Warburton Karen M, Shahane Amit A
Associate Professor of Medicine, Department of Medicine, University of Virginia Health System.
Associate Professor, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System.
J Grad Med Educ. 2020 Dec;12(6):773-777. doi: 10.4300/JGME-D-20-00007.1. Epub 2020 Dec 4.
Graduate medical education (GME) learners may struggle with clinical performance during training. A subset of these trainees has mental health conditions (MHCs).
To characterize the MHCs that underlie poor trainee performance and their relationship to specific clinical performance deficit (CPD).
At the University of Virginia (UVA), GME learners not meeting appropriate milestones, or who request help, have the option to self-refer or be referred to COACH (Committee on Achieving Competence Through Help). A physician remediation expert assesses the learner and identifies a primary CPD. If there is concern for an MHC, referral is made to a psychologist with expertise in working with trainees. All learners are offered remediation for the CPD. Using descriptive statistics, we tracked the prevalence of MHC and their correlation with specific CPDs.
Between 2016 and 2019, COACH assessed 7% (61 of 820) of GME learners at UVA. Thirty-eight percent (23 of 61) had an MHC associated with the CPD. Anxiety was the most common MHC (48%), followed by depression (17%), cognitive dysfunction (17%), adjustment disorder (13%), and other (4%). Professionalism was the most identified CPD among learners with MHCs (52%). Of remediated learners, 47% have successfully finished remediation, 21% were terminated or voluntarily left their program, and 32% are still being remediated (83% of whom are in good standing).
MHCs were identified in nearly 40% of struggling learners referred to a centralized remediation program. Professionalism is the most identified CPD among learners with MHCs.
毕业后医学教育（GME）学员在培训期间可能在临床能力表现方面存在困难。这些学员中有一部分存在心理健康问题（MHCs）。
明确导致学员表现不佳的心理健康问题及其与特定临床能力缺陷（CPD）的关系。
在弗吉尼亚大学（UVA），未达到适当里程碑或寻求帮助的GME学员可以选择自我推荐或被转介至COACH（通过帮助实现能力委员会）。一名医师补救专家对学员进行评估，并确定主要的CPD。如果担心存在MHC，则会转介给在与学员合作方面具有专业知识的心理学家。所有学员都会针对CPD接受补救。我们使用描述性统计方法跟踪了MHC的患病率及其与特定CPD的相关性。
在2016年至2019年期间，COACH对UVA的7%（820名中的61名）GME学员进行了评估。38%（61名中的23名）存在与CPD相关的MHC。焦虑是最常见的MHC（48%），其次是抑郁（17%）、认知功能障碍（17%）、适应障碍（13%）和其他（4%）。在存在MHC的学员中，专业素养是最常被确定的CPD（52%）。在接受补救的学员中，47%已成功完成补救，21%被终止或自愿退出项目，32%仍在接受补救（其中8个3%表现良好）。
在被转介至集中补救项目的近40%的学习困难学员中发现了MHC。在存在MHC的学员中，专业素养是最常被确定的CPD。
