Drozdowicz Linda, Gordon Elisabeth, Shapiro Desiree, Jacobson Sansea, Zalpuri Isheeta, Stewart Colin, Lewis A Lee, Robinson Lee, Myint Myo Thwin, Daniolos Peter, Williamson Edwin D, Pleak Richard, Graeff Martins Ana Soledade, Gleason Mary Margaret, Galanter Cathryn A, Miller Sarah, Stubbe Dorothy, Martin Andrés
Child Study Center, Yale School of Medicine, New Haven, CT, United States.
Private Practice, New York, NY, United States.
Front Psychiatry. 2020 Nov 17;11:593101. doi: 10.3389/fpsyt.2020.593101. eCollection 2020.
Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs). We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country. We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with "awkward" and "uncomfortable" the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge ( = 0.004) and in attitudes ( < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients ( < 0.001 for each). A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.
性与性健康问题在儿童和青少年精神病学(CAP)实践中很常见,但临床医生可能觉得自己没有足够的能力自信地处理这些问题。为了弥补培训和实践中的这一差距,我们开发、实施并评估了一个教育模块,该模块通过专家临床医生与扮演标准化病人(SPs)的专业演员互动的录像描述得到增强。我们开发了一种教育资源,突出了与CAP实践相关的性健康常见问题,包括性发育、精神药物相关副作用以及自闭症儿童的性取向。我们编写了原创剧本,两名临床医生根据剧本与三名标准化病人进行互动。对数字录音进行编辑后得到5个片段,总时长为20分钟。这些片段穿插在一个90分钟的课程中,该课程包括讲授和互动部分。由于新冠疫情,我们使用了同步视频会议,这使得内容能够传播到全国多个培训项目。我们通过美国儿童和青少年精神病学学会学习与创新联盟(AALI)从16个CAP培训项目中招募了125名学员。对青少年患者性功能的常规询问并不常见,只有28%的参与者报告进行过此类询问,“尴尬”和“不舒服”是提及这项临床任务时最常用的词汇。讲授式干预在2周后导致技能和知识(P = 0.004)以及态度(P < 0.001)方面有可测量的改善。改善最大的三个项目是:(a)提供适合不同发育阶段的资源;(b)在与未成年患者讨论性发育时感到自在;(c)与神经发育异常或发育障碍患者的父母或监护人讨论时感到自在(每项P < 0.001)。一个通过视频示例丰富的性健康课程可以使与CAP临床实践相关的结果有可测量的改善。这些教育材料可供当地教师分发、使用和改编。我们的研究还为通过同步视频会议在CAP中使用多地点教育倡议提供了原理证明。