By Madonna Delfish, M.P.H.

Dr. Vishal Madaan is the Chief of Education & Deputy Medical Director at the American Psychiatric Association (APA). In this role, Dr. Madaan leads content development and innovation for APA educational programs, including those offered through its Annual Meeting, online APA Learning Center, educational grants, and accreditation efforts. Dr. Madaan works closely with the Council on Medical Education and Lifelong Learning to provide high-quality and innovative medical education for psychiatrists and other mental health clinicians to advance patient care.

Prior to this role, Dr. Madaan served as a tenured Associate Professor in Psychiatry and Neurobehavioral Sciences at the University of Virginia’s (UVA) Health System in Charlottesville, Virginia. In addition, he served there as Training Director at the UVA Child Psychiatry Fellowship Program and founding Director of the Center for Psychopharmacology Research in Youth. Dr. Madaan is a Distinguished Fellow of the American Psychiatric Association, Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry and is the recipient of many national honors and awards.

Q&A with Dr. Madaan

One of the critical missions of APA is to promote psychiatric education that would further enhance the impact of improved care and well-being for our patients and families. That's the ultimate goal.

The broader vision is to make relevant, accurate, timely, inclusive, innovative, and evidence-based education resources available. But it's also to make available resources that represent the full spectrum of APA membership and the wide variety of diagnoses and social determinants of mental health that our psychiatry colleagues work with when helping their patients and their families.

The idea is to make APA the premiere resource for psychiatric education and to meet the educational needs of our members, using a variety of responsive learning opportunities, learning models, and learning avenues.

I would like the APA to become the one-stop shop for psychiatrists.

Our two big meetings, APA's Annual Meeting in May in San Francisco and the Mental Health Services Conference in October in Washington, D.C., both continue to be our biggest resources, whether you're looking for residency-related resources, career development, networking, CME credits or just meeting with your colleagues from across the nation, and internationally.

At the upcoming Mental Health Services Conference in October, we will continue to provide interprofessional team-based learning modules. This year, we will be adding a leadership track and micro-learning sessions for our RFM and ECP members on topics such as navigating the intern year, cultural competencies, surviving residency, career development, and others. In addition, we would like to work on creating a resource for advocacy tools that residency programs can use at different levels.

SMI Adviser continues to be an important asset in improving evidence-based care delivery for serious mental illness. When you visit smiadviser.org, you will find 270+ CME credit courses and a portal to enter consultation questions which are answered within twenty-four hours. We have had over 4,300 individual consultations so far. There's a wide variety of opportunities at different stages.

The division is focusing on ensuring that the educational content at our meetings provides the membership with the most cutting-edge, interactive scientific material by creating relevant resources that meet the needs of our members at every stage of their careers.

We're bringing together online resources, such as the Emerging Topics Webinar Series and micro-learning resources for ECPs, ensuring the inclusion of faculty with diverse backgrounds and viewpoints and continuing to create content related to the DEIB issues and social determinants of mental health.

We are also upgrading the learning management system used for the APA Learning Center to provide the learners with a more streamlined experience.

And we are working with leaders and allied organizations to create meaningful resources for our audience and exploring the role of Artificial Intelligence (AI) and machine learning in psychiatric education.

The biggest challenge, which I take as an opportunity, is ensuring that we have diverse voices and inclusive viewpoints in our discourse. We have been working hard towards it, but there is room to grow and work on designing learning resources that include lived experiences and scientific data. Having this combination is critical to mimic what real-world experience teaches us.

Another one of our current challenges is meeting clinicians where they are. Clinicians are busy, and we hope to eventually provide them with quick access to evidence-based resources, such as clinical guidelines, at their point of care.

This is something that is close to my heart; the challenges related to IMGs are multifold and occur at multiple levels. However, over the past four or five years, the biggest challenge that has emerged is related to entry into a psychiatry residency program.

There are a growing number of U.S. M.D. and D.O. medical students with an increased interest in psychiatry. Because of this, the IMG applicants are currently being squeezed out; the number of interviews they receive has decreased significantly. This will have considerable downstream effects on sub-specialty fellowships because many of those were traditionally taken on by IMGs.

In addition, IMGs take on several public psychiatry positions, which will likely suffer over time if entry resources into U.S. residency programs for IMGs are not improved. Opportunities to gain U.S. clinical experience, a requirement for most programs, have declined substantially, especially during the pandemic. Visa challenges, specifically the J-1 Visa waiver, create several limitations for IMGs, the positions that offer such opportunities are very limited in number, and the chances of being exploited by a potential employer remain high.

IMGs have what I call double minority status. The second minority status comes from these visa-related challenges. The pandemic has significantly impacted IMGs, including difficulties with travel to visit families, loss of employment, and the possibility of being deported. As IMG's careers progress, they often hit a ceiling regarding academic promotions or leadership opportunities.

That being said, IMGs bring in a unique skill set, especially their resilience, industriousness, and willingness to work through some of these issues. Remember, they've navigated all these bureaucratic hassles coming over to the U.S., so we hope they will continue using these strengths to navigate these challenges successfully. Nevertheless, the journey right now is a bit more stressful than it used to be.

There are three things I can think of right away.

One would be organizing multiple educational opportunities for IMGs who were trying to enter residency and fellowship programs; the Caucus was able to put together around seven opportunities in a short period.

The second was advocating for IMGs during the pandemic, working through some of the administrative challenges related to Visa issuances, stoppage of Visas to specific countries, etc. We worked with ADDPRT and APA leadership to develop some advocacy resources to help.

Last was setting up the IMG Workforce Group with APA, commissioned by the Joint Resource Committee, which I initially co-chaired. One of the workgroup's goals was to create a resource guide for our IMGs and to find other areas where IMGs can receive more return on their investment as APA members.

It's absolutely critical. In fact, many psychiatric educators believe that the most profound learning happens in the first year of independent practice after residency training.

I encourage all ECPs to be open and to reach out to their mentors, former supervisors, and former training directors when needed. Whether it's a tricky clinical situation or a career challenge, you must trust the process, and the outcome will take care of itself.

Focusing on this is really critical for the IMGs. It's helpful to have one mentor who is a non-IMG and one mentor who is an IMG. I can think of several personal and professional mentors who have been helpful in my journey by listening to my ideas, providing constructive criticism, and shaping some of my thoughts. This is really vital for ECPs.