Nelson William A, Pomerantz Andrew, Schwartz Jonathan
Department of Psychiatry, Dartmouth Medical School, 35 Centerra Parkway-HB7251, Lebanon, NH 03766, USA.
Acad Psychiatry. 2007 Nov-Dec;31(6):423-9. doi: 10.1176/appi.ap.31.6.423.
Evidence indicates disparities in the number of psychiatrists practicing in rural America compared to urban areas suggesting the need for a greater emphasis on rural psychiatry in residency training programs. The authors offer suggestions for integrating a rural focus in psychiatry residency training to foster greater competency and interest in rural psychiatry.
The authors surveyed the limited rural psychiatry training and the more extensive family medicine rural residency literature to review efforts to develop rural focused training curricula.
Many factors in the rural environment influence mental health care, including overlapping professional-patient relationships, caregiver isolation and stress, limited availability and access to mental health resources, disease stigma, and economic and health status. To enhance both an interest in and the quality of the training for a rural practice, the authors suggest three levels of training for integrating rural factors into psychiatry programs from a basic didactic understanding of the contextual issues affecting rural psychiatry, to creating rural clinical experiences and preceptors, to developing a rural psychiatry fellowship.
Providing trainees with an understanding of the rural mental health issues and experiences might contribute to trainees' selecting rural practices and enhance the rural competency of psychiatrists.
有证据表明，与城市地区相比，美国农村地区执业精神科医生的数量存在差异，这表明在住院医师培训项目中需要更加强调农村精神病学。作者提出了将农村重点纳入精神科住院医师培训的建议，以提高对农村精神病学的能力和兴趣。
作者调查了有限的农村精神病学培训以及更广泛的农村家庭医学住院医师文献，以回顾制定以农村为重点的培训课程的努力。
农村环境中的许多因素会影响精神卫生保健，包括专业人员与患者关系重叠、照顾者孤立和压力、精神卫生资源的可用性和可及性有限、疾病污名以及经济和健康状况。为了提高对农村执业培训的兴趣和培训质量，作者建议进行三个层次的培训，将农村因素纳入精神病学项目，从对影响农村精神病学的背景问题的基本教学理解，到创造农村临床经验和带教老师，再到发展农村精神病学 fellowship。
让受训人员了解农村心理健康问题和经历可能有助于受训人员选择农村执业，并提高精神科医生的农村能力。
