Department of Psychiatry, University of Toronto, Ontario, Canada.
Can J Psychiatry. 2012 Jun;57(6):375-80. doi: 10.1177/070674371205700607.
To identify how psychiatric residents perceive their ability to conduct violence risk assessments and the risk factors they considered relevant in an emergency department setting.
We surveyed 55 of 159 psychiatric residents at the University of Toronto as to their experience and education in assessing suicide and violence risk. The residents, and a comparison group of 11 of 16 staff psychiatrists in the Law and Mental Health program at the Centre for Addiction and Mental Health, then participated in a mock interview with one of the authors. The subjects were directed to ask for all risk factors that would be relevant in determining the violence risk of a hypothetical patient with homicidal ideation. The risk factors they requested were compared with the risk factors found in the Historical, Clinical and Risk Management-20 (HCR-20) structured clinical judgment tool.
Psychiatric residents, on average, inquired about 6 fewer HCR-20 risk factors than staff psychiatrists (8.5, compared with 14.7). The number of HCR-20 items identified by residents correlated with several items; more risk factors were elicited by residents in a higher year of training, those who had received more formal and informal education, the number of patients for whom they had discharged a duty to warn, and the number of suicidal and violent patients they had previously assessed. Confidence at assessing violence risk was not correlated with performance.
Psychiatric residents identify significantly fewer risk factors for violence than staff psychiatrists. Resident performance was correlated with increasing experience and education. It was not related to self-confidence in performing this task.
确定精神科住院医师如何看待自己进行暴力风险评估的能力，以及他们在急诊科环境中认为相关的风险因素。
我们调查了多伦多大学的 159 名精神科住院医师中的 55 名，了解他们在评估自杀和暴力风险方面的经验和教育情况。这些住院医师和成瘾与心理健康中心法律与心理健康计划的 16 名工作人员精神科医生中的 11 人参加了与作者之一的模拟面试。要求受试者询问所有与确定具有杀人意念的假设患者的暴力风险相关的风险因素。他们要求的风险因素与历史、临床和风险管理-20 （HCR-20）结构化临床判断工具中的风险因素进行了比较。
精神科住院医师平均询问的 HCR-20 风险因素比工作人员精神科医生少 6 个（8.5 个，而工作人员精神科医生为 14.7 个）。住院医师确定的 HCR-20 项目数量与几个项目相关；接受更高年资培训的住院医师会引出更多的风险因素，接受更多正规和非正规教育的住院医师，为其发出警告义务的患者人数，以及他们之前评估的自杀和暴力患者人数。评估暴力风险的信心与表现无关。
精神科住院医师确定的暴力风险因素明显少于工作人员精神科医生。住院医师的表现与经验和教育的增加有关。与执行此任务的自信心无关。
