Academic Psychiatry最新文献

Objective: Assessment at medical schools plays a crucial role by providing feedback, monitoring student promotion, and informing resident selection. Limited research has been conducted to synthesize key features of assessments, and even less is known about how these studies sought validity and reliability evidence. A scoping review was performed to explore key features of assessments and their validity and reliability evidence.

Methods: Various databases were searched ranging from 2004 to April 2021 following PRISMA guidelines. In-depth reviews of the full text were performed on all selected empirical studies during the extraction phase.

Results: The final analysis included 218 empirical studies. Various tools were identified, ranging from traditional multiple-choice questions to more contemporary tools incorporating technology and more contextualized workplace-based assessment. Patient care and medical knowledge were the most frequently assessed, primarily using the quantitative methodology. These studies often adopted traditional perspectives in collecting validity evidence based on relations to other variables and internal structure. Many of them used a narrow conceptualization of validity, with some failing to reference validity at all.

Conclusions: There was no single assessment that could easily differentiate medical students in a standardized, meaningful way. Despite the existence of contemporary validity theories for over two decades, there remains a need for greater education regarding the pivotal role of validity in conducting assessment research. While psychiatry and other residency programs will continue to face challenges in differentiating applicants, these changes present opportunities for medical educators and schools to validate assessments that are highly contextualized to their specific educational environments.

Objective: The purpose of the study was to evaluate pediatric residents' self-reported comfort in screening, assessment, and treatment of common child mental health problems before and 1 year after piloting an integrated mental health (IMH) rotation.

Methods: Residents evaluated patients with mental health problems in their continuity clinic. Residents were supervised remotely by a child psychiatrist. Residents rated their comfort in mental health skills on a scale from 1 = very uncomfortable to 5 = very comfortable before and 1 year after the rotation was implemented. Changes in mean comfort in screening, assessment, and treatment of child mental health problems were calculated.

Results: Baseline pediatric resident (n = 62) comfort in providing IMH care was low, with modestly higher rates for screening and assessment than treatment. Fewer than half of the residents at baseline were comfortable with any of the aspects of treatment. At 1 year follow-up, resident (n = 64) overall comfort in treatment significantly increased from baseline (3.3 ± 0.8 versus 2.8 ± 0.8, p ≤ 0.003). There was a significant increase in the proportion of residents who reported comfort screening for attention-deficit/hyperactivity disorder (ADHD) (63.9% vs. 79.7%, p ≤ 0.050), educating families about mental health problems (33.3% vs. 51.6%, p ≤ 0.041), and starting a medication for ADHD (36.2% vs. 54.0%, p < 0.05) from baseline to follow-up.

Conclusion: This IMH rotation allowed residents to improve their comfort in treating children with mental health conditions. Remote supervision by a child psychiatrist for IMH may be practical for dissemination given the limited workforce of child psychiatrists.

Objective: There is a global recruitment crisis in psychiatry, with insufficient medical students choosing this specialty as their medical career. Previous research describes multiple interacting factors that may influence medical students' attitudes toward a psychiatry career but not which are most important for whom, in what respects, and in what contexts, nor how they interact to shape attitudes. Therefore, this study aimed to develop a theory to explain the complex factors shaping medical students' attitudes toward a psychiatry career.

Methods: This realist evaluation involved three phases: phase 1 was the development of an initial program theory from published literature; in phase 2, a final program theory was developed from realist interviews with 31 UK medical students; in phase 3, evidence-based recommendations were developed.

Results: This study identified seven important contexts (positive personal experiences of mental health services; exposure to multiple psychiatry subspecialties as undergraduates; positive experiences on psychiatry placement; perceived good work-life balance for psychiatrists; perceived danger from psychiatric patients; perceived poor patient prognoses; perceived negative emotions evoked through work) and six important mechanisms (being inspired to make a difference; being interested in psychiatry; seeing psychiatry as aligned with desired lifestyle; being concerned about safety; feeling unable to make a difference; being concerned about emotional burden). These contexts and mechanisms interacted to shape positive or negative attitudes toward a psychiatry career.

Conclusions: Based on the findings, the authors recommend more pre-clinical psychiatry placements, exposure to passionate psychiatry teachers especially on psychiatry placements, and a focus on retention of interested students.