Yedidia Michael J, Gillespie Colleen C, Bernstein Carol A
Graduate School of Public Health Service, New York University, 295 Lafayette Street, 2nd Floor, New York, New York 10012, USA.
Psychiatr Serv. 2006 Feb;57(2):238-43. doi: 10.1176/appi.ps.57.2.238.
This study assessed how resident psychiatrists are being prepared to deliver effective public-sector care.
Ten leaders in psychiatric education and practice were interviewed about which tasks they consider to be essential for effective public-sector care. The leaders identified 16 tasks. Directors of all general psychiatry residency programs in the United States were then surveyed to determine how they rate the importance of these tasks for delivery of care and how their training program prepares residents to perform each task.
A total of 114 of 150 residency directors (76 percent) responded to the survey. Factor analysis divided 14 of the tasks into three categories characterized by the extent to which their performance requires integration of services: within the mental health system (for example, lead a multidisciplinary team), across social service systems (for example, interact with staff of supportive housing programs), and across institutions with different missions (for example, distinguish behavioral problems from underlying psychiatric disorders among prisoners). Preparation for tasks that involved integration of services across institutions was rated as least important, was least likely to be required, and was covered by less intensive teaching modalities. Tasks entailing integration within the mental health system were rated as most important, preparation was most likely to be required, and they were covered most intensively. Midway between these two categories, but significantly different from each, were tasks relying on integration across social service systems.
Tasks that involved integrating services across institutions with different missions were consistently downplayed in training. Yet the importance of such tasks is underscored by the assessments of the psychiatric leaders who were interviewed, the high valuation placed on this type of integration by a substantial subset of training directors, and the extent of mental illness among populations who are institutionalized in nonpsychiatric settings.
本研究评估了住院精神科医生如何为提供有效的公共部门护理做准备。
采访了10位精神科教育与实践领域的领导者，询问他们认为哪些任务对于有效的公共部门护理至关重要。这些领导者确定了16项任务。随后对美国所有普通精神科住院医师培训项目的主任进行了调查，以确定他们如何评价这些任务对于提供护理的重要性，以及他们的培训项目如何使住院医师为执行每项任务做好准备。
150位住院医师培训项目主任中有114位（76%）回复了调查。因子分析将其中14项任务分为三类，其特征在于任务执行所需的服务整合程度：在心理健康系统内（例如，领导多学科团队）、跨社会服务系统（例如，与支持性住房项目的工作人员互动）以及跨具有不同使命的机构（例如，在囚犯中区分行为问题与潜在的精神疾病）。涉及跨机构服务整合的任务被评为最不重要，最不可能被要求执行，并且教学方式的强度也较低。需要在心理健康系统内进行整合的任务被评为最重要，最有可能被要求执行，并且教学覆盖最密集。介于这两类之间但与两者均有显著差异的是依赖跨社会服务系统整合的任务。
涉及跨具有不同使命的机构整合服务的任务在培训中一直被轻视。然而，接受采访的精神科领导者的评估、相当一部分培训主任对这种整合类型的高度重视以及在非精神科环境中被收容人群的精神疾病程度都凸显了此类任务的重要性。
