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Burruss NC, Murray C, Li W, Sowa NA. Integrated Care Education for General Psychiatry Residents in the US: a Review of the Literature. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:390-401. [PMID: 36944754 DOI: 10.1007/s40596-023-01760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The purpose of this review was to synthesize published literature describing integrated care education available to general psychiatry residents in the United States (US) in order to better understand curricular models and summarize curriculum barriers and facilitators. METHODS The authors searched electronic databases for articles describing integrated care education for general psychiatry residents. Minimum inclusion criteria were focus on an ambulatory integrated care curriculum, description of the study population and training program, publication in English, and program location in the US. Data extracted included trainee, faculty, or collaborator evaluations, educational model, level of care integration, and barriers or facilitators to implementation. RESULTS The literature search identified 18 articles describing curricula at 26 residency programs for inclusion. Most programs offered clinical and didactic curricula to advanced trainees across a variety of care integration levels. Common barriers included fiscal vulnerability and difficulties identifying team members or clarifying team member roles. Common facilitators included institutional and interdepartmental support, dedicated space, and faculty supervision. No statistical analysis was able to be performed due to study heterogeneity. CONCLUSIONS This review found a relatively small number of articles written about integrated care education for psychiatry residents. Resident evaluation suggests this training is valuable regardless of curriculum structure, training years, or level of care integration. Dedicated funding, staff, and space were crucial for successful curricula. This review highlights a need for more rigorous research characterizing and evaluating integrated care education.
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Affiliation(s)
| | | | - Winston Li
- University of North Carolina Hospitals, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Nathaniel A Sowa
- University of North Carolina Hospitals, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M, Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry 2023; 62:91-119. [PMID: 35779696 DOI: 10.1016/j.jaac.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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Pheister M, Cowley D, Sanders W, Keeble T, Lu F, Pershern L, Wolf K, Walaszek A, Aggarwal R. Growing the Psychiatry Workforce Through Expansion or Creation of Residencies and Fellowships: the Results of a Survey by the AADPRT Workforce Task Force. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:421-427. [PMID: 34292538 PMCID: PMC8296832 DOI: 10.1007/s40596-021-01509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The USA needs to produce more psychiatrists to meet projected workforce deficits. The American Association of Directors of Psychiatric Residency Training Directors (AADPRT) sought to examine opportunities for and obstacles to expanding or creating residencies and fellowships. METHODS In November 2019, the authors conducted a survey of residency and fellowship directors. The survey gathered information about new positions, new programs, participation in interprofessional education, and loss of residency or fellowship positions. RESULTS The survey was distributed to psychiatry residency (N=231) and fellowship (N=194) directors, with a response rate of 33.4%. One quarter of responding residencies and fellowships reported creating new programs; 24.7% of residency and 17.5% of fellowships reported expansion. The most common reason to develop or expand programs was the shortage of psychiatrists, with the local institution as the most common funding source. Fifty-seven percent reported that they had wanted to expand, but faced barriers, primarily lack of funding. Recruitment and retention of faculty are major challenges. Psychiatry departments frequently (87.5%) participate in interprofessional education, generally perceived as positive. Unfortunately, 15.7% of respondents reported loss of positions or closure of programs. CONCLUSIONS Creating and expanding residencies and fellowships are common strategies for addressing the shortage of psychiatrists. Barriers include lack of funding and challenges recruiting/retaining faculty. The loss of residency/fellowship positions or closure of programs is a worrisome trend.
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Affiliation(s)
| | - Deborah Cowley
- University of Washington School of Medicine, Seattle, WA, USA
| | - William Sanders
- Pine Rest Christian Mental Health Services, Michigan State University - College of Human Medicine, Grand Rapids, MI, USA
| | | | - Francis Lu
- University of California, Davis, Sacramento, CA, USA
| | - Lindsey Pershern
- Baylor College of Medicine, Menninger Department of Psychiatry, Houston, TX, USA
| | - Kari Wolf
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Art Walaszek
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Shaligram D, Skokauskas N, Aragones E, Azeem MW, Bala A, Bernstein B, Cama S, Canessa L, Silva FD, Engelhard C, Garrido G, Guerrero APS, Hunt J, Jadhav M, Martin SL, Miliauskas C, Nalugya J, Nazeer A, Ong SH, Robertson P, Sassi R, Seker A, Watkins M, Leventhal B. International perspective on integrated care models in child and adult mental health. Int Rev Psychiatry 2022; 34:101-117. [PMID: 35699101 DOI: 10.1080/09540261.2022.2059346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.
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Affiliation(s)
| | | | - Enric Aragones
- Institut de Recerca en Atencio Primaria Jordi Gol, Spain
| | | | | | | | - Shireen Cama
- Cambridge Health Alliance/Harvard Medical School, USA
| | - Laura Canessa
- Facultad de Medicina, Universidad de la República, Uruguay
| | | | | | | | | | - Jeffrey Hunt
- Brown University Warren Alpert Medical School, USA
| | | | - Sarah L Martin
- Texas Tech University Health Science Center El Paso, Texas, USA
| | | | - Joyce Nalugya
- Makerere University College of Health Sciences, Uganda
| | | | | | - Paul Robertson
- Department of Psychiatry, The University of Melbourne, Australia
| | - Roberto Sassi
- University of British Columbia, BC Children's Hospital, Canada
| | - Asilay Seker
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
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- The University of Texas System, Texas, USA
| | - Michael Watkins
- The University of Texas Health Science Center at Tyler, Texas, USA
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Heinze G, Sartorius N, Guizar Sanchez DP, Bernard-Fuentes N, Cawthorpe D, Cimino L, Cohen D, Lecic-Tosevski D, Filipcic I, Lloyd C, Mohan I, Ndetei D, Poyurovsky M, Rabbani G, Starostina E, Yifeng W, EstefaníaLimon L. Integration of mental health comorbidity in medical specialty programs in 20 countries. Int J Psychiatry Med 2021; 56:278-293. [PMID: 33827304 DOI: 10.1177/00912174211007675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
METHODS A systematic analysis was performed of the medical specialization academic programs of 20 different countries to establish which medical specialties take into account mental health issues in the specialty curricular design and which mental health content these programs address. The criteria that were explored in the educational programs include: 1) name of the medical specialties that take into account mental health content in curriculum design, 2) name of the mental health issues addressed by these programs. After independent review and data extraction, paired investigators compared the findings and reached consensus on all discrepancies before the final presentation of the data. Descriptive statistics evaluated the frequency of the data presented. RESULTS Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs. In four countries: Bangladesh, Serbia, the Netherlands and France, 50%of all graduate specialty training programs include mental health content. In ten countries: Germany, Sweden, the United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel and Spain, between 20% and 49% of all graduate specialty training programs include mental health content. In six countries - Brazil, Chile, Colombia, Croatia, Kenya, and the United States-less than 20% of all graduate specialty training programs include mental health content. DISCUSSION The proposal that we have made in this article should be taken into account by decision-makers, in order to complement the different postgraduate training programs with mental health issues that are frequently present with other physical symptoms. It is not our intention that the different specialists know how to treat psychiatric comorbidities, but rather pay attention to their existence and implications in the diagnosis, evolution and prognosis of many other diseases. The current fragmentation of medicine into ever finer specialties makes the management of comorbidity ever more difficult: a reorientation of post- graduate training might improve the situation.
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Affiliation(s)
- Gerhard Heinze
- Departamento de Fisiología National Autonomous University of Mexico (UNAM) School of Medicine, Mexico City, Mexico
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | | | - Napoleón Bernard-Fuentes
- Departamento de Fisiología National Autonomous University of Mexico (UNAM) School of Medicine, Mexico City, Mexico
| | - David Cawthorpe
- Department of Psychiatry & Community Health Sciences, Cumming School of Medicine, Institute for Child & Maternal Health, The University of Calgary, Calgary, Canada
| | - Larry Cimino
- Dialogue on Diabetes and Depression, ProConsult, LLC, Las Vegas, USA
| | - Dan Cohen
- Heerhugowaard, Mental Health Organization, Amsterdam, the Netherlands
| | - Dusica Lecic-Tosevski
- Serbian Academy of Sciences and Arts, Institute of Mental Health, Scholl of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Filipcic
- Faculty of Dental Medicine and Health, Department of Psychiatry, University of Osijek, Osijek, Croatia
| | - Cathy Lloyd
- Faculty of Wellbeing, Education and Language Studies, School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Isaac Mohan
- Community, Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Australia
| | - David Ndetei
- University of Nairobi, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Michael Poyurovsky
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.,Ma'ale HaCarmel Mental Health Center, Tirat Carmel, Israel
| | - Golam Rabbani
- Ma'ale HaCarmel Mental Health Center, Tirat Carmel, Israel
| | - Elena Starostina
- Neurodevelopmental Disability Protection Trustee Board of Bangladesh, Dhaka, Bangladesh
| | - Wei Yifeng
- Department of Endocrinology, Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - Limón EstefaníaLimon
- Departamento de Fisiología National Autonomous University of Mexico (UNAM) School of Medicine, Mexico City, Mexico
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The Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of Consultation-Liaison Psychiatry Residency Education Subcommittee. PSYCHOSOMATICS 2020; 61:436-449. [PMID: 32650995 PMCID: PMC7235569 DOI: 10.1016/j.psym.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 01/22/2023]
Abstract
Background As mental health services in outpatient medical clinics expand, psychiatrists must be trained to practice in these settings. Objectives The Academy of Consultation-Liaison Psychiatry residency education subcommittee convened a writing group with the goal of summarizing the current evidence about outpatient consultation-liaison psychiatry (CLP) training and providing a framework for CLP educators who are interested in developing outpatient CLP rotations within their programs. Method MEDLINE (via PubMed), Embase, and PsycINFO (via OVID) were reviewed each from inception to December 2019, for psychiatric CLP services in ambulatory settings that involved residents or fellows. The CLP education guidelines were reviewed for recommendations relevant to outpatient CLP. We also searched MedEd portal for published curriculums relevant to CLP. The group held 2 conferences to reach consensus about recommendations in setting up outpatient CLP rotations. Results Seventeen articles, 3 Academy of Consultation-Liaison Psychiatry–supported guidelines, and 8 online didactic resources were identified as directly reporting on the organization and/or impact of an outpatient CLP rotation. These manuscripts indicated that residents found outpatient CLP rotations effective and relevant to their future careers. However, the literature provided few recommendations for establishing formal outpatient CLP training experiences. Conclusions Outpatient CLP rotations offer multiple benefits for trainees, including exposure to specific clinical scenarios and therapeutic interventions applicable only in the outpatient setting, increased continuity of care, and the unique experience of providing liaison and education to non-mental health providers. The article outlines recommendations and examples for developing outpatient CLP rotations which CLP educators can incorporate in their programs.
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Generoso MB, Mazaferro PN. Integrated Residency in Psychiatry: an Innovative Model of Medical Training in Brazil. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:551-552. [PMID: 31407228 DOI: 10.1007/s40596-019-01102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
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Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
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Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
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Shen N, Sockalingam S, Charow R, Bailey S, Bernier T, Freeland A, Hawa A, Sur D, Wiljer D. Education programs for medical psychiatry collaborative care: A scoping review. Gen Hosp Psychiatry 2018; 55:51-59. [PMID: 30384004 DOI: 10.1016/j.genhosppsych.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand the current state of collaborative care education programs reported in the literature. METHODS Following Arksey and O'Malley methodology for scoping reviews, data was abstracted in following domains: article details, program details, program outcomes, and implementation factors. Numerical summaries were calculated where necessary. Implementation factors underwent a qualitative thematic analysis. RESULTS This review identified 40 unique collaborative care education programs. Most programs (n = 25; 62.5%) were delivered to a multi-disciplinary group of learners through didactic (n = 34; 85.0%) and/or in vivo (n = 32; 80.0%) training methods. The majority of programs focused on clinical knowledge/skill acquisition (n = 38; 95.0%) as opposed to attitudes towards mental health and collaboration (n = 27; 67.5%). Implementation factors fell within four themes: program development, supportive environment, necessary resources, and clinical change agents/leaders. CONCLUSION Despite the growing evidence for collaborative care, few collaborative care education programs are reported in the literature. Key elements of collaborative care education programs include: routine multi-disciplinary interaction, curriculum focus on attitudes; clinical change agents and leaders to accelerate implementation; and a user-centred design development process. Future implementations can learn from these experiences to avoid potential barriers and focus on enabling successful programs to enhance care.
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Affiliation(s)
- Nelson Shen
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Rebecca Charow
- University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada.
| | - Sharon Bailey
- Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Thérèse Bernier
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada.
| | - Alison Freeland
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Trillium Health Partners, 100 Queensway W, Mississauga, Ontario L5B 1B8, Canada.
| | - Aceel Hawa
- Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
| | - Deepy Sur
- Trillium Health Partners, 100 Queensway W, Mississauga, Ontario L5B 1B8, Canada.
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
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Sunderji N, Ion A, Huynh D, Benassi P, Ghavam-Rassoul A, Carvalhal A. Advancing Integrated Care through Psychiatric Workforce Development: A Systematic Review of Educational Interventions to Train Psychiatrists in Integrated Care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:513-525. [PMID: 30097003 PMCID: PMC6099757 DOI: 10.1177/0706743718772520] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Integrated or collaborative care is a well-evidenced and widely practiced approach to improve access to high-quality mental health care in primary care and other settings. Psychiatrists require preparation for this emerging type of practice, and such training is now mandatory for Canadian psychiatry residents. However, it is not known how best to mount such training, and in the absence of such knowledge, the quality of training across Canada has suffered. To guide integrated care education nationally, we conducted a systematic review of published and unpublished training programs. METHOD We searched journal databases and web-based 'grey' literature and contacted all North American psychiatry residency programs known to provide integrated care training. We included educational interventions targeting practicing psychiatrists or psychiatry residents as learners. We critically appraised literature using the Medical Education Research Study Quality Instrument (MERSQI). We described the goals, content, and format of training, as well as outcomes categorized according to Kirkpatrick level of impact. RESULTS We included 9 published and 5 unpublished educational interventions. Studies were of low to moderate quality and reflected possible publication bias toward favourable outcomes. Programs commonly involved longitudinal clinical experiences for residents, mentoring networks for practicing physicians, or brief didactic experiences and were rarely oriented toward the most empirically supported models of integrated care. Implementation challenges were widespread. CONCLUSIONS Similar to integrated care clinical interventions, integrated care training is important yet difficult to achieve. Educational initiatives could benefit from faculty development, quality improvement to synergistically improve care and training, and stronger evaluation. Systematic review registration number: PROSPERO 2014:CRD42014010295.
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Affiliation(s)
- Nadiya Sunderji
- Mental Health and Addictions Service, St. Michael’s Hospital, Toronto,
Ontario
- Li Ka Shing Knowledge Institute, Toronto, Ontario
- Department of Psychiatry, Faculty of Medicine, University of Toronto,
Toronto, Ontario
| | - Allyson Ion
- Mental Health Research Group, St. Michael’s Hospital, Toronto, Ontario
- School of Social Work, McMaster University, Toronto, Ontario
| | - Dan Huynh
- Department of Psychiatry, University of Saskatchewan, Saskatoon,
Saskatchewan
| | - Paul Benassi
- Department of Psychiatry, Faculty of Medicine, University of Toronto,
Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University
of Toronto, Toronto, Ontario, Canada
| | - Abbas Ghavam-Rassoul
- Department of Family and Community Medicine, St. Michael’s Hospital,
Toronto, Ontario
- Department of Family and Community Medicine, University of Toronto,
Toronto, Ontario
- Department of Family and Community Medicine, Dalla Lana School of Public
Health, University of Toronto, Toronto, Ontario
| | - Adriana Carvalhal
- Department of Psychiatry, School of Medicine, Queen’s University, Kingston,
Ontario
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Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, Fortney J. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. PSYCHOSOMATICS 2017; 59:227-250. [PMID: 29544663 DOI: 10.1016/j.psym.2017.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California, Veterans Administration Health Care System, Mather, CA; Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC).
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine, Burlington, Vermont; Division of Consultation Psychiatry and Psychosomatic Medicine, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Robert M McCarron
- Psychiatry & Behavioral Sciences and Department of Internal Medicine, University of California, Irvine Health System, Irvine, CA
| | - David J Katzelnick
- Department of Psychiatry and Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN
| | - Trina Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amy M Bauer
- Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA; Behavioral Health Integration Program (BHIP) and Washington State's Mental Health Integration Program (MHIP), Seattle, WA
| | - John Fortney
- Division of Population Health, Seattle, WA; Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA
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Competencies and Training Guidelines for Behavioral Health Providers in Pediatric Primary Care. Child Adolesc Psychiatr Clin N Am 2017; 26:717-731. [PMID: 28916010 DOI: 10.1016/j.chc.2017.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article focuses on the cross-discipline training competencies needed for preparing behavioral health providers to implement integrated primary care services. After a review of current competencies in the disciplines of child and adolescent psychiatry, psychology, and social work, cross-cutting competencies for integrated training purposes are identified. These competencies are comprehensive and broad and can be modified for use in varied settings and training programs. An existing and successful integrated care training model, currently implemented at Children's Hospital of Philadelphia, is described. This model and the training competencies are discussed in the context of recommendations for future work and training.
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Huang H, Forstein M, Joseph R. Developing a Collaborative Care Training Program in a Psychiatry Residency. PSYCHOSOMATICS 2017; 58:245-249. [PMID: 28233531 PMCID: PMC5446275 DOI: 10.1016/j.psym.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Collaborative care is an evidence-based approach for improving quality mental health access in primary care settings. Although job opportunities will grow over the next decade, few psychiatry residencies have established curricula to train the next generation of psychiatrists to work in this expanding model of care. OBJECTIVE In this article, the authors describe the collaborative care training experience at a safety-net academic institution to provide a template for psychiatry residencies designing curricula to prepare psychiatry residents for collaborative care practices.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA.
| | | | - Robert Joseph
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA
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Cowley DS, Keeble T, Jones J, Layton M, Murray SB, Williams K, Bakker C, Verhulst J. Educating Psychiatry Residents to Practice in Smaller Communities: A Regional Residency Track Model. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:846-849. [PMID: 27114242 DOI: 10.1007/s40596-016-0558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/31/2016] [Indexed: 06/05/2023]
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Hilty DM, Crawford A, Teshima J, Chan S, Sunderji N, Yellowlees PM, Kramer G, O'neill P, Fore C, Luo J, Li ST. A framework for telepsychiatric training and e-health: Competency-based education, evaluation and implications. Int Rev Psychiatry 2016; 27:569-92. [PMID: 26540642 DOI: 10.3109/09540261.2015.1091292] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Telepsychiatry (TP; video; synchronous) is effective, well received and a standard way to practice. Best practices in TP education, but not its desired outcomes, have been published. This paper proposes competencies for trainees and clinicians, with TP situated within the broader landscape of e-mental health (e-MH) care. TP competencies are organized using the US Accreditation Council of Graduate Medical Education framework, with input from the CanMEDS framework. Teaching and assessment methods are aligned with target competencies, learning contexts, and evaluation options. Case examples help to apply concepts to clinical and institutional contexts. Competencies can be identified, measured and evaluated. Novice or advanced beginner, competent/proficient, and expert levels were outlined. Andragogical (i.e. pedagogical) methods are used in clinical care, seminar, and other educational contexts. Cross-sectional and longitudinal evaluation using quantitative and qualitative measures promotes skills development via iterative feedback from patients, trainees, and faculty staff. TP and e-MH care significantly overlap, such that institutional leaders may use a common approach for change management and an e-platform to prioritize resources. TP training and assessment methods need to be implemented and evaluated. Institutional approaches to patient care, education, faculty development, and funding also need to be studied.
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Affiliation(s)
- Donald M Hilty
- a Department of Psychiatry & Behavioral Sciences , Keck School of Medicine at USC and LAC + USC Medical Center , Los Angeles , California
| | - Allison Crawford
- b Department of Psychiatry , University of Toronto , Ontario , Canada
| | - John Teshima
- b Department of Psychiatry , University of Toronto , Ontario , Canada
| | - Steven Chan
- c Department of Psychiatry & Behavioral Sciences , University of California, Davis School of Medicine & Health System , Davis , California
| | - Nadiya Sunderji
- b Department of Psychiatry , University of Toronto , Ontario , Canada
| | - Peter M Yellowlees
- c Department of Psychiatry & Behavioral Sciences , University of California, Davis School of Medicine & Health System , Davis , California
| | - Greg Kramer
- d National Center for Telehealth and Technology's (T2) Telehealth Program , Tacoma , Washington
| | - Patrick O'neill
- e Department of Psychiatry and Behavioral Health , Tulane University School of Medicine , New Orleans , Louisiana
| | - Chris Fore
- f Indian Health Service , Albuquerque Area TeleBehavioral Health Center of Excellence , Albuquerque , NewMexico
| | - John Luo
- g Psychiatry Residency Program , UC Riverside , California , USA
| | - Su-Ting Li
- c Department of Psychiatry & Behavioral Sciences , University of California, Davis School of Medicine & Health System , Davis , California
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An expert consensus on core competencies in integrated care for psychiatrists. Gen Hosp Psychiatry 2016; 41:45-52. [PMID: 27302722 DOI: 10.1016/j.genhosppsych.2016.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/14/2016] [Accepted: 05/15/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE All psychiatry residents in Canada are required to train in integrated care (also known as "shared care" or "collaborative care"). We sought to define the competencies required for integrated care practice, with an emphasis on those competencies necessary for all psychiatric postgraduate learners regardless of their intended future practice setting or population. METHOD We conducted a mixed methods study including qualitative interviews with nine psychiatrists practicing integrated care across Canada and a quantitative survey of 35 experts using a modified Delphi method. RESULTS Our participants believed that integrated care aims to build capacity for improved quality of mental health care in unspecialized settings, and as such, its practice requires broad clinical expertise as well as competencies in interprofessional teamwork, collaborative leadership, knowledge exchange and program consultation. All psychiatrists require knowledge of evidence-based models of integrated care and the ability to work with organizations to implement these models. CONCLUSION Psychiatrists are best prepared for integrated care practice through clinical exposure to primary care and/or community settings, as well as didactic teaching regarding the evidence for integrated care, quality improvement methods, leadership, health systems and population health.
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Abstract
Psychiatrists are currently ill equipped to exploit the growing interest in public mental health. Training, service infrastructure and organisational links are deficient, which will impede population-based interventions. However, the potential benefits make correcting this worthwhile.
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Coverdale JH, Roberts LW, Balon R, Beresin EV, Tait GR, Louie AK. Integrated Care in Community Settings and Psychiatric Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:419-421. [PMID: 26036348 DOI: 10.1007/s40596-015-0363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
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Badre N, Baron D, Gross L, Goin M, Pine J, Slaby A, Sumner C. Psychopharmacologic Management in Integrated Care: Challenges for Residency Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:466-469. [PMID: 26036347 DOI: 10.1007/s40596-015-0350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
The integration of psychiatric care in primary care is becoming a reality. Psychiatric training programs are facing multiple challenges to accommodate this transition. We here present the perspectives of Group for the Advancement of Psychiatry Committee on Psychopharmacology. The members of the group respond to the concerns raised by a resident currently confronting this changing landscape. By discussing the training, clinical, and communicating challenges of integrated care, they shed light on many of the questions being tackled by residency training programs. This commentary on the timely discussion about integrated care seeks to provide insight on the future of training in psychiatry by outlining the core questions of this change.
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Affiliation(s)
- Nicolas Badre
- University of California, San Diego, San Diego, CA, USA
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Coverdale J, Roberts LW, Balon R, Beresin EV. Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:430-436. [PMID: 26059737 DOI: 10.1007/s40596-015-0364-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. METHOD The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. RESULTS The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. CONCLUSIONS These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.
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McCarron RM, Bourgeois JA, Chwastiak LA, Folsom D, Hales RE, Han J, Rado J, Rivelli S, Scher L, Yu A. Integrated Medicine and Psychiatry Curriculum for Psychiatry Residency Training: a Model Designed to Meet Growing Mental Health Workforce Needs. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:461-465. [PMID: 26015164 DOI: 10.1007/s40596-015-0348-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Robert M McCarron
- University of California, Davis School of Medicine, Sacramento, CA, USA,
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Dubé B, Verduin ML. A Brief Examination of Integrated Care in Undergraduate Medical Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:457-60. [PMID: 25993980 DOI: 10.1007/s40596-015-0332-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/12/2015] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This study examines how behavioral and physical health are currently integrated in undergraduate medical education, both in the classroom and during clinical rotations. METHODS Members of the Association of Directors of Medical Student Education in Psychiatry (n = 215) were invited to complete a short survey on the integration of physical and behavioral health at their institution. RESULTS In addition to undergraduate medical courses traditionally taught by psychiatrists, behavioral science topics are often addressed in neurology, reproduction, and doctoring courses. During clinical rotations, behavioral health topics are most likely taught during the family medicine clerkship and, conversely, least likely during the surgery clerkship; furthermore, behavioral health topics are much less likely to be taught by psychiatrists during clinical rotations. CONCLUSIONS Integration of behavioral and physical health in medical education is beginning to occur in a meaningful context.
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Affiliation(s)
- Benoit Dubé
- University of Pennsylvania, Philadelphia, PA, USA,
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Huang H, Barkil-Oteo A. Teaching Collaborative Care in Primary Care Settings for Psychiatry Residents. PSYCHOSOMATICS 2015. [PMID: 26211980 DOI: 10.1016/j.psym.2015.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Job descriptions for psychiatrists will change significantly over the next decade, as psychiatrists will be called on to work as caseload consultants to the primary care team. OBJECTIVE The purpose of this pilot study was to examine the effects of an American Association of Directors of Psychiatric Residency Training-approved collaborative care curriculum on caseload consulting skills among psychiatry residents. METHODS In 2014, 46 psychiatry residents (5 postgraduate year 1s, 10 postgraduate year 2s, 22 postgraduate year 3s, and 9 postgraduate year 4s) from 5 academic psychiatry residency programs in the New England area were given the 2-hour pilot collaborative care curriculum. Participants were asked to complete an anonymous survey at both the beginning and the end of the workshop to rate their comfort level in aspects of collaborative care psychiatry (7 items from SBP4 psychiatry milestones) based on a Likert scale (1-not at all, 2-slightly, 3-moderately, and 4-extremely). Paired t-test was used to examine the difference between pretest and posttest results of residents participating in the workshop. RESULTS The pretest mean score for the group was 2.9 (standard deviation = 0.44), whereas the posttest mean was 3.51 (standard deviation = 0.42), p < 0.0001. Only 15% (n = 7) of residents reported having some form of primary care or ambulatory specialty care consultation experience while in training. CONCLUSION This brief collaborative care curriculum significantly improved resident confidence in milestone criteria related to population health and case-based consultations.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA (HH).
| | - Andres Barkil-Oteo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT (AB-O)?>
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