Psychiatric training in medicine residencies: current needs, practices, and satisfaction

Knowledge and expectations of direct support professionals towards effects of psychotropic drug use in people with intellectual disabilities

BACKGROUND/INTRODUCTION

In this study, we investigated intellectual disability support professionals' knowledge and expectations towards effects of psychotropic drug use on behaviour and drug use in their clients, because shortcomings may lead to misinterpretations of behavioural symptoms and inappropriate drug use.

METHODS

Two self-designed questionnaires were used to measure the knowledge and expectations of 194 support professionals in 14 residential facilities regarding psychotropic drug use and effects of antipsychotics on behavioural, cognitive and mental functioning of people with intellectual disability. The psychometric properties of both questionnaires were adequate.

RESULTS

A majority of the professionals had unrealistic expectations regarding the positive effects of antipsychotics on cognitive and behavioural functioning, and 94% scored below the cut-off scores regarding knowledge; 60% indicated they needed education and training.

CONCLUSIONS

To achieve sufficient collaboration of intellectual disability support professionals in reducing inappropriate psychotropic drug use of clients, vocational educational training is needed.

Mental health education programmes for generalist health professionals: an integrative review

Mainstreaming of mental health services has led to an increase in the presentation and care of mental health patients in generalist health settings. The lack of adequate mental health educational preparation of general health professionals (GHP) has been identified as a major barrier to meeting the health-care needs of mental health patients. This study aimed to review and synthesize research evidence on mental health education programmes (MHEP) that have been designed to develop the knowledge, skills, and attitudes of GHP. An integrative literature review was conducted following a search of key electronic databases and hand searching of references of relevant papers, and 25 papers met the study inclusion criteria. Knowledge, skill, and attitudinal improvements in GHP post MHEP were shown in most studies. MHEP that included supervised clinical experience, role play, and case scenarios were reported as being more effective. Issues such as patient participation in education, interprofessional education models, and the willingness, interest and, motivation for GHP to be involved in MHEP warrant further research.

The comfort level of internists with the prescription of psychotropic medication

INTRODUCTION

Empirical data indicate that patients seen in internal medicine outpatient settings have substantial rates of depression and other psychiatric disorders. Surprisingly, the training requirements established by the Residency Review Committee in Internal Medicine do not include a specific psychiatry training curriculum, but rather vaguely refer to "sufficient instruction and clinical experience" in psychiatry.

METHOD

In this study, internists on staff at a community hospital were surveyed to ascertain their general level of comfort with prescribing psychotropic medication. The study hypotheses were: (1) compared with other psychotropic medications, internists would generally be most comfortable with the prescription of antidepressants; (2) younger, rather than older, internists would be more comfortable with prescribing psychotropic medications; and (3) internists with greater outpatient, versus inpatient, responsibilities would be more comfortable with psychotropic medication prescription.

RESULTS

This sample of internists demonstrated differences in prescribing comfort by medication group (F(3) = 48.99, p < .001) and was most comfortable in prescribing antidepressants and benzodiazepines, in contrast to antipsychotics and other types of psychotropic medications; comparing older with younger internists, there was a significant between-group difference in the mean number of medications positively endorsed, t(66) = 2.16, p <.05, with younger internists indicating broader comfort levels; and inpatient internists were significantly more comfortable prescribing antipsychotics than outpatient internists, t(117) = -3.38, p = .001.

CONCLUSIONS

There are some distinct psychotropic prescription trends among internists, which have implications for future training and quality improvement programs.

Psychosocial training in U.S. internal medicine and family practice residency programs

PURPOSE

Competence in the psychosocial aspects of medical care is necessary for primary care physicians to function effectively. This study investigated the psychosocial training internal medicine and family practice residents receive in U.S. programs.

METHODS

In 1996, program directors of all U.S. internal medicine (IM) and family practice (FP) residency programs were surveyed regarding the format, content, and quantity of psychosocial training provided in their programs, their opinions on topics related to psychosocial training, and demographics of their programs.

RESULTS

The response rate was 61%. Ninety-nine percent of FP and 62% of IM program directors reported requiring at least one psychosocial training experience. Family practice programs required an average of 352 hours (SD +/- 175; range 27-2,664) of psychosocial training compared with 118 hours (SD +/- 272; range 0-1,050) for IM programs. Most IM and FP program directors expected residents to achieve at least basic competency in virtually all psychosocial topic areas; however, FP programs provided a greater range of psychosocial experiences. FP program directors most often identified psychologists and IM program directors most often identified internists as providing the most psychosocial training in their programs. Both IM and FP program directors considered lack of curricular time to be the main obstacle to development of psychosocial training.

CONCLUSION

Residents' competence in psychosocial areas is important to both IM and FP program directors. However, content and time devoted to psychosocial training vary considerably both within and between program types.