Episodes

In this episode of Psychiatry Boot Camp, Dr. Mark Mullen continues his conversation with Dr. Jacob Appel, covering two intersecting frontiers. The replacement of human physicians by AI "replicants" and the emerging use of AI as a surrogate decision-maker, or "robo-proxy," for patients who lack decisional capacity. Dr. Appel argues that while AI will outperform human physicians in probabilistic, pattern-recognition tasks, it is structurally incapable of providing the authentic empathy, shared vulnerability, common sense, and irrational human trust that constitute the actual substance of healing and that deploying replicant physicians at scale will produce a deeply inequitable two-tiered healthcare system where wealthy patients see humans and less wealthy patients see machines.




The second half of the episode addresses the coming reality of AI robo-proxies where patients appoint chatbots as their legal healthcare proxy to make decisions in the event of incapacity. Dr. Appel outl…

In this episode of Psychiatry Boot Camp, 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 of intervention pr…

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 th…

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 …

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) st…

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 plat…

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, awa…