It’s ten o’ clock – do you know where your kids are (seeking mentorship)?

1. It’s ten o’ clock – do you know where your kids are (seeking mentorship)? Anonymous online mentorship and peer support in psychiatry. Jason P. Caplan, MD1; Scott A. Oakman, MD, PhD2,3; Edward M. Zawadzki, DO4 1Department of Psychiatry, Creighton University School of Medicine at St. Joseph’s Hospital and Medical Center, Phoenix, AZ 2Department of Psychiatry, Regions Hospital, St. Paul, MN 3Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 4Treasure Coast Forensic Treatment Center, Indiantown, FL BACKGROUND PSYCHIATRY CONTROVERSIES Most Popular Threads by Number of Views 2009-2010 The content of the SDN Psychiatry forum has a fairly regular annual cycle of prominent topics in concert with the academic year. Towards the end of summer, questions about the process of residency application and the match begin to surface. Over the following months, discussion progresses to perceived strengths and weaknesses of residency programs, announcements of interview invitations, reviews of programs based on interview days, rank list dilemmas, and finally announcement of match results (with attendant posts of congratulations or commiserations). As our charts demonstrate, >50% of all new posts in the past academic year were focused on issues regarding the match and residency training, and the 3 most frequent viewed threads were directly related to the match process. Despite the primary focus on issues of residency training, other areas of frequent discussion include clinical dilemmas, career options, and psychiatry in popular culture. There are a number of topics that arise with some regularity that require action on the part of the moderator. A frequent example of a post that warrants immediate closure is a request for direct medical advice. Questions such as “How do I take myself off Effexor?” are not uncommon. These posts are always met with a standard response encouraging the user to seek medical or professional help, with a warning that SDN is not to be used for medical advice. Awareness of countertransference to a particular member and monitoring of feelings aroused by certain subjects are also important skills for effective moderation. For example, a psychology trainee might start a thread in the psychiatry forum celebrating the passage of a prescribing bill for psychologists in a certain state and add that this signals the impending death of the field of psychiatry. While seen by some as “trolling” (starting an argument on the internet for the sole purpose of rousing a negative response), it is the job of the moderator (regardless of their own feelings on the subject) to allow posting to continue until useful discussion is exhausted or until a TOS violation occurs. Posts from Scientologists and other members of the “anti-psychiatry” movement are also venues for careful moderation. Training programs themselves are not immune from controversy. Disgruntled residents or unmatched applicants may post uncomplimentary reviews of a program or otherwise cast aspersions on the quality of the faculty or training. It is not uncommon in these situations for trainees at the program in question to rise its defense. Such discussions can often become quite intense and require intervention by the moderators. Using the internet, medical trainees of all disciplines can seek mentorship outside the walls of their own institution at any hour of the day. Student Doctor Network (SDN) is a non-profit online community focused on trainees in all aspects of healthcare. Participants range from high-school students to established attending physicians. With over 100 volunteers and over 40,000 members, SDN is the largest online community dealing specifically with pre-health and health professionals in a web-based forum. Formed in 1999, the site has grown to over include over 60 specialty specific forums and sub-forums. The psychiatry forum of SDN is a vibrant locus of discussion of many issues pertinent to psychiatric training and practice receiving thousands of hits daily. Medical students and residents use the forum to consult with each other and attendings on issues of clinical practice and to voice the fears and frustrations they face in the course of their training. Anonymity on the site is preserved by the use of screen-names for identification. For example, on SDN, the authors are known only as Doc Samson (JPC), Old Psych Doc (SAO), and Anasazi23 (EMZ). 2009-10 Interview Offers Thread – 25,266 Psych Interview Trail 08-09 Season – 21,158 Official Interview Review Thread – 19,701 Oregon House Bill 2702 – 14,310 MODERATION/MENTORSHIP Child Psych is Miserable – 13,007 Moderating such a large forum may be viewed as a novel mentorship role in psychiatry. SDN handles this task by enlisting moderators, divided by experience level into moderators, super moderators, advisors, and administrators. Moderators peruse the forums on a frequent basis and police the threads to ensure that the topics and tone of discussions remain appropriate, civil, and within the terms of service of the site (TOS). Universal moderator duties include editing of profanity, warnings of repeat offenders, and monitoring for unapproved advertisements or other violations of TOS. The clinical skill set of the psychiatrist may be of particular benefit in the redirection of members that violate TOS and in managing the angry responses that can result from official warnings about these violations. After establishing a consistent presence on the forum, moderators and other senior members often receive direct requests for advice or mentorship, either in open discussion on the forums or via the “personal message” function of the site (which essentially serves as a site specific e-mail system). These may include requests for guidance on residency applications, clinical questions, or negotiating conflict with peers or supervisors. Members may feel more comfortable raising these issues in an anonymous setting in order to avoid discord in their own training setting. Subject Breakdown of New Threads 2009-2010 CONCLUSIONS Participation in online professional forums such as SDN allows for the development of mentoring relationships that differ from more traditional arrangements due to their anonymity and may represent a unique opportunity for psychiatrists in nonacademic or isolated settings to remain connected to trainees and the larger professional community. Psychiatrists may be particularly suited to serving as moderators of such forums due to prior training in a number of key skills. Training directors should be aware of these forums to allow for effective rebuttal of any potential misinformation about their program that may be posted.