Toward a resolution of contradictions. Utility of feedback from the GHQ.

Methodologic problems in prior research have contributed to contradictory findings about the effect of feedback from self-report questionnaires on the recognition of mental disorders in primary care settings. This study addresses those problems by assigning family practice resident physicians (N = 32), not their patients, to experimental and control groups, and by collecting baseline as well as postintervention data, for a total of 1040 patient encounters. The 28-item GHQ served as the screening instrument and was given to all participating patients seen by the experimental group. Following training in their interpretation, feedback of GHQ results constituted the intervention. Measures of recognition included a psychiatric diagnosis, psychologic and psychosocial chart notations, and various treatment options (e.g., therapy, consultation, referral, drugs, singly and in combination). Evidence for a diagnosis of mental disorder was limited to the Assessment portion of the SOAP note. Results indicate that GHQ feedback resulted in a significant twofold increase in the total number of psychiatric diagnoses. Recognition was heightened in all diagnostic categories, with a statistically significant increase in the number of depression diagnoses. Similarly, employment of all treatment modalities increased following feedback, although the only statistically significant increase was the prescription of antidepressant drugs. Psychologic notations increased as well, but psychosocial notations did not. Physicians who tended to recognize psychiatric morbidity at pretest benefited most from GHQ feedback. Implications for future research are discussed.

Family practice residents' evaluation of a competency-based psychiatry curriculum.

The authors report the formal evaluation of a competency-based curriculum in psychiatry in a family practice residency program at a community hospital five years after the program was implemented. In interviews, the 35 residents in the program in 1985 responded to a questionnaire on their understanding of and attitude toward the requirements of the competencies and the difficulties they encountered in documenting the competencies. All but two of the residents were aware of the nature of the curriculum, but only 43 percent had completed one or more of the 15 required competencies. The residents' attitude toward the requirements of demonstrating specific competencies in psychiatry during the residency were generally negative, although they were favorable toward required competencies in other disciplines. The results of the present study identify specific problems in implementing such a curriculum. Successful implementation may have been impeded by the novelty of the new educational format and a lack of reinforcement by faculty members.

Mental health training in family practice residency programs.

This paper presents a national survey of psychiatric and behavioral science training in approved family medicine residency programs. A 64 percent response rate resulted in data describing residency programs approved by the American Academy of Family Physicians: the residents, faculty, and curriculum content, and the teaching-learning format utilized in mental health training. Though improvement in the mental health services of primary care providers is a major health issue, training is typically provided by part-time or volunteer faculty; less than 5 percent of the total faculty are full-time psychiatrists. Critical elements of effective curriculum design and content that are inadequate or omitted are discussed.