design is particularly well suited to questions where the answer is not a simple yes or no but a map of motivations, barriers, and unmet expectations.

The scholarly context also reveals why the psychiatric pipeline is fragile. A widely cited 2011 paper in Academic Medicine by Parker, Burrows, Nash, and Rosenblum argued that evaluating clinician scientist programs requires going beyond the classic Kirkpatrick framework of training evaluation, shifting the question from whether a program works to how it works. That reframing acknowledges that the outcomes of physician-researcher training, such as grant funding, publications, and sustained academic careers, unfold over decades and depend on mechanisms that simple outcome metrics cannot capture. Meanwhile, a 2017 study in BMC Medical Education by Holmes, Karlin, Stonington, and Gottheil reported the first nationwide survey of MD-PhDs in the social sciences and humanities, documenting distinct training patterns and career choices for physician-scholars whose work sits outside the biomedical laboratory. Psychiatry, which draws heavily on the social sciences, humanities, and clinical psychology, sits squarely in that interdisciplinary territory.

Indeed, the humanities dimension of the project is not incidental. The study was funded in part through a Medical Humanities Education Matching Funding Grant, and the broader literature suggests this is more than a stylistic choice. A 2018 multi-institutional survey published in the Journal of General Internal Medicine by Mangione, Chakraborti, Staltari, Harrison, Tunkel, Liou, and colleagues found that medical students’ exposure to the humanities correlated with positive personal qualities and reduced burnout. For a specialty in which burnout and emotional exhaustion are well documented occupational hazards, integrating humanistic and scholarly training may serve a dual purpose: cultivating the reflective capacities that good research demands while protecting the wellbeing of the trainees themselves. The Toronto team’s framing of clinician scholarship as an educational enterprise rooted in the medical humanities signals an expansive vision of what research training can be.

The institutional footprint of the project extends beyond a single department. The author team spans the Leslie Dan Faculty of Pharmacy, the Department of Psychiatry within the Temerty Faculty of Medicine, the Centre for Addiction and Mental Health, and University Health Network’s Toronto General Hospital and Centre for Mental Health, reflecting the multi-site reality of modern academic psychiatry in Toronto. The work was also shared with the international medical education community before publication: the team presented the project as a poster at the 2023 Association for Academic Psychiatry Annual Meeting and as an online short communication at the 2023 AMEE conference, the annual gathering of the International Association for Health Professions Education. That trajectory, from local needs assessment to international presentation to peer-reviewed publication, illustrates the standard pathway by which educational innovations are tested, disseminated, and adopted.

The corresponding author, Certina Ho, and her colleagues report no conflicts of interest, and the datasets underlying the study are not publicly available, a restriction the authors attribute to the need to protect the privacy and confidentiality of the residents and fellows who participated. For the field, the significance of the work lies less in any single data point than in its methodological stance: that the design of clinician scholar training should begin with systematic evidence about the people it is meant to serve. As departments of psychiatry worldwide grapple with how to replenish a shrinking cadre of physician-researchers, the Toronto study offers a template, pairing an environmental scan with reflexive qualitative analysis to surface what residents actually want from research training, what they have experienced so far, and where the gaps lie. The next step, translating those findings into curricula that measurably expand the pipeline of interdisciplinary psychiatric researchers, is the challenge the team’s earlier work has already set in motion.

Subject of Research: Needs assessment of psychiatry residents' interests, experiences, and training needs for clinician scholar development

Article Title: Training the Next Generation of Clinician Scholars in Psychiatry: Understanding Residents’ Interests, Experiences, and Needs

Article References: Ho, C., Ma, E., Garg, A., Sockalingam, S., & Sheehan, K. A. (2026). Training the Next Generation of Clinician Scholars in Psychiatry: Understanding Residents’ Interests, Experiences, and Needs. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02414-9

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02414-9

Keywords: psychiatry residency, clinician scholar, medical education, research training, thematic analysis, needs assessment, qualitative research, physician-scientist pipeline, University of Toronto, academic psychiatry, medical humanities, curriculum development

The study was designed as a brief report but carries outsized practical significance. Between 2025 and 2026, the research team delivered an identical course across four psychiatry residency programs in the Northeastern United States, allowing them to evaluate whether the educational effect held across different institutions, faculty cultures, and trainee cohorts. This multi-site approach matters because single-site curriculum evaluations can be confounded by local enthusiasm, a charismatic lecturer, or an unusually motivated group of residents. By replicating the intervention at four programs, the authors strengthened the case that the improvements they observed reflect the curriculum itself rather than idiosyncrasies of any one training environment.

The curriculum was organized into six modules delivered over six hours, covering foundational concepts and evidence as well as clinical considerations. That structure followed the well-established six-step approach to curriculum development for medical education articulated by Thomas, Kern, and Hughes, a framework widely used in graduate medical education. The modules moved residents from basic pharmacology and history through the current state of clinical trial evidence, and then into the practical territory that residents will actually encounter in clinics and emergency departments: what the evidence supports, what it does not, and how to talk to patients who arrive with questions shaped by media coverage, anecdote, or marketing.

Assessment was built into the design from the start. Participants completed anonymous pre-course surveys before the first module and post-course surveys after the final one. Of the forty trainees who participated across the institutions, thirty-four completed the pre-course survey and twenty-two completed the post-course survey—a retention pattern typical of voluntary educational evaluations in busy residency programs, though one that the authors appropriately acknowledge in interpreting the results. The surveys captured three distinct dimensions: self-assessed knowledge, performance on a knowledge quiz, and confidence in counseling patients across specific domains including clinical research, harm reduction, and treatment risks.

The baseline findings were as revealing as the outcomes. Most trainees reported minimal prior didactic exposure to psychedelic medicine, confirming what earlier survey work had suggested. A previous study by the same research group, published in International Review of Psychiatry, surveyed psychiatric residency program directors and documented how rarely formal psychedelic content appears in accredited training. Other work by Barnett and colleagues found that psychiatrists at professional conferences reported limited knowledge of the field, and a 2025 survey in the Journal of Psychoactive Drugs concluded that trainees feel unprepared for advances in psychedelic medicine. The new study’s baseline data place four residency programs squarely within that national pattern.

After the course, the changes were statistically significant on the measures that matter most for clinical readiness. Self-assessed knowledge improved, and so did scores on the objective knowledge quiz, indicating that the gains were not merely an illusion of confidence. Trainees also rated their understanding of two complementary concepts more highly: the rationale for psychedelic treatments and the limitations of the evidence base. That pairing is deliberate and pedagogically important. A curriculum that teaches only mechanisms and promises risks producing uncritical enthusiasm; one that teaches only skepticism risks leaving physicians unable to engage with a fast-moving scientific literature. Measuring both dimensions suggests the course designers aimed for calibrated judgment rather than advocacy.

The most substantial improvements, according to the authors, appeared in counseling confidence. Residents reported greater confidence across domains covering clinical research—helping patients interpret what a trial result does and does not mean—along with harm reduction, a framework for reducing negative consequences of substance use that many patients will ask about as access expands, and treatment risks, including the psychiatric and physiological considerations that accompany serotonergic hallucinogens. For trainees who may soon face patient questions in routine appointments, this shift from abstract knowledge to practical conversational competence is arguably the study’s central contribution.

Just as telling is what did not change. Baseline interest in psychedelic medicine was already high when residents began the course, and it did not increase significantly afterward. Nor did the course significantly alter trainees’ plans to pursue opportunities in the field. The authors interpret this null result as a feature rather than a failure: the curriculum improved knowledge and counseling skills without overinflating enthusiasm for psychedelics as a clinical enterprise. In an area of medicine where public hype has at times outrun the evidence, an educational intervention that raises competence while leaving excitement levels untouched represents a meaningful calibration achievement. It suggests the course functioned as science education rather than promotion.

The findings arrive at a pivotal moment for the field. Regulatory decisions on psilocybin-based therapies for depression are advancing, clinical trials continue to multiply, and thePsychedelic Education Partnership launched in March 2026 with the explicit goal of advancing evidence-based education for the healthcare workforce. Meanwhile, the funding landscape reflects growing institutional seriousness: the curriculum described in this study was developed with support from the Heffter Research Institute, a long-established funder of psychedelic research, specifically to create residency and fellowship teaching materials. The study team spanned Johns Hopkins, NYU Grossman School of Medicine, Yale, Columbia, the New York State Psychiatric Institute, the University of Vermont, King’s College London, and Stanford, indicating the depth of academic investment in training infrastructure.

Limitations remain and deserve attention. The sample of forty trainees, with twenty-two completing post-course assessment, is modest, and the anonymous survey design, while ethically appropriate and exempted from full-board review by the Johns Hopkins Institutional Review Board, cannot track individual knowledge retention over time. The study measured immediate post-course outcomes rather than durable learning months later, and it assessed one region of the United States. Still, the multi-site consistency of the improvements, the alignment between subjective and objective knowledge gains, and the carefully preserved baseline of enthusiasm together make a strong case that standardized psychedelic medicine curricula can be implemented at scale. As patients increasingly bring questions about psilocybin, MDMA-assisted therapy, and related treatments into psychiatric offices, the study suggests that the answer to the training gap need not be a full semester of coursework—six well-designed hours, replicated across institutions, may be enough to prepare residents for the conversations they will actually have. For residency programs weighing whether and how to add this content, the study provides a template, an assessment framework, and evidence that the investment pays off in exactly the competence that clinical practice will demand.

Subject of Research: Evaluation of a standardized psychedelic medicine curriculum for psychiatry residents across four U.S. residency programs

Article Title: A Multi-Site Evaluation of a Psychedelic Medicine Curriculum for Psychiatry Trainees

Article References: Yaden, M. E., O’Donnell, K. C., Roberts, D. E., Goldway, N., Tiwari, P., Ching, T. H. W., Hokanson, J., Gukasyan, N., Appold, B., Glick, G., Kelmendi, B., Ross, S., & Pittenger, C. (2026). A Multi-Site Evaluation of a Psychedelic Medicine Curriculum for Psychiatry Trainees. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02444-3

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02444-3

Keywords: psychedelic medicine, psychiatry residency, medical education, psilocybin, curriculum evaluation, harm reduction, counseling confidence, graduate medical education, psychopharmacology, clinical trials, trainee knowledge, Academic Psychiatry

The authors begin with a deceptively simple question that the primary literature has largely ignored: who administers LAIs? In their experience across multiple institutions, practices vary dramatically. In some settings, injections are delivered exclusively by allied health professionals such as nurses, while physicians confine themselves to the prescription pad. In others, including community mental health centers, street psychiatry teams, assertive community treatment programs, solo private practices, and teaching hospitals where faculty must instruct trainees, the prescribing physician administers the injection directly. This patchwork of practice raises an obvious educational question: if the skill may be needed in practice, shouldn’t residency guarantee exposure to it?

The regulatory landscape offers little clarity. The Accreditation Council for Graduate Medical Education requires that psychiatry residents perform all “medical, diagnostic, and surgical procedures considered essential for the area of practice,” but provides no specific enumeration of which procedures qualify. The result, the authors report based on their own experience and communications with colleagues, is wide divergence among United States programs. At the University of Illinois Chicago, LAI administration is a required learning objective in the postgraduate year three and four, with residents expected to inject patients in clinic. At Northwestern Medicine, by contrast, injections are handled exclusively by nurses and support staff, and residents receive no opportunity to learn the procedure at all. Two prestigious programs in the same city, in other words, produce graduates with fundamentally different procedural skill sets.

The educational argument for requiring LAI training is compelling on its face. Experiential learning, the authors argue, sticks in ways that textbook reading does not. A resident who orders haloperidol decanoate and then draws up the correct volume from a multidose vial will understand dosing more deeply than one who merely reads about it. A resident who examines an injection site reaction and participates in its management gains clinical intuition that a secondhand description from a nurse cannot convey. Procedural competence also deepens prescriber empathy and knowledge, which in turn shapes how confidently physicians discuss these treatments with ambivalent patients.

The public health stakes are considerable, because LAIs are dramatically underutilized. Studies cited in the commentary show that only 19 to 30 percent of patients with schizophrenia are prescribed LAIs, and an analysis of the National Mental Health Services Survey found that only 30 percent of surveyed providers prescribe them at all. A major driver is prescriber knowledge and attitude: many psychiatrists view LAIs as a “last-resort” treatment or assume they are less effective in first-episode psychosis, beliefs contradicted by current evidence. Crucially, greater knowledge about LAIs is associated with more positive attitudes toward them. The implication is that residents who administer LAIs during training may be more likely to prescribe or deliver them afterward, slowly eroding the attitudinal barriers that keep an effective treatment class on the shelf.

Hands-on experience may also improve the therapeutic conversation itself. Initiating an LAI is often a delicate negotiation, since patients frequently have mixed feelings about injections versus oral medication, and some decline them because injections feel controlling or coercive. Notably, psychiatrists cite injection site pain as a reason for reluctance, yet only a minority of patients report it as a barrier, suggesting that unfamiliar prescribers misjudge the patient experience. Research also shows that the way a provider offers an LAI influences whether the patient accepts it. A physician who administers the injection personally may signal genuine faith in the treatment, reinforcing the therapeutic alliance, improving adherence, and ultimately increasing both patient and prescriber satisfaction.

There are career and access arguments as well. Some positions specifically require physicians who can administer LAIs, and graduates with the skill are more competitive for them; learning in residency offers a more structured, supportive environment than picking the technique up in practice. In resource-poor regions without support staff, a psychiatrist who can deliver injections may be the only person able to do so across a large geographic area, making the skill a matter of access, not just convenience. Offering both oral and long-acting formulations, tailored to individual patient factors, the authors contend, simply constitutes higher quality care.

Yet the commentary is careful to present the counterarguments, and they are substantial. Residents themselves often describe administering LAIs as repetitive, comparing it to drawing blood, with educational value that diminishes over years of exposure. Residency already presents an overwhelming range of learning objectives, and adding another risks work compression. The ACGME defines “non-physician obligations” as duties normally performed by nursing, allied health, transport, or clerical staff, and injection administration could plausibly fall under that umbrella, though the definition remains controversial. Burnout looms over the entire debate: up to 75 percent of resident physicians report symptoms of burnout, and the American Medical Association’s top cited stressors include too many administrative tasks and inadequate support staff. Layering a procedural requirement onto that load, critics would argue, only deepens the problem.

Practical infrastructure poses another obstacle. Proper LAI training demands staffing, pharmacy support, clinic space, supplies, scheduling, documentation, and navigation of state and institution-specific policies about whether residents may even perform the task. Many resident clinics, in the authors’ experience, lack key infrastructure or struggle to sustain it over time, and asking trainees to learn injections in an under-resourced clinic risks pushing them outside their comfort zone while degrading the patient experience. There is also a macro-level question: with a projected shortage of between 14,280 and 31,091 psychiatrists in the 2020s, is physician time spent holding a syringe the best allocation of a scarce resource, or should injections remain with allied health professionals?

Teng and Zimmerman come down, on balance, in favor of expanded training. They suggest programs could either mandate LAI training for all residents, maximizing public health benefit at the cost of significant resources, or offer it as an elective, capturing motivated trainees while risking low uptake. Either path requires deliberate support: protected time outside other clinical duties, instruction from qualified experts including pharmacists, nurses, and attending physicians, written reference materials, repeated observed practice with patients from continuity clinics, real-time supervision on request, extended 45-minute appointment slots to avoid work compression, and a clinical experience lasting at least six months to cover initiation, efficacy monitoring, and adverse effect management. The authors frame the debate as emblematic of a broader tension in graduate medical education, balancing educational and public health benefits against resident workload and burnout, and they call for research to characterize the diversity of educational approaches, codify best practices, and quantify the true costs and benefits of psychiatrists administering LAIs during training. Whether residency programs heed the call may shape not just a generation of psychiatrists’ skill sets, but the accessibility of one of psychiatry’s most underused treatments.

Subject of Research: Whether psychiatric residents should be required to learn to administer long-acting injectable medications during training

Article Title: Should Residents Be Required to Administer Long-Acting Injectables?

Article References: Teng, T. Z., & Zimmerman, E. C. (2026). Should Residents Be Required to Administer Long-Acting Injectables?. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02441-6

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02441-6

Keywords: long-acting injectables, psychiatry residency, medical education, antipsychotics, ACGME, resident burnout, schizophrenia, medication adherence, workforce shortage, psychopharmacology, clinical training, patient care

The research, led by Kamini Vasudev of the Schulich School of Medicine and Dentistry at Western University, together with James Ross, Arlene G. MacDougall, Emma Kalapun, and Tara A. Burra of the University of Toronto, set out to answer a deceptively simple question: what are Canadian psychiatry residents actually being taught about improving the systems in which they will practice? In 2024, the team distributed a Qualtrics survey to all seventeen Canadian psychiatry residency programs, asking program directors to confirm whether their program had a quality improvement curriculum and, if so, to describe its content and their experiences delivering it. To triangulate the survey data, the researchers also reviewed the websites of every program for any mention of quality improvement education.

The response rate alone tells part of the story. Twelve of the seventeen programs, or 70.6 percent, replied to the survey. Among those twelve, eight, or 66.7 percent, indicated that they deliver a quality improvement curriculum. But only five of those eight, representing 41.7 percent of respondents, shared a structured curriculum when asked, while the remaining three did not provide one. Four programs, a full third of respondents, reported that they do not deliver a quality improvement curriculum at all. Two of those four teach introductory quality improvement content, with one program sharing PowerPoint slides from a lecture, and the other two reported the complete absence of any formalized quality improvement curriculum or related materials.

The picture darkens further when the five non-responding programs are considered. The researchers turned to the public websites of these programs as a proxy for what they might offer. Only one of the five mentions quality improvement work on its psychiatry residency website, and even that reference appears as a possible elective nonclinical rotation. The remaining four programs have no mention of quality improvement anywhere on their websites. Taken together, the survey and website review paint a portrait of a national training landscape in which a psychiatry resident’s exposure to quality improvement depends heavily on where they happen to train, ranging from structured curricula with shared materials, to a single introductory lecture, to nothing whatsoever.

Why does this matter so much? The technical answer lies in what quality improvement actually is. Unlike clinical research, which seeks to generate generalizable knowledge, quality improvement applies iterative cycles of measurement and change, often formalized as the Plan-Do-Study-Act cycle, to local systems of care. Practitioners identify a gap between current performance and a desired standard, define measurable outcomes, analyze the processes and contextual forces driving the gap, intervene, remeasure, and adjust. The skill set draws on epidemiology, data literacy, human factors engineering, and implementation science. It is the mechanism by which health systems convert good intentions into reliably better care, and it is increasingly embedded in the accreditation architecture of medical education on both sides of the border.

In Canada, the Royal College of Physicians and Surgeons of Canada requires psychiatry residents to demonstrate competencies in quality improvement under the CanMEDS framework, which positions the physician not only as a medical expert but also as a scholar, leader, and health advocate. The framework’s 2015 iteration explicitly elevated the role of physicians as agents of system-level improvement. In the United States, the Accreditation Council for Graduate Medical Education embeds quality improvement and patient safety requirements in its Common Program Requirements and in specialty-specific milestones. A 2018 content analysis of twenty-six sets of ACGME milestones, cited in the study, concluded that every graduating resident needs foundational knowledge in quality improvement and patient safety. The Association of American Medical Colleges has likewise published competencies in quality improvement and patient safety spanning the entire learning continuum, and recent cross-specialty analyses of entrustable professional activity guides have asked whether quality and safety are adequately represented in the tasks trainees must be trusted to perform.

Against this regulatory backdrop, the Canadian findings read as a gap between mandate and reality. The study’s authors argue that action is needed to provide quality improvement education to all residents, not only to meet certification requirements but also to address unmet societal mental health care needs. That second rationale is not rhetorical decoration. Mental health care in Canada, as in much of the world, faces chronic access problems, long wait times, and well-documented variability in the quality of care delivered. Research cited in the paper has documented changing practice patterns among Ontario psychiatrists with implications for access, and international work has emphasized that measuring and improving the quality of mental health care is a global priority. Youth mental health, in particular, has been described by Canadian researchers as deserving top priority in health care planning. When the system charged with training the next generation of psychiatrists leaves a third of its trainees without formal quality improvement education, it forfeits a powerful lever for addressing those systemic failures.

The study also situates itself within a substantial literature on how quality improvement should be taught, and why teaching it well is difficult. Realist reviews of quality improvement curricula in undergraduate and postgraduate medical education have identified the characteristics of successful programs, including experiential learning, protected time, faculty mentorship, and integration with real clinical projects rather than classroom abstraction alone. Systematic reviews have repeatedly found that lecture-based teaching produces knowledge gains but that durable skill development requires residents to actually conduct improvement projects within their clinical environments. Prior studies in psychiatry specifically have tested various models: a prospective cohort study found that an experiential quality improvement training program during residency improved residents’ confidence and knowledge; work on residents-as-teachers showed gains in quality improvement knowledge and skills; and a 2021 study identified barriers to resident engagement in quality improvement initiatives in psychiatry, including time pressures, competing clinical demands, and a perceived lack of relevance. More recent contributions have developed and evaluated dedicated quality improvement curricula for psychiatry residents, contextualized quality improvement and systems-based practice within psychiatric clinical teaching settings, and even created novel leadership roles, such as patient safety and quality improvement resident representatives, to improve peer engagement with root cause analyses.

What the new Canadian survey adds to this literature is a national baseline, and the baseline is sobering. The authors describe considerable variability in postgraduate quality improvement education practices across Canadian psychiatry programs, a diplomatic phrasing for a system in which some residents graduate having led data-informed improvement projects and others graduate having never encountered the discipline beyond, at best, a single lecture. The methodological approach, combining direct survey of program directors with systematic website review, has inherent limitations that the authors implicitly acknowledge: program directors’ self-reports may not capture informal teaching, and website silence does not prove curricular absence, as the non-responding programs could not be directly assessed. Still, the convergence of the two data sources, with two responding programs reporting a complete absence of formalized quality improvement education and four non-responding programs showing no online trace of it, suggests the variability is real rather than an artifact of measurement.

The implications extend beyond Canada’s borders. Psychiatry residency programs in the United Kingdom operate under Royal College of Psychiatrists curricula, and American programs face ACGME requirements, yet the Canadian experience suggests that formal requirements do not automatically translate into uniform implementation. The study’s authors, who have themselves published a primer on applying quality improvement to clinical practice for psychiatrists and an evaluation of a quality improvement module for psychiatry residents, frame the solution as a matter of both compliance and mission. Certification bodies can demand competence, but the deeper argument is that psychiatrists equipped with quality improvement skills are better positioned to close the persistent gaps in mental health care that no individual clinician, however skilled, can fix alone. As health systems worldwide grapple with rising mental health needs and constrained resources, the finding that a third of Canadian psychiatry programs report no formal quality improvement curriculum is less a bureaucratic footnote than a warning about how the specialty’s future workforce will, or will not, be prepared to improve the systems it inherits.

Subject of Research: The status of quality improvement education in Canadian psychiatry residency programs

Article Title: Status of Quality Improvement Curricula in Psychiatry Residency Programs Across Canada

Article References: Vasudev, K., Ross, J., MacDougall, A. G., Kalapun, E., & Burra, T. A. (2026). Status of Quality Improvement Curricula in Psychiatry Residency Programs Across Canada. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02432-7

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02432-7

Keywords: quality improvement, psychiatry residency, medical education, Canada, curriculum, patient safety, CanMEDS, graduate medical education, program directors, mental health care, survey study, Royal College