Patients with serious mental illness die an average of eight years earlier than the general US population, partly related to their higher burden of chronic medical conditions. With the development of patient-centered medical homes, psychiatrists are increasingly required to recognize and manage acute and chronic medical illnesses in outpatient and inpatient settings. This demand necessitates the development and implementation of a standardized Internal Medicine curriculum during Psychiatry training, creating a unique teaching opportunity for Internal Medicine faculty. The purpose of this study is to assess the unmet educational needs of Psychiatry residents with respect to the medical care of their patients and to use this information in the development of a hospitalist-led Internal Medicine curriculum.
An interdisciplinary curriculum development committee was established consisting of Internal Medicine Hospitalist faculty, Psychiatry residents, and Psychiatry faculty at an academic medical center. The committee designed a needs assessment survey to assess the educational needs of Psychiatry residents with respect to the medical care of their psychiatric inpatients. The survey used Likert scales to address residents’ satisfaction with their Internal Medical education, their perception of the relevance of and their confidence in performing patient care for acute and chronic medical issues in inpatient settings, their perspectives on the relevance of Internal Medicine topics to their future clinical practice, and perceived effectiveness of various learning strategies. IRB approval for this survey was obtained. The survey was delivered by email to all Psychiatry residents (N= 67) in the academic residency program.
Forty-six of 67 Psychiatry residents responded to the survey (69%). Respondents included 11 interns (24%) and 35 residents (76%), with 42% of respondents planning a career in outpatient psychiatry, 17% inpatient psychiatry, and 9% psychosomatic medicine. All indicated that Internal Medicine knowledge is relevant to their current and future clinical practice. Residents reported low confidence in performing many patient care activities which they reported were highly relevant to their practice. 71%, 58%, and 28% of residents reported low confidence in interpreting EKGs, interpreting imaging, and counseling patients on medical conditions, respectively. Hypertension, diabetes, and coronary artery disease (including chest pain and acute coronary syndrome) were reported as the most common medical conditions encountered in psychiatric inpatients. The most commonly identified educational needs were medical complications of psychiatric medications, ingestion syndromes, withdrawal syndromes, management of hypertension, and management of diabetes. Based on these findings, a list of core competencies was established and identified topics were integrated into an ongoing hospitalist-led lectures series.
There is growing national demand to improve the Internal Medicine training of Psychiatry residents, and Internal Medicine clinical educators have the expertise to lead this effort. This innovative, multidisciplinary initiative between Internal Medicine faculty, Psychiatry residents, and Psychiatry faculty provides a framework which can be replicated in other training settings and institutions.
To cite this abstract:Bann, M; Zaros, MC; Gollapudi, D . INTERNAL MEDICINE EDUCATION FOR PSYCHIATRY RESIDENTS: AN UNMET NEED. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 22. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/internal-medicine-education-for-psychiatry-residents-an-unmet-need/. Accessed July 15, 2019.