Martine Stecher Nielsen and colleagues' article ( 2021) in the Asia Pacific Psychiatry, which is the official journal of the Pacific Rim College of Psychiatrists and the Asian Federation of Psychiatric Associations, compared the status of child and adolescent psychiatry training programs and the workforce in child and adolescent mental health services in three geographical regions, namely South East Europe, the Middle East, and the Far East, to identify similar problems, highlight success stories, and to make recommendations for future regional studies. The study (Stecher-Nielsen et al., 2021) used data from the World Psychiatric Association, Child and Adolescent Psychiatry Section's regional projects including data from 44 countries. The study (Stecher-Nielsen et al., 2021) is extremely important, because it shows there is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in South East Europe, the Middle East, and the Far East, with great differences in religion, culture, and economy. The aforementioned lack of qualified child and adolescent psychiatrists and allied professionals may result in various problems, which, in turn can lead to delayed identification, diagnosis, and treatment of child and adolescent mental disorders that can have lifelong consequences, due to the temporally regulated modifications brain undergoes during this neurodevelopmental period (Kieling et al., 2011). This (Skokauskas et al., 2019) is in line with the United Nations' Sustainable Development Goals (United Nations, 2015), adopted in 2015, which contributed to the greater recognition of both the current global mental health epidemic, and the urgent need for countries to allocate more resources. Martine Stecher Nielsen and colleagues (2021) in their article suggested, among other things that the future increase of the child and adolescent mental health workforce size, would inevitably mandate the implementation of other strategies such as advocating for child and adolescent psychiatry or child and adolescent mental health as a focus for both undergraduate and postgraduate trainees to ensure the long term expansion of training positions. This is very salient observation considering recent advances in genetics of childhood neurodevelopmental disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disability (Parenti et al., 2020). Specifically, rare variants frequently affect protein function directly, providing a promising chance to discover the molecular mechanisms of neurodevelopmental disorders, such as autism spectrum disorder (Sanders et al., 2019). Various functional studies, using disease models such as induced pluripotent stem cells and genome-edited animals, with deleterious rare variants have been done to clarify the mechanism of pathogenesis and facilitate novel drug discovery. The aforementioned is conceptually in line with the Rese
{"title":"An international medical education perspective on training in child and adolescent psychiatry","authors":"Branko Aleksic MD, PhD, Hideki Kasuya MD, PhD","doi":"10.1111/appy.12509","DOIUrl":"10.1111/appy.12509","url":null,"abstract":"Martine Stecher Nielsen and colleagues' article ( 2021) in the Asia Pacific Psychiatry, which is the official journal of the Pacific Rim College of Psychiatrists and the Asian Federation of Psychiatric Associations, compared the status of child and adolescent psychiatry training programs and the workforce in child and adolescent mental health services in three geographical regions, namely South East Europe, the Middle East, and the Far East, to identify similar problems, highlight success stories, and to make recommendations for future regional studies. The study (Stecher-Nielsen et al., 2021) used data from the World Psychiatric Association, Child and Adolescent Psychiatry Section's regional projects including data from 44 countries. The study (Stecher-Nielsen et al., 2021) is extremely important, because it shows there is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in South East Europe, the Middle East, and the Far East, with great differences in religion, culture, and economy. The aforementioned lack of qualified child and adolescent psychiatrists and allied professionals may result in various problems, which, in turn can lead to delayed identification, diagnosis, and treatment of child and adolescent mental disorders that can have lifelong consequences, due to the temporally regulated modifications brain undergoes during this neurodevelopmental period (Kieling et al., 2011). This (Skokauskas et al., 2019) is in line with the United Nations' Sustainable Development Goals (United Nations, 2015), adopted in 2015, which contributed to the greater recognition of both the current global mental health epidemic, and the urgent need for countries to allocate more resources. Martine Stecher Nielsen and colleagues (2021) in their article suggested, among other things that the future increase of the child and adolescent mental health workforce size, would inevitably mandate the implementation of other strategies such as advocating for child and adolescent psychiatry or child and adolescent mental health as a focus for both undergraduate and postgraduate trainees to ensure the long term expansion of training positions. This is very salient observation considering recent advances in genetics of childhood neurodevelopmental disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disability (Parenti et al., 2020). Specifically, rare variants frequently affect protein function directly, providing a promising chance to discover the molecular mechanisms of neurodevelopmental disorders, such as autism spectrum disorder (Sanders et al., 2019). Various functional studies, using disease models such as induced pluripotent stem cells and genome-edited animals, with deleterious rare variants have been done to clarify the mechanism of pathogenesis and facilitate novel drug discovery. The aforementioned is conceptually in line with the Rese","PeriodicalId":8618,"journal":{"name":"Asia‐Pacific Psychiatry","volume":"14 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2022-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39637847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>I write this commentary from Australia in the Asia-Pacific region. The work of the World Psychiatric Association (WPA) Consortium of Academic Child and Adolescent Psychiatrists (CAP) in undertaking such international comparison is immense. Collaboration allows us to learn from each other and find better ways of doing things. International comparison also supports CAP advocacy allowing benchmarking against comparable countries. An effective approach in Australia where CAP numbers are less than comparable European countries (RANZCP, <span>2019</span>).</p><p>In this study the CAP profession almost universally reports a large ‘treatment gap’ between available CAP resources and community need, even in wealthy countries. Not surprisingly it shows wealthier countries have more CAP resources than less wealthy countries; not just number of CAP but also access to a CAP training program, national training guidelines, a broader range of training rotations and guidance from a National Child and Adolescent Mental Health Policy. But the connection between a countries wealth and CAP resources is far from universal. Collaborative approaches examining this variation will help us understand the enablers and barriers to greater CAP resources in all countries.</p><p>The study asks CAP about the perceived need for more CAP and CAMH professionals. Almost universally such a need is reported. Understandably it focuses on CAP. However, CAP do not work in isolation and what care they provide is determined by the system of care in which they work and how tasks are allocated between the various professions; both within specialist CAMH services (if available) and between primary and specialist care. The relative cost of training and employing various professionals is relevant with CAP being expensive to train and employ. A future challenge is looking at a broader multidisciplinary comparison of the CAMH workforce and the system of care they work in.</p><p>Modern CAMH place CAP in a role of clinical leadership, delivering direct and indirect consultation to other professionals, and oversight of care delivery by others. Defining the professional capabilities of the modern CAP guides what CAP training should include in curriculum and workplace training experiences provided.</p><p>The study asks about professional structures supporting CAP including the presence of a National Society, CAP Journal and availability of University CAP Academic Departments. It explores if CAP is a recognized specialty or subspecialty and the interface with general psychiatry. Such structures support the CAP profession, however distilling which and how such professional structures enable the profession requires further exploration. International collaboration is required to better understand what works best. The study demonstrates general psychiatrists deliver a lot of CAP care even in the presence of a CAP workforce. Clearly their training in CAP is important. In Australia debate exists on the bal
一群澳大利亚海外出生的CAP聚集在一起,为斯里兰卡(Rathnayaka等人,2016)和印度(www.pathwaysfoundationkovai.org)的项目开发和交付提供相互支持和帮助。在这种多元文化的劳动力中,在国际上支持CAP的潜力巨大。亚太地区正在采用更广泛的“国内”方式来开展共同农业计划的区域参与。澳大利亚和新西兰皇家精神病学院(RANZCP),儿童和青少年精神病学学院(FCAP)与太平洋岛国合作开发了一种方法,使用ANZ CAP志愿者支持培训和劳动力发展(Kowalenko等,2020;Robertson, Hagali等,2019;Robertson, Paul等人,2019)。这样的努力也发生在其他地方。澳新银行对志愿者服务感兴趣,这代表了一个重要的志愿者队伍,以支持CAMH的区域发展。如何最好地组织和部署这样的志愿者队伍目前正在通过试点志愿者计划进行探索。“在国内”培训对接受者、志愿者和支持这种努力的组织有其风险,特别是在资源不平等、结构性种族主义以及殖民主义和文化剥夺对土著人民的持续影响等情况下。在与国际CAP同事发展关系时,我们需要深思熟虑,确保相互尊重、相互影响和相互学习;同时认识到资源的巨大差距。自2020年以来,COVID大流行带来了严重限制国际旅行的变化。海外学员在澳大利亚的培训机会更加有限,澳新银行提供“国内”项目的旅行已经停止。然而,大流行已使远程保健(视频会议)成为主流。远程保健促进国际参与的潜力是巨大的,尽管它的全部益处和局限性还有待发掘。2020年,斐济国立大学(FNU)、圣文森特精神卫生中心和斐济精神卫生中心(FCAP)建立了伙伴关系,重点通过远程医疗提供为期12周的CAMH午餐时间专业发展课程(OPHELIA培训:在线太平洋卫生交流;Chang et al. 2022)。两年一次的FCAP Pasifika研究小组(PSG) (Robertson, Hagali等,2019)于2021年9月首次在线举行。然而,远程保健依赖于充足的基础设施,有可能进一步扩大差距。不管怎样,远程医疗将改变我们未来的工作。最后,让我谈谈太平洋地区的共同农业政策。它不是WPA-CAP研究的一部分,但可能在未来。太平洋地区的共同农业政策与本研究的三个地区既有相似之处,也有显著差异。拥有900万人口的巴布亚新几内亚(PNG)有一名CAP和大约10名普通精神病医生。巴布亚新几内亚大学提供专科普通精神病学培训,包括为所罗门群岛和东帝汶等邻国提供培训。SI有两个普通精神病医生。在讲英语的西太平洋岛国斐济、瓦努阿图、萨摩亚、汤加、纽埃、基里巴斯和其他国家,斐济有一个单一的CAP,以及一系列在CAMH方面接受过一些培训的普通精神病医生和心理健康医生。FNU有望很快提供精神病学培训。另一方面,现代澳大利亚和新西兰都是英国殖民主义的产物,拥有重要的土著文化遗产,是富裕的国家,拥有完善的卫生系统,包括CAMH服务。CAP的培训遵循与英国和北美类似的传统。太平洋地区有一些国家对澳新货币政策不太熟悉,包括新喀里多尼亚和塔希提讲法语的岛屿领土,它们为澳新货币政策提供了充足的资源,并且与法国有关;菲律宾和夏威夷也在太平洋上。我们可以看到,西太平洋岛屿国家、巴布亚新几内亚和西太平洋岛国在CAP或CAMH方面资源不足,严重依赖初级保健。太平洋呈现出独特的差异,太平洋岛国是幅员辽阔的海洋中人口少(200万)的小陆地。PNG和SI地形崎岖,道路基础设施有限。旅行既昂贵又富有挑战性。远程保健正在发展并具有巨大潜力,但存在重大的基础设施挑战。太平洋也是世界上热带风暴和海啸频发的自然灾害多发地区之一,也是气候灾害的重灾区。扩大国际合作将使太平洋地区的儿童和青少年及其家庭受益。
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