Department of Pediatrics, Weill Cornell Medicine, New York, New York;
Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Pediatrics. 2019 Sep;144(3). doi: 10.1542/peds.2018-2596. Epub 2019 Aug 5.
There is an urgent need to advance mental health (MH) education and/or training in pediatric residency programs, yet no consensus on how to achieve this. We created an operational framework from ideas provided by a diverse group of stakeholders on how to advance MH education.
Concept-mapping methodology was used, which involves brainstorming ideas by completing a focus prompt, sorting ideas into groups, and rating them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis grouped ideas into clusters. Average importance and feasibility were calculated for each statement and cluster and compared statistically in each cluster and between subgroups.
Ninety-nine ideas were generated. Sorted ideas yielded a 7-cluster concept map: (1) modalities for MH training, (2) prioritization of MH, (3) systems-based practice, (4) self-awareness and/or relationship building, (5) training in clinical assessment of patients, (6) training in treatment, and (7) diagnosis-specific skills. Two hundred and sixteen participants rated ideas for importance and 209 for feasibility. Four clusters had a statistically significant difference between their importance and feasibility ratings ( < .001). Suburban and rural area respondents (versus urban) rated clusters higher in importance and feasibility ( < .004), trainees rated all clusters higher in feasibility than practicing clinicians, and MH professionals rated prioritization of MH higher in feasibility (3.42 vs 2.98; < .001).
This comprehensive set of ideas, especially those rated highly in both importance and feasibility, should inform curricular and policy initiatives. Differences between importance and feasibility may explain why there has been little progress in this field.
在儿科住院医师培训计划中推进心理健康(MH)教育和/或培训迫在眉睫,但尚未就如何实现这一目标达成共识。我们根据来自不同利益相关者的想法创建了一个操作框架,以了解如何推进 MH 教育。
采用概念映射方法,通过完成焦点提示来集思广益,将想法分为组,并对其重要性和可行性进行评分。多维缩放和层次聚类分析将想法分为聚类。为每个语句和聚类计算平均重要性和可行性,并在每个聚类和子组之间进行统计学比较。
共生成 99 个想法。排序后的想法产生了一个 7 聚类概念图:(1)MH 培训方式,(2)MH 优先级,(3)基于系统的实践,(4)自我意识和/或关系建立,(5)对患者进行临床评估的培训,(6)治疗培训,和(7)特定于诊断的技能。216 名参与者对重要性进行了评分,209 名参与者对可行性进行了评分。四个聚类在重要性和可行性评分之间存在统计学差异(<0.001)。与城市相比,郊区和农村地区的受访者(而非城市)对聚类的重要性和可行性评价更高(<0.004),受训者对所有聚类的可行性评价均高于执业临床医生,而 MH 专业人员对 MH 优先级的可行性评价更高(3.42 对 2.98;<0.001)。
这组全面的想法,尤其是那些在重要性和可行性方面都得到高度评价的想法,应该为课程和政策计划提供信息。重要性和可行性之间的差异可能解释了为什么该领域几乎没有取得进展。