心理行为状况管理培训：急诊医学住院医师需求评估调查
Training in the Management of Psychobehavioral Conditions: A Needs Assessment Survey of Emergency Medicine Residents.
作者信息
Pickett Jason, Haas Mary Rose Calderone, Fix Megan L, Tabatabai Ramin R, Carrick Angela, Robertson Jennifer, Barnes Angelica Veronica, Ondeyka Amy, Brown Mary Jane, Edwards Andrew R, Dehon Erin
机构信息
Department of Emergency Medicine University of Mississippi Medical Center Jackson MS.
Department of Emergency Medicine University of Michigan Medical School Ann Arbor MI.
出版信息
AEM Educ Train. 2019 Jul 30;3(4):365-374. doi: 10.1002/aet2.10377. eCollection 2019 Oct.
OBJECTIVE
Mental health-related ED visits are increasing. Despite this trend, most emergency medicine (EM) residency programs devote little time to psychiatry education. This study aimed to identify EM residents' perceptions of training needs in emergency psychiatry and self-confidence in managing patients with psychobehavioral conditions.
METHODS
A needs assessment survey was distributed to residents at 15 Accreditation Council for Graduate Medical Education-accredited EM programs spanning the U.S. Survey items addressed amount and type of training in psychiatry during residency, perceived training needs in psychiatry, and self-confidence performing various clinical skills related to emergency psychiatric care. Residents used a 5-point scale (1 = nothing; 5 = very large amount) to rate their learning needs in a variety of topic areas related to behavioral emergencies (e.g., medically clearing patients, substance use disorders). Using a scale from 0 to 100, residents rated their confidence in their ability to independently perform various clinical skills related to emergency psychiatric care (e.g., differentiating a psychiatric presentation from delirium).
RESULTS
Of the 632 residents invited to participate, 396 (63%) responded. Twelve percent of respondents reported completing a psychiatry rotation during EM residency. One of the 15 participating programs had a required psychiatry rotation. Residents reported that their program used lectures (56%) and/or supervised training in the ED (35%) to teach residents about psychiatric emergencies. Most residents reported minimal involvement in the treatment of patients with psychiatric concerns. The majority of residents (59%) believed that their program should offer more education on managing psychiatric emergencies. Only 14% of residents felt "quite" or "extremely" prepared to treat psychiatric patients. Overall, residents reported the lowest levels of confidence and highest need for more training related to counseling suicidal patients and treating psychiatric issues in special populations (e.g., pregnant women, elderly, and children).
CONCLUSIONS
Most EM residents desire more training in managing psychiatric emergencies than is currently provided.
目的
与心理健康相关的急诊就诊人数正在增加。尽管有这一趋势，但大多数急诊医学（EM）住院医师培训项目在精神病学教育上投入的时间很少。本研究旨在确定急诊医学住院医师对急诊精神病学培训需求的看法以及管理有心理行为问题患者的自信心。
方法
向美国15个经研究生医学教育认证委员会认证的急诊医学项目的住院医师发放了一份需求评估调查问卷。调查项目涉及住院医师培训期间精神病学培训的数量和类型、对精神病学培训需求的认知以及执行与急诊精神病护理相关的各种临床技能的自信心。住院医师使用5分制（1 = 没有；5 = 非常多）对他们在与行为紧急情况相关的各种主题领域（例如，对患者进行医学检查、物质使用障碍）的学习需求进行评分。住院医师使用0至100分的量表对他们独立执行与急诊精神病护理相关的各种临床技能（例如，区分精神病表现与谵妄）的能力进行评分。
结果
在邀请参与的632名住院医师中，396名（63%）做出了回应。12%的受访者报告在急诊医学住院医师培训期间完成了精神病学轮转。15个参与项目中有1个设有必修的精神病学轮转。住院医师报告称，他们的项目通过讲座（56%）和/或在急诊科的带教培训（共35%）向住院医师传授精神病学急诊知识。大多数住院医师报告称很少参与有精神问题患者的治疗。大多数住院医师（59%）认为他们的项目应该提供更多关于管理精神病学急诊的教育。只有14%的住院医师觉得自己“相当”或“极其”有准备治疗精神科患者。总体而言，住院医师报告称在咨询自杀患者以及治疗特殊人群（例如，孕妇、老年人和儿童）的精神问题方面自信心最低，且最需要更多培训。
结论
大多数急诊医学住院医师希望获得比目前更多的精神病学急诊管理培训。
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