ABSTRACT
OBJECTIVE: We tested the hypothesis that trained medical faculty can train residents effectively in a mental health care model. METHODS: After the authors trained medical faculty intensively for 15 months in primary care mental health, the newly trained faculty taught medical residents intensively. Residents were evaluated pre- and post-residency and compared to non-equivalent control residents in another city. Using ANOVA, the primary endpoint was residents' use of a mental health care model with simulated patients. Secondary endpoints were residents' skills using models for patient-centered interviewing and for informing and motivating patients. RESULTS: For the mental health care model, there was a significant interaction between study site and time (F = 33.51, p < .001, Eta2 = .34); mean pre-test and post-test control group scores were 8.15 and 8.79, respectively, compared to 7.44 and 15.0 for the intervention group. Findings were similarly positive for models of patient-centered interviewing and informing and motivating. CONCLUSIONS: Training medical faculty to teach residents a mental health care model offers a new educational approach to the widespread problem of poor mental health care. PRACTICE IMPLICATIONS: While the models tested here can provide guidance in conducting mental health care, further evaluation of the train-the-trainer program for preparing residents is needed.
Subject(s)
Education, Medical, Graduate/methods , Faculty, Medical , Internship and Residency , Mental Health Services/organization & administration , Patient-Centered Care/methods , Patient-Centered Care/organization & administration , Program Evaluation/methods , Staff Development/methods , Clinical Competence , Communication , Educational Measurement , Humans , Male , Mental Health , Program Development/methods , Surveys and Questionnaires , TeachingABSTRACT
OBJECTIVE: To improve efficiency and retain the 4 factors of a reliable, valid interview satisfaction questionnaire (ISQ). METHOD: 105 residents conducted 301 patient-centered interviews with 10 simulated patients (SP). SPs portrayed three scenarios for each resident and completed the ISQ and the Communication Assessment Tool (CAT) after each. A confirmatory factor analysis (CFA) of the ISQ and CAT determined which items had >0.5 factor loadings and <0.1 error, criteria for retaining items in a shortened scale. RESULTS: After the CFA, 13 items were deleted resulting in a 12-item scale (RMSE=0.06) that confirmed the initial 4 factor structure of satisfaction with: open-endedness, empathy, confidence in the resident, and general. Scale reliability of each factor was high (Cronbach's alpha ranged from .74 to .93). Demonstrating concurrent validity, all four factors of the ISQ correlated highly with the one-factor CAT (r>.7, p<.001), and the second order unidimensional ISQ scale also correlated highly with the CAT (r=.83, p<.001). CONCLUSIONS: The ISQ is an efficient, reliable, and valid instrument that uniquely deconstructs satisfaction with the patient-physician interaction into 4 key components. PRACTICE IMPLICATIONS: The 4 components provide a means for better understanding poor satisfaction results.
Subject(s)
Communication , Patient Satisfaction , Physician-Patient Relations , Psychometrics/instrumentation , Surveys and Questionnaires , Empathy , Female , Humans , Interviews as Topic , Male , Quality of Health Care/organization & administration , Reproducibility of ResultsABSTRACT
OBJECTIVE: Many express concern that modern medicine fails to provide adequate psychosocial and mental health care. Our educational system has not trained the primary care providers who care for most of these patients. Our objective here is to propose a quantum change: prepare residents and students during all years of training so that they are as effective in treating psychosocial and mental health issues as they are medical problems. METHOD: We operationalize this objective, following Kern, by developing an intensive 3-year curriculum in psychosocial and mental health care for medical residents based on models with a strong evidence-base. RESULTS: We report an intensive curriculum that can guide others with similar training interests and also initiate the conversation about how best to prepare residency graduates to provide effective mental health and psychosocial care. CONCLUSION: Identifying specific curricula informs education policy-makers of the specific requirements they will need to meet if psychosocial and mental health training are to improve. PRACTICE IMPLICATIONS: Training residents in mental health will lead to improved care for this very prevalent primary care population.
