Estimates of Mental Health Problems in a Vulnerable Population within a Primary Care Setting

Integration of Primary Care and Psychiatry: A New Paradigm for Medical Student Clerkships

BACKGROUND

Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems.

AIM

To implement an integrated primary care-psychiatry clerkship for third-year medical students.

SETTING

Undergraduate medical education, amid institutional curriculum reform.

PARTICIPANTS

Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017.

PROGRAM DESCRIPTION

Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines.

PROGRAM EVALUATION

Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting.

CONCLUSIONS

While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century.

Reliability and validity of Somali version of the PHQ-9 in primary care practice

Objectives Depression is one of the common mental health problems noticed in immigrants because of the experiences related to their resettlement which is the case for Somali population. Depression increases mortality, morbidity, disability, and costs of health care which can be controlled by screening depression in the primary care setting using a culturally and linguistically congruent screening tool. The aim of the current study is to translate the English PHQ-9 into Somali language using evidence-based translational methodology and establish psychometric properties of the Somali PHQ-9. Methods The initial validation of the Somali PHQ-9 was studied by comparing the original and back translation versions using the comparability and interpretability tool in a sample of 56 monolingual health care professionals. The reliability and validity of the Somali version were established by psychometric analysis in a sample of 47 bilingual health-care workers. Results Cronbach's alpha was 0.79 for the Somali version with the inter-item correlation mean of 0.33 and item-to-total correlation mean in the range of 0.40-0.80 ( p < 0.01). Pearson correlation for the item-to-item correlation between English and Somali version was between 0.70 and 0.93 ( p < 0.01) with the paired t-test showing no significant difference between the item means. Conclusions The Somali PHQ-9 showed a good reliability, homogeneity, and internal consistency. The construct validity for the Somali PHQ-9 was also established showing that the Somali PHQ-9 has similar reliability and validity like the other translated versions of PHQ-9.