Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC.
Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC.
Acad Pediatr. 2021 Sep-Oct;21(7):1288-1296. doi: 10.1016/j.acap.2021.04.015. Epub 2021 May 29.
This national study identified the rotations in which pediatric residents received training in the assessment and treatment of behavioral/mental health (B/MH) problems, and examined associations between learning B/MH skills during multiple clinical rotations and resident-reported interest in B/MH issues.
Cross-sectional survey of applicants for the initial American Board of Pediatrics certifying exam (62.4% response rate; 1555 eligible respondents). Respondents reported their overall interest in B/MH issues, and specified where they had received training in 7 B.M. assessment skills and 8 treatment skills. Logistic regression models were estimated to identify associations between learning B/MH assessment and treatment skills in multiple clinical rotations and resident-reported B/MH interest, adjusting for respondent characteristics.
Respondents reported continuity clinic as the predominant site of B/MH learning, followed by development-behavioral and adolescent rotations. Multisite learning varied across B/MH skills, ranging from 45.1 % (n = 678) for using rating scales to titrate medications to 82.1% (n = 1234) for eliciting parent concerns. 946 (63.2%) reported having overall interest in B/MH issues. Adjusting for respondent characteristics, learning the majority of B/MH skills in >1 rotation was associated with an increased odds of B/MH interest for both assessment and treatment domains (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] 1.16-1.83 for assessment skills and aOR = 1.36, 95% CI 1.09-1.69 for treatment skills).
The majority of residents report learning B/MH skills in continuity clinic, with substantial variation in the proportion learning these skills in more than one rotation. Teaching B/MH skills during multiple clinical rotations may enhance resident interest in B/MH care delivery for children.
本研究旨在确定儿科住院医师接受行为/心理健康（B/MH）问题评估和治疗培训的轮转科室，并探讨在多个临床轮转科室中学习 B/MH 技能与住院医师报告对 B/MH 问题的兴趣之间的关联。
对首次美国儿科学会认证考试（ABP）申请人进行横断面调查（62.4%的应答率；1555 名符合条件的应答者）。应答者报告了他们对 B/MH 问题的总体兴趣，并具体说明了他们在 7 项 B/MH 评估技能和 8 项治疗技能方面的培训地点。使用逻辑回归模型来确定在多个临床轮转科室中学习 B/MH 评估和治疗技能与住院医师报告的 B/MH 兴趣之间的关联，同时调整了应答者特征。
应答者报告以连续性诊所为 B/MH 学习的主要场所，其次是发育行为和青少年轮转科室。多站点学习在 B/MH 技能方面存在差异，从使用评定量表滴定药物的 45.1%（n=678）到引出家长关注的 82.1%（n=1234）不等。946 名（63.2%）报告对 B/MH 问题有总体兴趣。调整应答者特征后，在>1 个轮转科室中学习大多数 B/MH 技能与评估和治疗领域的 B/MH 兴趣增加相关（评估技能的调整比值比[aOR]为 1.46，95%置信区间[CI]为 1.16-1.83，治疗技能的 aOR 为 1.36，95%CI 为 1.09-1.69）。
大多数住院医师在连续性诊所学习 B/MH 技能，而在多个轮转科室中学习这些技能的比例存在很大差异。在多个临床轮转科室中教授 B/MH 技能可能会增强住院医师对儿童 B/MH 护理的兴趣。
