RESUMO
This article reviews the existing literature related to medical training in public advocacy and provides the reader with several training examples to consider in a child and adolescent psychiatry fellowship or in combined training programs. Advocacy training embedded within community, forensic, integrated care, school, and many other experiences throughout training provides the skills and tools that the trainee will use in the future when they practice in any setting. This comprehensive training approach aligns with the evolving landscape of child and adolescent mental health where a deep commitment to public health and advocacy is increasingly essential.
Assuntos
Psiquiatria Infantil , Humanos , Psiquiatria Infantil/educação , Psiquiatria do Adolescente/educação , Saúde Pública/educação , Criança , Adolescente , Bolsas de Estudo , Defesa do Paciente/educaçãoRESUMO
The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.
Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Equidade em Saúde , Adolescente , Criança , Humanos , Psiquiatria do Adolescente/educação , Psiquiatria Infantil/educação , Diversidade CulturalRESUMO
Background: Developing theoretical courses for post-graduate medical training that are aligned to current workplace-based learning practices and adaptive to change in the field is challenging, especially in (sub) specialties where time for re-design is limited and needs to be performed while education continues. Approach: An instructional design method was applied based on flexible co-design to improve post-graduate theoretical courses in child and adolescent psychiatry (CAP) in the Netherlands. In four phases over a period of three years, courses were re-designed at a national level. Evaluation: Once common vision and learning goals were agreed upon and the prototype was developed (phases 1 and 2), the first courses could be tested in daily practice (phase 3). Phase 4 refined these courses in brief iterative cycles and allowed for designing additional courses building on and adding to previous experiences in brief iterative cycles. The resulting national theoretical courses re-allocated resources previously spent on a local level using easily accessible online tools. This allowed trainees to align content with their clinical rotations, personal preferences and training schedules. Reflection: The development of theoretical courses for post-graduate medical training in smaller medical (sub-)specialties with limited resources may profit from a flexible instructional design method. We consider the potential merit of such a method to other medical specialties and other (inter-)national efforts to develop theoretical teaching courses. A longer-term implementation evaluation is needed to show to what extent the investment made in the re-design proves to be future-proof and enables rapid adaptation to changes in the field.
Assuntos
Educação de Pós-Graduação em Medicina , Humanos , Educação de Pós-Graduação em Medicina/métodos , Países Baixos , Currículo/tendências , Psiquiatria do Adolescente/educação , Psiquiatria do Adolescente/métodos , Psiquiatria Infantil/educação , Psiquiatria Infantil/métodosRESUMO
Introduction: Pediatric behavioral and mental health (BMH) disorders are increasingly common, but most pediatricians feel inadequately trained to manage them. We implemented a case-based, longitudinal curriculum in BMH within a pediatric residency program to prepare trainees to diagnose and manage these conditions. Methods: The pediatric residency program at Wright State University/Wright-Patterson Medical Center implemented a new BMH curriculum in 2020-2021. The curriculum consisted of five simulated cases involving depression, anxiety, attention deficit disorder with hyperactivity (ADHD), developmental delays, behavioral concerns, and autism. To reflect follow-up within a continuity clinic, cases included initial encounters and multiple follow-up visits. Faculty facilitators led residents in monthly small-group meetings over the academic year, with each session consisting of two to three simulated patient encounters. Residents completed pre-post surveys regarding their confidence in diagnosing and managing BMH conditions and pre- and posttests to evaluate the impact of the curriculum on knowledge gains. Results: All 47 pediatric residents participated in the curriculum; 38 (81%) completed pre-post surveys. Upon completion of the curriculum, residents reported significantly increased confidence in managing ADHD, treating depression, creating safety plans for suicidality, recognizing autism, and counseling patients and families on special education services. Knowledge-based pre- and posttests completed by 25 residents (53%) also demonstrated significant improvement (M = 92.4, SD = 10.9, pre vs. M = 99.3, SD = 6.6, post, p = .009). Discussion: This case-based, longitudinal curriculum in pediatric BMH simulating patient continuity improved residents' confidence and knowledge in diagnosing and managing common BMH conditions.
Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Currículo , Internato e Residência , Pediatria , Humanos , Masculino , Feminino , Pediatria/educação , Educação de Pós-Graduação em Medicina , Transtornos Mentais , Saúde Mental , Psiquiatria Infantil/educação , Educação Baseada em Competências , Psiquiatria do Adolescente/educação , Criança , AdultoRESUMO
OBJECTIVE: This study examined the current state of forensic education among child and adolescent psychiatry (CAP) fellowship programs, regarding specific forensic topics, teaching resources, methods, and experiences. The authors aimed to gather and analyze this data to assess the need for additional standardization of forensic psychiatry education in CAP fellowship, such as broader access to resources, and/or inform the development of a standardized curriculum, including milestones, in child and adolescent forensic psychiatry. METHODS: The authors collaboratively developed a survey instrument on child and adolescent forensic psychiatry education, which was then sent to 135 accredited CAP fellowship programs. The items included in the survey instrument were designed based on literature review, expert consensus, and a 1992 American Association of Directors of Psychiatric Residency Training survey on teaching ethics and forensic psychiatry. RESULTS: Completed response data was returned by 25 of the 135 programs surveyed. Complete responses came primarily from academic institutions (52% public, 36% private) with small- or medium-sized programs (1-12 total fellows, 88%; 11-29 faculty members, 56%). Programs reported on CAP forensic rotation sites, faculty members' level of expertise and involvement in forensic CAP, common forensic topics and experiences offered, and programs' attitudes towards specific topics and experiences. CONCLUSIONS: Child and adolescent psychiatrists must gain a clear understanding of the essential components of CAP forensic psychiatry during CAP fellowship, to mitigate discomfort when interacting with the legal system and meet the rising need for forensic CAP expertise across systems and structures impacting youth populations.
Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Currículo , Bolsas de Estudo , Psiquiatria Legal , Humanos , Psiquiatria do Adolescente/educação , Psiquiatria Legal/educação , Psiquiatria Infantil/educação , Adolescente , Inquéritos e Questionários , Criança , Estados UnidosRESUMO
Fast-tracking is an option for residents to pursue fellowship training in place of their final residency year. It is currently permissible to fast-track into a child and adolescent psychiatry fellowship, but this remains a controversial idea for other psychiatry subspecialties. In 2022, the Annual Meeting of the Academy of Consultation-Liaison Psychiatry featured a plenary session debate about the pros and cons of fast-tracking. Here, the authors present some of the information discussed at that session and highlight the potential benefits and pitfalls of fast-tracking into consultation-liaison psychiatry.
Assuntos
Competência Clínica , Bolsas de Estudo , Humanos , Internato e Residência , Encaminhamento e Consulta , Psiquiatria/educação , Psiquiatria Infantil/educação , Psiquiatria do Adolescente/educaçãoRESUMO
OBJECTIVES: This study aimed to identify factors affecting current general psychiatry residents' interest in child and adolescent psychiatry (CAP) at Lehigh Valley Health Network (LVHN). Furthermore, it aimed to identify areas for improvement in clinical education to address the shortage of child psychiatrists at the institution at the time of this study. METHODS: An electronic anonymous pre-implementation survey was sent to all the current general psychiatry residents at LVHN. It assessed the most important factors for trainees in deciding their career paths into CAP, their comfort level with children and families, and overall CAP and related systems-based knowledge. Interventions based on the survey results were implemented in the LVHN psychiatry residency program. The residents then completed a post-intervention survey to assess the impact of these interventions on their perspectives toward CAP. RESULTS: CAP rotation experience and work with families were strong influencers for general psychiatry residents at LVHN in pursing CAP. Systems-based knowledge was particularly lacking compared to overall CAP knowledge. Educational interventions that were implemented at LVHN led to improvements in residents' sense of competence working with children and families with no net loss of interest in CAP. CONCLUSIONS: Educational modifications enhanced attitudes toward CAP among LVHN general psychiatry residents. Implementing such modifications at other residency programs may be likewise effective in retaining interest in CAP among their general psychiatry residents.
Assuntos
Psiquiatria do Adolescente , Escolha da Profissão , Psiquiatria Infantil , Internato e Residência , Humanos , Psiquiatria Infantil/educação , Psiquiatria do Adolescente/educação , Feminino , Inquéritos e Questionários , Masculino , Adulto , Atitude do Pessoal de Saúde , Psiquiatria/educaçãoRESUMO
OBJECTIVES: Eating disorders are serious psychiatric conditions that affect people of all ages. Many psychiatry trainees' first and only experience with eating disorders during training is their Child and Adolescent Psychiatry (CAP) rotation. This study aimed to explore the learning experience of psychiatry trainees working within an Eating Disorder Program (EDP) during their CAP rotation. METHODS: Fifteen trainees who participated in the EDP were recruited to complete an online survey and focus groups; a thematic analysis design was used to identify themes emerging from their responses. RESULTS: Themes emerged from the trainee learning experience of working in the EDP around what they found they learnt, what aided that process, what was difficult, and recommendations for future improvement. CONCLUSIONS: This study provided insight into the trainee experience in an EDP as one example of how trainees can learn about eating disorders and one way that could inform future workforce and training initiatives.
Assuntos
Psiquiatria Infantil , Transtornos da Alimentação e da Ingestão de Alimentos , Internato e Residência , Psiquiatria , Criança , Humanos , Adolescente , Psiquiatria/educação , Inquéritos e Questionários , Currículo , Psiquiatria do Adolescente/educação , Psiquiatria Infantil/educaçãoRESUMO
The American Academy of Child and Adolescent Psychiatry (AACAP) promotes the healthy development of children, adolescents, and families through advocacy, education, and research. This requires effectively meeting the mental health needs of historically minoritized communities. A diverse clinician workforce is an essential component of meeting those needs. This article will discuss AACAP's strategic plan for diversifying the workforce, this will be done with 3 main points: promoting diversity, equity, and inclusion (DEI) across all mission area, creating a pipeline of child and adolescent psychiatrists, and monitoring DEI activities and progress on an organizational level.
Assuntos
Psiquiatria Infantil , Psiquiatria , Adolescente , Estados Unidos , Humanos , Criança , Psiquiatria Infantil/educação , Mão de Obra em Saúde , Recursos Humanos , Psiquiatria do Adolescente/educaçãoRESUMO
The national shortage of child psychiatrists has resulted in the necessity of primary care providers (PCPs) managing increased mental health concerns of youth. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) is one of several programs throughout the United States which provide PCPs with education, consultation, and resource support related to pediatric mental health. To evaluate initial impact of the program, data from 190 pediatricians and family practitioners from the Wisconsin Health Information Organization (WHIO) were analyzed. Enrollment in the WI CPCP was associated with a significant increase in rates of mental health diagnoses within primary care visits. In addition, the number of providers who made any mental health diagnosis increased from 56% of PCPs pre-enrollment to over 99% post-enrollment. These data provide additional support for pediatric psychiatry consultation programs within primary care.
Assuntos
Psiquiatria Infantil , Transtornos Mentais , Adolescente , Humanos , Criança , Psiquiatria Infantil/educação , Wisconsin , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta , Saúde Mental , Transtornos Mentais/terapiaRESUMO
OBJECTIVES: The CanMEDS framework, an educational framework for physicians used in Canada, defined competencies that physicians require to meet patients' needs, all of which can be cultivated through mentorship activities. The Advocacy Mentorship Initiative (AMI) at the University of Toronto used a cascading mentorship model (CMM), whereby resident mentors (RMs) mentored undergraduate medical student mentors (MSMs), who in turn mentored youth raised in at-risk environments. Both RMs and MSMs were mentored by the AMI programme lead, a staff psychiatrist, with expertise in child and adolescent psychiatry. The research question of this study was as follows: What were the merits of using a CMM in enhancing the knowledge, competencies and residency experiences of RMs in AMI? DESIGN: Qualitative interview study. SETTING AND PARTICIPANTS: RMs involved in AMI from January 2017 to December 2020 were invited to participate in the study. A total of 11 RMs agreed to participate. METHODS: Interviews were conducted to canvas participants about how AMI impacted them, and these were recorded, transcribed and anonymised. Braun and Clarke's approach to thematic analysis was used to identify 'subthemes' and 'themes'. RESULTS: Eleven RMs participated in the study. A major theme identified was how AMI enhanced the medical learner experience by augmenting the educational experience of MSMs, strengthening RMs' values and attitudes, and strengthening RMs' knowledge and competencies. The second theme captured was the effective facets of a mentorship programme in AMI, including the CMM, and collaborative and inclusive relationships between mentors and mentees. CONCLUSIONS: RMs identified that the CMM of AMI cultivated CanMEDS competencies in medical learners; deepened medical learners' understanding of social determinants of health; and offered a bidirectional approach to teaching and learning between MSMs and RMs. MSMs and RMs also learnt from the staff psychiatrist.
Assuntos
Internato e Residência , Mentores , Humanos , Canadá , Pesquisa Qualitativa , Faculdades de Medicina , Psiquiatria Infantil/educação , Psiquiatria do Adolescente/educação , Modelos Educacionais , Competência ClínicaRESUMO
OBJECTIVE: A pilot survey was created to sample early career child and adolescent psychiatrists (CAPs) and fellows to identify factors contributing to recruitment, satisfaction, and general practice trends. METHOD: A 44-item survey was developed based on a previous study of early career CAPs and discussion at an early career forum. Participants were recruited at a professional meeting and through emails sent to all 125 US training program directors. RESULTS: Only 184 out of 2209 responses were received. Approximately two-thirds were female and one-third had completed fellowship. Most decided to pursue a career in child psychiatry during medical school and expected full time salaries between $175,000 and $250,000 after fellowship. Forty-five percent owed more than $150,000 in educational debt. The top reasons for pursuing a career in child psychiatry included the following: working with children, working in an interesting field, and helping society. Males (x = 85.7, SD 22.9) compared with females (x = 77.5, SD 25.3) were more interested in pursuing full time work. A higher proportion of participants were confident in prescribing medications (x = 79.9, SD 17.1) compared with providing psychotherapy (X = 63.3, SD 23.9). CONCLUSIONS: The vast majority of early career CAPs were recruited during medical school, motivated by altruistic reasons, and rated high confidence in their career choice despite significant student loan debt. Training directors should consider increasing competency in psychotherapeutic skills. Early child psychiatry exposure and a means of addressing physician debt are needed to improve recruitment to this specialty.