Promoting mental health competency in residency training

Objective

To evaluate the effect our developmental-behavioral pediatrics (DBP) curricular model had on residents’ comfort with handling mental health issues.

Methods

From August 2007 to January 2010, residents participating in the Indiana University DBP rotation completed a self-assessment questionnaire at baseline and at rotation end. Residents rated their comfort with the identification, treatment, and counseling of mental health problems using a 5-point scale.

Results

Ninety-four residents completed both self-assessments. At baseline, categorical pediatric residents possessed higher comfort levels toward identification (mean 2.8 vs. 2.3 for non-categorical pediatrics residents, p < 0.05), treatment (2.6 vs. 2.2, p < 0.05) and counseling of mental health issues (2.7 vs. 2.1, p < 0.005). Residents who were parents were also more comfortable. At rotation end, all residents showed significant improvements in self-rated comfort (4.0 vs. 2.6 for identification, p ≤ 0.05; 4.0 vs. 2.4 for treatment, p ≤ 0.05; and 4.0 vs. 2.4 for counseling, p ≤ 0.05). This remained true regardless of being a categorical pediatric resident, a parent, or primary care-oriented.

Conclusion

Our curricular model promotes residents’ comfort with handling common mental health issues in practice.

Practice implications

Increasing residents’ comfort may influence the frequency of active discussion of mental health issues during well-child visits and lead to earlier diagnosis and needed treatment.     

Cardiovascular disease prevention counseling in residency: resident and attending physician attitudes and practices

PURPOSE: This study seeks to establish resident and attending physician attitudes and practice patterns with regard to cardiovascular disease (CVD) preventive counseling within a teaching hospital setting. METHODS: A 75-question survey was administered to residents and their attending physicians within a single academic medical residency program at a large, urban public hospital. RESULTS: Physician CVD risk factor counseling rates were lowest for exercise and diet (16% and 20%, respectively) and somewhat higher, although not ideal, for medication compliance and smoking (52% and 88%, respectively). Physicians did not often recommend behavior change strategies, and few physicians felt very effective in their counseling of smoking, exercise, diet, and weight reduction (25%, 24%, 27%, and 23%, respectively). Physicians acknowledged the existence of many patient, physician, and system barriers that interfered with providing more preventive counseling. There were few differences in counseling practices and attitudes between residents and attending physicians, and no significant gender differences. CONCLUSIONS: Our study found low counseling rates for CVD prevention, particularly in the areas of diet, exercise, and weight loss. Future interventions should highlight the importance of diet, exercise, and weight control in preventing CVD, and efforts should be directed toward training both resident and attending physicians, as counseling rates are low in both groups.     

Motivation and satisfaction in GP training: a UK cross-sectional survey

Background

Recruitment to general practice has had periods of difficulty, but is currently going through a phase of relative popularity in the UK.

Aim

To explore motivators for career choice and career satisfaction among UK GP trainees and newly qualified GPs.

Design and setting

Cross-sectional web-based questionnaire of GP trainees and GPs within the first 5 years of qualification in the UK.

Method

All 9557 UK GP trainees and 8013 GPs who were within the first 5 years of qualification were invited to participate by email. Further publicity was conducted via general practice publications and the internet.

Results

Overall, there were 2178 responses to the questionnaire (12.4% response rate, 61.5% women, 61.8% trainees). Levels of satisfaction were high, with 83% of responders stating that they would choose to be a doctor again; of these, 95% would choose to be a GP again. The most frequently cited reason for choosing general practice was ‘compatibility with family life’, which was chosen by 76.6% of women and 63.2% of men (P<0.001). Other reasons given were: ‘challenging medically diverse discipline’ (women 59.8%, men 61.8%, P = 0.350), ‘the one-to-one care general practice offers’ (women 40.0%, men 41.2%, P = 0.570), ‘holistic approach’ (women 41.4%, men 30.1%, P<0.001), ‘autonomy and independence’ (women 18.0%, men 34.8%, P<0.001), ‘communication’ (women 20.6%, men 12.2%, P<0.001), ‘negative experiences in hospital’ (women 12.8%, men 9.8%, P= 0.036), and ‘good salary’ (women 7.8%, men 14.9%, P<0.001).

Conclusion

The most important reason for both women and men choosing general practice as a career in the UK is its compatibility with family life. As such, changes to UK primary care that decrease family compatibility could negatively impact on recruitment.     

Spanish mental health residents' perspectives about residency education on the genetics of psychiatric disorders: A cross-sectional survey

Despite compelling evidence that some patients with a psychiatric diagnosis could benefit from genetic assessment, genetic testing for psychiatric patients is underutilized. Few studies have reported psychiatric genetics training for mental health specialists, and such research is especially lacking in Spain. We aimed to gather the opinions of Spanish mental health residents, including resident intern nurses (RINs), doctors (RIDs) and psychologists (RIPs). A short survey was prepared by an expert team and distributed to all mental health residency centers in Spain during the first semester of 2021. Of the 2028 residents, 18% responded. Participants were mainly females (71%), in their first year of residency (37%) and within the 27–31-year age range. While participants received little theoretical (13.4%) and practical (4.6%) training on average, RIDs had the most affirmative responses. Notably, RINs and RIDs were interested in genetics during residency (>40%) and strongly believed (85.0%) that genetics training using both theoretical and practical methodologies should be incorporated into residency training. However, RIPs were less interested (20%), and only 60% believed that genetics training should be incorporated. Spanish mental health residents, although interested in genetics in psychiatry, receive little training on this topic. They strongly believe that genetics training using theoretical and practical methodologies should be incorporated.     

Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents

STUDY OBJECTIVES: To examine the relationship between residents' self-reported sleep hours, work hours, and other empirical correlates. DESIGN: Using the American Medical Association's Graduate Medical Education database, a national, random sample of PGY (postgraduate year) 1 and PGY2 residents in the 1998-1999 training year was surveyed by mail. MEASUREMENTS AND RESULTS: Residents completed a 5-page survey with 44 questions requiring 144 separate responses about their residency experience. Completed surveys were received from 3,604 of 5,616 residents contacted, a 64.2% response rate. Although work hours and sleep hours were significantly correlated (r = -.39), this relationship was less robust than is generally assumed. Total average sleep hours varied across specialties but also within specialties. Just over 20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors. CONCLUSIONS: Reduced sleep hours were significantly related to a number of work-related, learning, and personal health variables. Capping residents' work hours is unlikely to fully address the sleep deficits and resulting impairments reported by residents.     

Well-being, positivity and mental health: an introduction to the special issue

Enhancing well-being, as opposed to reducing distress, has traditionally not been a focus for clinical practice. There are differences in views about the nature of well-being, but enhancing well-being in clinical settings is a straightforward goal whatever concept of well-being is adopted. Reasons for adopting a well-being enhancing, as well as a distress-reducing, focus include the fact that many psychological problems do not fit the simple acute treatment model of disorder, that positive experience inhibits negative experience, and that people can benefit from therapists seeing them as more than the sum of their problems. In recent years, well-being has been of increasing interest to researchers and clinicians, and enhancing well-being is emerging as a potentially valuable element of effective clinical practice.     

Program evaluators in community mental health centers: results of a national survey

A national survey of CMHC directors and program evaluators yielded responses by both directors and evaluators from 323 CMHCs (60% response rate). The majority of centers reported only one full-time equivalent evaluator or less. Evaluators generally had little or no specific formal education in program evaluation and the majority had a master's degree or less as their highest degree. However, consultants were widely used and evaluators expressed much interest in hearing about conferences, continuing education opportunities, and publications dealing with program evaluation.     

A community mental health survey in Cantabria: a general description of morbidity

A two-stage mental illness survey of a random sample of persons aged 17 years and over from a rural community in Cantabria, Spain, is described. In the first stage newly qualified doctors and final year medical students interviewed 1223 respondents (583 males and 640 females) at their homes, using the General Health Questionnaire (GHQ-60) and other psychopathological and social questionnaires. In the second stage senior psychiatrists carried out an at-home interview on a sample composed of all those who in the first stage scored above the cut-off point on the GHQ, and of a similar number of persons selected at random from two independent batches of below-threshold scorers on the GHQ. Because of this design the prevalence figures have to be weighted in order to represent the whole first stage sample. Of the total population, 14.7% (8.1% of the men and 20.6% of the women) had psychiatric disorders as defined by the PSE-ID system. In males depression accounted for about twice as many cases as anxiety states, but in females there was a predominance of a combination of anxiety, phobic and obsessive conditions. Men presented a higher prevalence of disorders over the age of 35, with a peak around the age of forty, while in women the rise of prevalence was over the age of 45. There was, however, no significant association with marital status. Unemployment was related to mental illness in males but not in females, while the reverse was true of the type of work. In both sexes the presence of children under fourteen in the household was not related to a rise in prevalence. Women exhibited a high rate of mental illness in the low educational level and in the low social and religious integration groups, but in men a rise in prevalence was found in the low social status, low educational level and low social integration groups. Lastly, in both sexes the presence of physical illness was related to mental disorders.     

Concepts of mental health--a survey of attendees at a mental health promotion conference

This survey of attendees at a Mental Health Promotion Conference in Hull, Yorkshire, England in the summer of 1996 was undertaken in part fulfilment of an MSc in Health Promotion. Of the 120 delegates, 99 attended the conference. There were 77 completed questionnaires. The most outstanding result of the survey was the very strong agreement among respondents that sense of self-worth is the most important attribute of being mentally healthy. The respondents were also strongly in favour of enablement strategies but on the whole envisioned these as having primarily an educational rather than a societal focus. About a third of the respondents tended to conceptualise mental health promotion within a clinical framework. The survey demonstrates the need to strengthen concepts of positive mental health and for mental health professionals to identify and work more closely with non-health workers in the promotion of positive mental health.     

Physician gender,physician patient-centered behavior,and patient satisfaction: A study in three practice settings within a hospital

Objective

To compare male and female physicians on patient-centeredness and patients’ satisfaction in three practice settings within a hospital; to test whether satisfaction is more strongly predicted by patient-centeredness in male than female physicians.

Methods

Encounters between physicians (N = 71) and patients (N = 497) in a hospital were videotaped and patients’ satisfaction was measured. Patient-centeredness was measured by trained coders.

Results

In the outpatient setting, female physicians were somewhat more patient-centered than male physicians; patient satisfaction did not differ. In the inpatient and emergency room settings, female physicians were notably more patient-centered than male physicians; satisfaction paralleled these differences. Nevertheless, there was some, though mixed, evidence that patient-centeredness predicted satisfaction more strongly in male than female physicians, suggesting that patients valued patient-centered behavior more in male than female physicians.

Conclusion

Even though satisfaction mirrored the different behavior styles of male and female physicians in the inpatient and emergency room settings, in all settings male physicians got somewhat more credit for being patient-centered than female physicians did.

Practice implications

If female physicians do not consistently receive credit for high patient-centeredness in the eyes of patients, this could lead female physicians to reduce their patient-centered behavior.     

Burnout in residents of otolaryngology-head and neck surgery: a national inquiry into the health of residency training.

PURPOSE: To characterize resident burnout on a national scale with a large sample size and to identify associated modifiable factors to minimize burnout and improve the quality of residency education. METHOD: A survey was mailed to all 1,364 U.S. residents of otolaryngology-head and neck surgery in September 2005. The main outcome measures were the Maslach Burnout Inventory-Human Services Study, demographic information, and potential burnout predictors, including stressors, satisfaction, self-efficacy, and support systems. RESULTS: The response rate was 50% (684/1,364). Current second-year through fifth-year residents were included for further analysis (514). Burnout was extremely common among otolaryngology residents. High burnout was seen in 10% of residents (51), moderate burnout in 76% (391), and low burnout in 14% (72). The strongest associated demographic factor was work hours (P < .001). Hours worked was predictive of emotional exhaustion, with exhaustion scores rising by 0.19 for each hour worked (P < .001). Furthermore, there was an 8% (41 resident) reported violation rate of the Accreditation Council for Graduate Medical Education (ACGME) 80-hour-workweek limitation. Satisfaction with the balance between personal and professional life, relationship stability, and satisfaction with career choice were negatively associated with burnout (all P < .001). CONCLUSIONS: Burnout is widely prevalent among U.S. otolaryngology residents and is present at greater levels than those seen in chairs or faculty of the same specialty. Work hours predict emotional exhaustion, and adherence to the ACGME 80-hour workweek may help protect against burnout and its deleterious consequences in residents of all specialties.     

Patients' satisfaction with general practitioner services: a survey by a community health council.

Brighton community health council responded to the invitation of five local general practitioners to undertake a patient satisfaction survey of their practices. A total of 177 mothers of children under five years old were interviewed in their own homes. Satisfaction with the services provided by the general practitioners and members of the primary health care team to the respondents and to their young children was high overall, but critical comment reflected a dissatisfaction with professionals' unwillingness to take mothers' concerns at face value and to recognize the validity of mothers' own experiential knowledge. Some women were not satisfied with the extent to which they could ask questions or explain their problem. They resented attempts by receptionists to bar access to doctors and the apparent reluctance of doctors and health visitors to make home visits. It is suggested that various strategies such as telephone consultations, written guidelines on childhood ailments and parent support groups within the context of a more interactive partnership between patients and professionals could lead to a more effective service.     

Suicidal ideas and behavior in contrasted generations: Evidence from a community mental health survey

A comparison was made of young (aged 18–24) and old (60 plus) respondents in a community mental health survey of 679 adults in Calgary, Alberta, Canada. Young people had significantly poorer mental health than did the elderly respondents and also reported more suicidal ideas and behavior in their lifetime. Assuming that these findings can be generalized to a wider population, the results imply a steady increase in suicidal behavior as the present generation of young people becomes older.     

Models of mental health training for primary care physicians: a validation study

Since the majority of persons with alcohol, drug abuse, and/or mental disorders (19%) of Americans during any 6-month period are seen exclusively within the general health sector, it is imperative to know the quality and quantity of mental health training for primary care residents. In this study, the five program training model types previously described--Consultation, Liaison, Bridge, Hybrid, Autonomous--are validated by a random sampling technique using a structured instrument to test eight hypotheses developed before data collection to preclude post hoc interpretations. Of 250 programs, 147 responded (60%): 67 Family Practice, 42 Primary Internal Medicine, and 38 Internal Medicine. Since all eight hypotheses were supported by the data, the construct validity of the program model types is significantly substantiated. Multiple discriminant analysis revealed that the relationships between twelve training program characteristics and the five program model types were such that the former could explain 57% of the variance in the latter and correctly classify 89% of the programs.     

Community mental health and the elderly: service and training approaches

There is a growing gap between needed and available mental health services for older adults. This article discusses the training needs, personnel shortages, and lack of effective service programs and proposes some strategies for dealing with the problems. There is a lack of adequate methods for identifying and referring frail elderly persons in need of mental health services. Services that are currently available to the elderly are identified along with factors that may influence their use by older adults and other service personnel. There are shortages of mental health professionals with special training and experience in gerontology and geriatrics, and clinical geropsychologists. An innovative and practical service model that was developed to coordinate and integrate the identification and treatment of frail, community-dwelling elderly is presented. Various aspects of the program that include outreach and case management approaches, the integration of student volunteer activities with those of special volunteer corps within public housing and specially trained paraprofessionals, telephone reassurance programs, and a system of layered supervision are described. Comparisons are made between this Coordinated Agency Resources for Elderly Services (CARES) model and existing service delivery programs. A three-tiered approach to training and coordinating the activities of trained mental health personnel: (a) paraprofessionals and volunteers, (b) middle-level professionals and (c) supervisory professionals within an integrated system is proposed. Specific roles and functions of personnel at each level are described. The summary discusses the potential of the proposed strategies for dealing with the problems created by the shortage of personnel and services. It suggests some time frames within which the strategies could be operationalized.     

Public health physician specialty training in Canada and the United States

Today's interconnected world has produced a distinct need for physician specialists in public health and preventive medicine. As the industrialized world confronts aging populations, rising health care costs, and a growing epidemic of chronic disease, it is clear that the focus of health care must become more preventive than curative.Although public health and preventive medicine exists in various forms worldwide, the literature has not yet examined different national strategies for postgraduate medical training in this unique specialty. This examination of present-day public health physician training in Canada and the United States represents a first step in addressing this gap.Using a standardized template for review, the authors compare key aspects of public health physician specialty training in both countries, including the definition and scope of the specialty; oversight and location of training; length of postgraduate training; specific clinical, academic, and practicum requirements; residency program funding; availability of residency positions; certification; and the roles of specialists.The authors explore similarities and differences between public health physician specialists in Canada and the United States in an effort to highlight training improvements for incorporation into each country's training program and to identify potential avenues of collaboration and cooperation across the border.     

Strategic directions within health care institutions: the role of the physician

The nature of the strategic problem faced by health care institutions is identified. Physicians are urged to be involved in the strategic decision-making process and are offered several alternative roles that they might play in strategy development. A set of conceptual frameworks from the generic management decision-making literature is used to organize the analysis in addition to the literature of health care management. This combination affords a different perspective into the nature of the problems and new insights into these critical issues.