Hampton Elisa, Richardson Joshua E, Bostwick Susan, Ward Mary J, Green Cori
a Department of General Academic Pediatrics, Weill Cornell Medical College , New York , New York , USA.
Teach Learn Med. 2015;27(2):147-54. doi: 10.1080/10401334.2015.1011653.
PHENOMENON: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier.
The purpose of this study is to describe pediatric residents' experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach.
Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and dissemination to enhance trainees' MH knowledge and skills to provide optimal MH care for children.
现象：心理健康（MH）问题在儿科人群中普遍存在，在资源有限的情况下，儿科医生需要在基层医疗单位提供心理健康护理，但由于在住院医师培训期间缺乏相关培训，他们对此感到不自在。
本研究的目的是描述儿科住院医师对心理健康培训的现状和理想状态的经历与看法，以及为弥合这一差距而进行课程开发的想法。对来自城市学术医疗中心的儿科住院医师进行了焦点小组定性研究。对录音进行转录，并采用扎根理论方法进行分析。
26名住院医师参加了3个焦点小组，此时达到了主题饱和。研究团队产生了5个主要主题：能力、舒适度、组织能力、应对方式和教育。住院医师在心理健康诊疗的每一步都表现出不确定性。确定的内部障碍包括舒适度低和负面情绪反应。外部障碍包括缺乏心理健康资源、心理健康护理方面的指导或组织能力不足。这些内部和外部障碍导致在处理心理健康问题时缺乏感知能力。作为回应，住院医师报告了应对策略不足，如忽视心理健康问题。为了积累知识和技能，住院医师更喜欢的教育方式包括讲授法、通过与心理健康专家合作进行体验式学习以及融入患者护理流程的工具。见解：儿科住院医师培训项目需要改进，以提高住院医师在心理健康护理方面的培训。住院医师所要求的技能和知识与美国儿科学会关于心理健康能力的声明一致。协作护理模式提供了住院医师所要求的类似学习方式。这些全国性的努力尚未在培训项目中实施，但可能有助于课程开发和推广，以增强学员的心理健康知识和技能，为儿童提供最佳的心理健康护理。
