“足够好”的边缘型人格障碍精神科住院医师培训:挑战、抉择点及通用型课程模式

"Good Enough" Psychiatric Residency Training in Borderline Personality Disorder: Challenges, Choice Points, and a Model Generalist Curriculum.

作者信息

Unruh Brandon T, Gunderson John G

机构信息

From Harvard Medical School and McLean Hospital, Belmont, MA.

出版信息

Harv Rev Psychiatry. 2016 Sep-Oct;24(5):367-77. doi: 10.1097/HRP.0000000000000119.

Abstract

While the public health burden posed by borderline personality disorder (BPD) rivals that associated with other major mental illnesses, the prevailing disposition of psychiatrists toward the disorder remains characterized by misinformation, stigma, aversive attitudes, and insufficient familiarity with effective generalist treatments that can be delivered in nonspecialized health care settings. Residency training programs are well positioned to better equip the next generation of psychiatrists to address these issues, but no consensus or guidelines currently exist for what and how residents should be taught about managing BPD. Instead, disproportionately limited curricular time, teaching of non-evidence-based approaches, and modeling of conceptually confused combinations of techniques drawn from specialty BPD treatments are offered. In this article, we (1) explain why training in a generalist model is sensible and why alternative approaches are not appropriate for residents, (2) propose a plan for giving residents adequate training via a generalist model, highlighting minimal didactic and clinical-training objectives (dubbed "core competencies" and "milestones") and a model curriculum developed at the Massachusetts General Hospital/McLean Hospital residency program, and (3) describe obstacles to implementation of effective generalist training posed by infrastructural, faculty-centered, and resident-centered variables.

摘要

虽然边缘性人格障碍(BPD)给公众健康带来的负担可与其他主要精神疾病相匹敌,但精神科医生对该疾病的普遍态度仍存在错误信息、污名化、厌恶态度以及对可在非专科医疗环境中提供的有效全科治疗不够熟悉等问题。住院医师培训项目处于有利地位,能够更好地让下一代精神科医生应对这些问题,但目前对于应该教给住院医师哪些关于管理BPD的内容以及如何教学,尚无共识或指导方针。相反,课程时间严重有限,传授的是非循证方法,且示范的是从BPD专科治疗中借鉴的概念混乱的技术组合。在本文中,我们(1)解释为何采用全科模式进行培训是合理的,以及为何其他方法不适用于住院医师;(2)提出一项通过全科模式为住院医师提供充分培训的计划,强调最低限度的教学和临床培训目标(称为“核心能力”和“里程碑”)以及由麻省总医院/麦克莱恩医院住院医师培训项目制定的示范课程;(3)描述由基础设施、以教员为中心和以住院医师为中心的变量所造成的有效全科培训实施障碍。

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