Sinai Health System, Toronto, Ontario, Canada.
The Wilson Centre, Toronto, Ontario, Canada.
Acad Psychiatry. 2023 Feb;47(1):35-42. doi: 10.1007/s40596-022-01692-3. Epub 2022 Jul 29.
For the most complex patients, like those with HIV and mental illness, integrated care occurs across diverse community and hospital contexts. There is a need for cross-discipline and cross-context educational opportunities for diverse providers to learn integrated care skillsets in real practice settings. The authors developed a Continuing Professional Development (CPD) experience for frontline case workers to be embedded in a hospital-based HIV psychiatry clinic that aims to enhance collaborative skills across hospital and community settings, called the Mental Health Clinical Fellowship.
Through qualitative pre- and post-interviews with 16 participants from October 2020 to October 2021, the authors explored patient, physician, clinician, resident learner, and the Mental Health Clinical Fellow's learning experiences and the impact on patient care.
Preliminary findings elucidate some common challenges providers experience in providing care to this complex population, including facing uncertainty of diagnosis and management, and not having enough time or resources to navigate this uncertainty. The opportunity to work and learn across disciplines through the fellowship reduced challenges, and also facilitated adaptive expertise development.
Cross-context and cross-discipline education opportunities facilitate perspective-sharing and enhanced ability to develop adaptive expertise in caring for complex populations. There is also promise for improving care and decreasing fragmentation because of the educational experience.
对于最复杂的患者，如患有 HIV 和精神疾病的患者，跨社区和医院环境的综合护理是常见的。因此，不同领域和不同背景的医疗服务人员需要有跨学科和跨环境的教育机会，以在真实的实践环境中学习综合护理技能。作者为一线个案工作者开发了一种持续专业发展（CPD）体验，将其嵌入一家医院的 HIV 精神病诊所，旨在提高跨医院和社区环境的协作技能，称为心理健康临床研究员计划。
通过对 2020 年 10 月至 2021 年 10 月的 16 名参与者进行定性的预访谈和后访谈，作者探讨了患者、医生、临床医生、住院医师和心理健康临床研究员的学习体验以及对患者护理的影响。
初步结果阐明了提供者在为这一复杂人群提供护理时所经历的一些共同挑战，包括面对诊断和管理的不确定性，以及没有足够的时间或资源来应对这种不确定性。通过该研究员计划，跨学科和跨领域的教育机会减少了挑战，也促进了适应专业知识的发展。
跨环境和跨学科的教育机会促进了观点的分享，并增强了为复杂人群提供护理的适应专业知识的能力。由于这种教育体验，改善护理和减少碎片化也有一定的前景。
