Psychiatry Boot Camp

By Mark Mullen, MDBusiness Medicine Health & Fitness Education Courses Careers

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Psychiatry Boot Camp episodes

October 04Is the Gold Standard of Decisional Capacity Assessment Broken? with Dr. Jacob Appel
In this episode of Psychiatry Bootcamp, Dr. Mark Mullen welcomes Dr. Jacob Appel, psychiatrist, attorney, bioethicist, polymath, and emergency psychiatrist, for a rigorous and clinically grounded critique of the Applebaum-Grisso "Four Abilities Model" of decisional capacity assessment. Dr. Appel traces the model's origins in the 1980s as a patient-empowerment tool, examines how its statutory adoption across more than half of US states has calcified it beyond its original intent, and describes in detail the categories of patients for whom the model systematically fails.
As an alternative, Dr. Appel describes the values-based model, which asks clinicians to identify a patient's current expressed choice, explore the underlying values that have governed the patient's life, and determine whether the two are congruent. He also introduces the consistent preferences approach, which situates capacity within a person's narrative arc rather than a moment-in-time snapshot.nce intervention programs in their own communities.
References:
Irrational People Have Rights Too: Moving Beyond Rationality in Decisional Capacity Assessment: https://pubmed.ncbi.nlm.nih.gov/41801616/
A Values Based Approach to Capacity Assessment: https://pubmed.ncbi.nlm.nih.gov/36638303/
Takeaways:
The Applebaum-Grisso model was designed for patients who temporarily deviate from a Western allopathic baseline.

Documented racial bias in capacity assessment stems in part from the model's privileging of patients who can articulate reasoning in medical-legal language, systematically disadvantaging those with less social capital who may know exactly what they want but cannot express it in those terms.

The values-based model offers a simpler alternative.
Capacity assessment is an intervention, not a neutral evaluation
In states without statutory definitions of capacity criteria, the values-based and consistent preferences approaches are likely protected under the respectable minority

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Chapter:
00:00 Meet Dr Appel
01:27 Capacity Model Origins
02:21 Four Abilities Breakdown
03:26 Standard of Care Law
05:46 Why Model Falls Short
06:22 Religion Culture Exceptions
07:07 Rationality Bias Inequity
12:02 Refusing To Engage
13:03 More Failure Prototypes
15:41 Not Capacity Abolition
16:39 Physician Exceptionalism
20:51 Values Based Model Steps
25:52 Sponsor Break Medlines
27:07 Standard Of Care Revisited
32:07 Bioethics Teaching Favorites
36:50 Genetics Incidental Findings
38:52 Closing And Credits
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43 min
September 21Firearm Violence as a Public Health Crisis with Dr. Kristin Mueller
In this episode of Psychiatry Boot Camp recorded live at Saint Louis University, Dr. Mark Mullen is joined by Dr. Kristin Mueller, an emergency medicine physician and physician-researcher at Washington University in St. Louis, for a discussion on firearm violence as a public health crisis. Dr. Mueller, who works closely with the Life Outside of Violence hospital-based violence intervention program, walks through the clinical fundamentals of lethal means counseling, including a live mock counseling session demonstrating how to approach a patient in mental health crisis with access to firearms. The conversation covers practical, evidence-informed strategies for secure storage counseling, verbal de-escalation, and navigating patient resistance without leading with statistics alone.
The discussion then turns to the epidemiology of firearm injury, including findings on non-fatal firearm injury rates, recurrent injury risk among adolescents and young adults, and the structural factors that shape risk beyond individual behavior. Dr. Mueller details the design and outcomes of the Life Outside of Violence program, a hospital-based intervention that pairs licensed clinical social workers with patients ages 8 to 30 following violent injury, and shares emerging data on goal-setting, goal achievement, and patient-reported outcomes. The episode closes with guidance for clinicians seeking to identify or refer patients to hospital-based violence intervention programs in their own communities.
To find your local hospital violence intervention program, visit www.HAVI.org.
Takeaways:
Clinicians in all specialties can and should ask patients about access to firearms and medications as part of routine safety counseling, not only during acute mental health crises.

Secure storage counseling is most effective when delivered with a calm, nonjudgmental approach that avoids leading with statistics alone.

Non-fatal firearm injuries vastly outnumber fatal ones, with 93% of firearm-injured patients at St. Louis's level one trauma centers surviving and returning home.

Patients treated for a firearm injury face a 7% risk of re-injury within one year and up to 17% within eight years, with adolescents and young adults at highest risk.

The Life Outside of Violence program pairs licensed clinical social workers with patients for up to a year after injury, addressing housing, transportation, and trauma counseling alongside medical recovery.
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Chapter:
00:00 Live Show Intro
00:45 Meet Dr Mueller
01:36 Asking About Firearms
04:12 Mock Counseling Roleplay
10:28 De Escalation Secrets
12:50 Legal Options And EROs
14:36 Psych Care Gaps In ED
18:49 Clinical Pearls And Resources
23:24 Ad Break
26:01 Back From Break
26:40 Firearm Violence Public Health
27:00 Firearm Injury Public Health
28:02 Beyond Politics and Blame
29:48 Data Gaps and Hospital Sharing
31:34 Nonfatal Injuries and Recurrence
33:49 Funding and Program Origins
34:45 How LOVE Works
37:39 Meeting Patients Where They Are
41:50 CVI Ecosystem Partnerships
43:26 Measuring Impact and Outcomes
51:54 Success Stories and LOV Meaning
55:27 Call to Action and Resources
57:14 Outro and Listener Review

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1 hr 2 min
September 07Connection, Not Correction: Motivational Interviewing with Dr. Allison Hadley
Dr. Mark Mullen welcomes Dr. Allison Hadley, a psychiatrist and medical director of the psychiatric emergency service at Oregon Health & Science University, for a discussion on motivational interviewing in high-acuity psychiatric settings. Dr. Hadley introduces a novel teaching framework that draws on Tina Fey's rules of improv from her memoir Bossy Pants, mapping core improv principles, including "yes, and," making statements rather than only asking questions, and treating perceived mistakes as opportunities, onto the foundational techniques of motivational interviewing. The conversation covers the OARS mnemonic (open-ended questions, affirmations, reflections, and summaries), the relationship between motivational interviewing and trauma-informed care, and practical strategies for identifying and reinforcing patient change talk.
The discussion also addresses the stages of change model and the ask-tell-ask method for delivering psychoeducation in a patient-centered way, along with harm reduction interventions used in the psychiatric emergency department, including methamphetamine safety kits. The episode concludes with an extended clinical role-play demonstrating how to apply these techniques with a patient presenting with anxiety and co-occurring cannabis use, illustrating how motivational interviewing can be used to build therapeutic alliance without alienating patients who are ambivalent about behavioral change.
Takeaways:
Motivational interviewing is considered a cornerstone, evidence-based treatment approach for substance use disorders in psychiatric practice.

The improv principle of "yes, and" can be applied clinically by affirming an emotionally salient part of a patient's statement before introducing a new therapeutic direction.

The OARS framework, open-ended questions, affirmations, reflections, and summaries, provides a structured method for conducting motivational interviewing conversations.

The ask-tell-ask method allows clinicians to deliver psychoeducation only when a patient has explicitly consented to receive it, preserving patient autonomy.

Harm reduction tools, such as methamphetamine safety kits distributed in emergency settings, reflect an evidence-based, non-judgmental approach to meeting patients where they are in their stage of change.
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Chapters:
00:00 Why Motivational Interviewing
01:09 Meet Dr Allison Hadley
02:33 Who MI Is For
04:37 How MI Works
07:27 Tina Fey Improv Lens
09:06 Improv Rules In Practice
19:19 OARS Core Skills
23:13 Reflections That Land
24:25 Summaries And Change Talk
25:01 Sponsor Break
27:38 Spotting Change Talk Cues
32:08 Stages Of Change Basics
34:23 Ask Tell Ask In Practice
39:30 Roleplay And Final Takeaways

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51 min
August 24NAMI to FNIH: Grand Rounds on Mental Health Innovation w/ Dr. Christine Crawford & Steve Hoffmann
Dr. Mark Mullen welcomes Dr. Christine Crawford, Chief Medical Officer at the National Alliance on Mental Illness (NAMI) and author of You Are Not Alone: For Parents and Caregivers, alongside Steve Hoffmann, Senior Vice President and Chief Preclinical Officer at the Foundation for the National Institutes of Health (FNIH). Dr. Crawford discusses NAMI's mission and its 650 chapters nationwide, the concept of the "distress radius" as a framework for identifying when a child's behavioral changes warrant professional evaluation, and practical strategies for engaging skeptical patients and families through primary care. She also highlights dialectical behavioral therapy (DBT) as a broadly applicable clinical tool and underscores the importance of evidence-based education for patients and caregivers navigating the mental health system. The conversation then shifts to Steve Hoffmann's work at the FNIH, including the newly launching Multimodal Assessment and Phenotyping in Depression (MAPD) study, a longitudinal, multi-site initiative designed to identify biological, clinical, and digital biomarkers associated with depression subtypes. Hoffmann outlines the study's design, including neuroimaging, genetic testing, digital wearables, and patient-reported outcomes, with the goal of moving depression treatment away from a trial-and-error model toward a precision medicine approach. Dr. Crawford and Hoffmann both emphasize the importance of including patient voices in research design, drawing parallels to the foundational impact of the Alzheimer's Disease Neuroimaging Initiative (ADNI) on that field.
Takeaways:
The "distress radius" framework encourages parents to evaluate whether a child's behavioral changes extend beyond the home into school, social, and extracurricular settings as a signal for further evaluation.
NAMI operates 650 chapters nationwide and offers peer-led support groups and educational workshops that clinicians can use as a clinical resource for patients and families.
Dialectical behavioral therapy (DBT) skills, including emotional regulation and mindfulness techniques, have broad applicability beyond borderline personality disorder and may benefit general populations.
The MAPD study aims to identify multimodal biomarkers, including neuroimaging, genetic, sleep, and digital data, to enable more precise, individualized depression treatment selection.
Engaging primary care providers early in the mental health conversation can reduce reliance on long specialist wait lists and help identify safety concerns sooner.
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Chapters:
00:00 Meet the Guests
00:58 What NAMI Does
02:31 Why NAMI Matters
04:24 Why Write You Are Not Alone
05:38 Building a Parent Roadmap
09:08 Distress Radius Warning Signs
12:46 NAMI as a Clinical Resource
18:37 Skeptical Patients and Primary Care
23:29 DBT Skills Everyone Needs
26:56 Sponsor Break
29:26 What Is the FNIH
33:32 MAPD Mapping Depression
46:40 Hopes and Takeaways

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58 min
August 10Inside Pediatric Emergency Psychiatry with Dr. Megan Schott
Dr. Mark Mullen welcomes Dr. Megan Schott, a child and adolescent psychiatrist specializing in pediatric emergency psychiatry, for a discussion on the escalating boarding crisis affecting youth in psychiatric emergencies.
Dr. Schott, who has built pediatric emergency psychiatry programs from the ground up across multiple academic health systems, details how the presence of a trained child psychiatrist in the emergency department can reduce unnecessary admissions by more than half. The conversation examines the definition of boarding, the systemic and financial pressures that limit psychiatric bed availability for children, and the often-overlooked risks of inpatient hospitalization, including social, academic, and long-term consequences for young patients.
The episode also features a supervision-style case discussion on managing a challenging conduct disorder presentation, along with a series of rapid-fire "hot takes" covering healthcare parity legislation, the risks social media platforms pose to adolescent safety, and practical guidance for emergency staff without access to a child psychiatrist.
Takeaways:
Having a trained child and adolescent psychiatrist in the pediatric ED can drastically reduce psychiatric admission rates

Boarding is technically defined as remaining in the ED or on a medical floor for eight or more hours after a disposition decision has been made.

Inpatient psychiatric admission carries real risks for children, including social stigma, academic disruption, and potential long-term consequences.

Mobile crisis teams and psychiatric urgent care models offer promising alternatives to traditional ED-based psychiatric evaluation for lower-acuity cases.

Clinicians should openly acknowledge systemic limitations to patients and families rather than overpromising solutions that the current system cannot deliver.
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Chapters
00:00 Meet Dr Megan Schott
01:44 Why CAPs in the ED
03:23 What Boarding Means
04:31 Why Beds Are Scarce
07:23 When Not to Admit
13:59 System Fixes and Crisis Teams
17:28 Tough Case Supervision
23:34 Cut Admin Burden
24:47 Medlines Podcast Plug
26:02 CPS Boarding Clash
32:33 Advocacy Beyond Psychiatry
34:02 Parity Law Hot Take
36:01 Social Media Dangers
38:31 ER Tips And Wrap Up

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51 min
July 27 A Practical Guide to the Psychiatry Match with Dr. Lia Thomas
In this Season 5 premiere of Psychiatry Boot Camp, Dr. Mark Mullen welcomes Dr. Lia Thomas, Associate Program Director at UT Southwestern, co-lead psychiatry specialty advisor for medical students at UTSW, and co-chair of the Psychiatry Residency Application Advisor Group for ADMSEP , for a comprehensive, practical review of the psychiatry residency match process.
Speaking from both the program director's and specialty advisor's perspectives, Dr. Thomas addresses the questions medical students and their advisors most frequently encounter: how many programs to apply to, how to strategically deploy the 10 available program signals, what program directors actually weigh when screening applications, and what can silently sink a candidacy even after a strong application earns an interview.
The conversation proceeds systematically through each major component of the ERAS application, including clerkship grades, board scores, the personal statement, meaningful experiences, research, away rotations, letters of recommendation, and academic "red flags," before turning to interview strategy for the virtual recruitment environment, post-interview communication, letters of intent, and the distinct considerations for couples matching, DO students, and international medical graduates.
Throughout, Dr. Thomas emphasizes that the match is a job application process governed by holistic review, and that the highest-yield investment an applicant can make is to know their application, know their competitiveness, and work closely with an advisor who can help them tell a coherent narrative about who they are.

Takeaways:
Psychiatry is meaningfully more competitive than a decade ago but remains well below the most competitive specialties like dermatology; applicants should consider targeting around 50 program applications, with 30–40 being appropriate for most students, as exceeding 50 produces diminishing returns on interview yield relative to cost.

Program signals should be deployed strategically rather than on prestige alone. Stacking geographic preference with program signals communicates a compellingly specific intent to train in a region, while burning signals on top-ranked programs the applicant is unlikely to competitively match at represents poor return on investment.

When screening ERAS applications for interview invitations, most program directors weigh clerkship grades and meaningful experiences above board scores, and letters of recommendation are nearly last, as they are largely homogeneous documents that speak more to the letter writer than the applicant.

Academic and professional leaves or red flags must be addressed head-on in the application with a clear account of what happened, what was learned, and how the applicant will be a better physician because of it. Defensiveness or excessive detail are both contraindicated, and applicants should review this language with a trusted advisor or dean before submitting.

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1 hr 17 min
June 29Psychiatry's Most Controversial Topics: Dr. Mark Mullen's Season 4 Retrospective with Dr. Preston Roche
In this season finale of Psychiatry Bootcamp, Dr. Mark Mullen assumes the role of guest as he is interviewed by guest host Dr. Preston Roche, co-host of How to Be a Patient, in a wide-ranging retrospective on Season 4. Drawing on listener questions, critical feedback, and audience-submitted comments curated from Spotify, TikTok, Instagram, and email, the episode revisits the season's most clinically significant and intellectually provocative conversations, including sports psychiatry, meaningful psychotherapy, problematic screen use, decisional capacity, DSM reform, TMS, physician-assisted suicide, complex PTSD, mental illness in the carceral system, involuntary treatment, and the role of artificial intelligence in the future of the field.

Takeaways:
The most important goal of psychotherapy is not symptom reduction but meaningful psychological change, the kind that reshapes a patient's self-understanding and relational patterns, a distinction that is largely absent from psychiatric residency training and deserves far greater clinical emphasis.
Psychiatric diagnoses have clear on-ramps but almost no off-ramps; clinicians should communicate to patients that meeting criteria for a disorder at one point in time does not mean they will require lifelong treatment, and should revisit diagnostic labels rather than carrying them forward indefinitely.
When conducting a decisional capacity assessment in a consultation-liaison setting, identifying all stakeholders and clarifying what the requesting team would actually do with the result often renders a formal capacity determination unnecessary and prevents unnecessary clinical and ethical conflict.
Delivering a personality disorder diagnosis in a brief inpatient or consultation encounter risks doing more harm than good; offering psychoeducation about personality organization and a referral to evidence-based psychotherapy, such as dialectical behavior therapy, may better serve the patient without prematurely affixing a label.
The Tarasoff doctrine, by requiring psychiatrists to disclose patient communications under specific threat conditions, may inadvertently suppress the very disclosures that would enable early intervention, particularly in patients at risk for suicide who avoid honesty with their treaters precisely because they fear the legal consequences of that honesty.
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1 hr 13 min
June 15 Inside Sports Psychiatry with Dr. David McDuff
In this episode of Psychiatry Bootcamp, Dr. Mark Mullen welcomes Dr. David McDuff, the "grandfather" of sports psychiatry, to examine the origins, clinical framework, and practical application of this rapidly evolving subspecialty. Dr. McDuff brings more than three decades of experience as team psychiatrist for the Baltimore Orioles and Baltimore Ravens, alongside service on the International Olympic Committee's Mental Health Working Group, to offer a uniquely authoritative perspective on mental health care in elite sport.

Takeaways:

The sports psychiatrist functions as an embedded, on-site clinician whose brief, informal interactions in training rooms and on practice fields carry genuine therapeutic weight, producing athlete utilization rates of 25–35%, five to seven times the standard employee assistance program benchmark.

Dr. McDuff treats the athlete's brain as neurobiologically sensitive, initiating all psychiatric medications at or below the lowest standard doses and preferring slow-titration combination pharmacotherapy over high-dose monotherapy to maximize adherence and harness placebo effect.

Common therapeutic factors like engaging a support system can be especially effective in athletes and especially difficult to initiate due to stimga.

Therapeutic use exemptions do not require a prior trial of non-stimulant agents, stimulants remain guideline-concordant first-line treatment for ADHD in athletes, and withholding them without clinical justification constitutes a lower standard of care.

Clinicians seeking formal training in sports psychiatry can pursue a 27-module certificate through the International Society of Sports Psychiatry (https://sportspsychiatry.org/) or board certification through the American Board of Sport and Performance Psychiatry, which now offers three distinct pathways for medical students, residents, and experienced clinicians.

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1 hr 16 min
June 01 Meaningful Psychotherapy: Psychoanalytic Principles in Modern Psychotherapy with Dr. Jonathan Shedler
In this profound episode of Psychiatry Boot Camp, host Dr. Mark Mullen sits down with world-renowned researcher and clinician Dr. Jonathan Shedler. Moving beyond the "alphabet soup" of modern modalities, Dr. Shedler argues for a return to the foundational psychoanalytic principles that constitute the "trunk and roots" of all effective talk therapy.
The discussion challenges the standard medical model of "diagnose and prescribe," urging psychiatrists to unlearn passive history-taking in favor of a collaborative partnership that traverses into the unknown. From critiquing the superficiality of "therapy speak" and the "first aid" nature of short-term institutional treatments to highlighting the vital roles of personal therapy and high-quality supervision, Dr. Shedler offers a rigorous roadmap for practitioners seeking to restore the soul of psychiatry.
Takeaways:
Traversing the Unknown: Real psychological change requires both patient and therapist to abandon familiar, repetitive patterns and enter an unscripted, shared space of discovery.
Partnership vs. Procedure: Meaningful therapy is a collaborative partnership where the clinician is not an all-knowing expert performing a procedure on a passive patient, but a participant-observer figuring out the problem together.
Aptitude and Experience: Developing clinical expertise requires three pillars: inherent aptitude for the work, the clinician’s own personal psychotherapy, and high-quality, non-administrative clinical supervision.
The "Fever" Metaphor: Symptoms like depression and anxiety are non-specific responses to underlying difficulties; meaningful treatment identifies the cause of the "fever" rather than just providing symptom-suppressing "aspirin".
The Danger of Therapy Speak: Popular cliches like "your feelings are valid" or "toxic narcissist" often act as intellectual defenses that bypass the hard work of understanding specific, particular experiences.
Dose and Duration: Research suggests that meaningful, life-shifting psychological change typically begins around six months of weekly treatment, contrasting sharply with the 12-session models common in institutional settings.

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1 hr 8 min
May 25 BONUS: Call for Submissions: Shaping the Season Four Final Forum
In this brief bonus segment of Psychiatry Boot Camp, host Dr. Mark Mullen steps into the feed with a direct request from you...the listenters.
As Season Four approaches its conclusion, the platform is shifting its final episode to a peer-responsive format driven entirely by listener inputs. Dr. Mullen notes that the season has featured highly controversial topics and that he frequently abandoned an unbiased stance to take explicit clinical positions.
Psychiatrists, residents, and mental health professionals are invited to submit their critiques, follow-up questions on any covered material, or general psychiatry queries to be read and answered on the air.

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2 min

About Psychiatry Boot Camp

From the publisher's feed

Your clear, practical introduction to the field of psychiatry. Each episode features a leading expert unpacking complex topics like suicide risk, schizophrenia, catatonia, and childhood anxiety. Originally created as a crash course for new doctors, Psychiatry Boot Camp has grown into essential listening for professionals preparing for residency, advancing their careers, or sharpening their clinical decision-making.