Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
Psychiatr Serv. 2013 Aug 1;64(8):808-11. doi: 10.1176/appi.ps.201200461.
This study examined differences in disposition decisions among mental health professionals using a standardized Web-based simulation.
Using a Web-based simulation that described, across users, the same complex psychiatric patient, credentialed clinicians in a psychiatry department conducted a violence risk assessment and selected a level of follow-up care.
Of 410 clinicians who completed the simulation, 60% of psychiatrists were more likely than other types of clinicians to select higher levels of care (inpatient or emergency services) for the standardized virtual patient (odds ratio=2.67, 95% confidence interval=1.67-4.25), even after adjustment for other factors. Virtual actions taken, such as contracting with the patient for safety and discussing hospitalization, elucidated these training differences.
Training backgrounds were important determinants of clinicians' actions and the dispositions they recommended for a psychiatric patient at high risk of self-harm and harm to others in the educational setting and may suggest the need for further training to standardize and optimize care.
本研究使用标准化的网络模拟来考察心理健康专业人员在处置决策上的差异。
通过一个网络模拟，向不同用户描述同一位复杂的精神病患者，精神病学部门的认证临床医生对暴力风险进行评估并选择后续护理的级别。
在完成模拟的 410 名临床医生中，60%的精神科医生比其他类型的临床医生更有可能为标准化虚拟患者选择更高水平的护理（住院或急诊服务）（优势比=2.67，95%置信区间=1.67-4.25），即使在调整了其他因素之后也是如此。虚拟采取的行动，如与患者签订安全协议和讨论住院事宜，阐明了这些培训差异。
培训背景是临床医生在教育环境中对高自杀风险和对他人有伤害风险的精神病患者的行为和建议处置的重要决定因素，这可能表明需要进一步的培训来规范和优化护理。
