For at least 4 decades, the need for improved pediatric residency training in behavioral and mental health has been recognized. The prevalence of behavioral and mental health conditions in children, adolescents, and young adults has increased during that period. However, as recently as 2013, 65% of pediatricians surveyed by the American Academy of Pediatrics indicated that they lacked training in recognizing and treating mental health problems. Current pediatric residency training requirements do not stipulate curricular elements or assessment requirements in behavioral and mental health, and fewer than half of pediatric residents surveyed felt that their competence in dealing with mental health problems was good to excellent. It is time that pediatric residency programs develop the capacity to prepare their residents to meet the behavioral and mental health needs of their patients. Meeting this challenge will require a robust curriculum and effective assessment tools. Ideal training environments will include primary care ambulatory sites that encourage residents to work longitudinally in partnership with general pediatricians and behavioral and mental health trainees and providers; behavioral and mental health training must be integrated into both ambulatory and inpatient experiences. Faculty development will be needed, and in most programs it will be necessary to include nonpediatrician mental health providers to enhance pediatrician faculty expertise. The American Board of Pediatrics intends to partner with other organizations to ensure that pediatric trainees develop the competence needed to meet the behavioral and mental health needs of their patients.
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January 2017
Special Article|
January 01 2017
Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action
Julia A. McMillan, MD;
aJohns Hopkins School of Medicine, Baltimore, Maryland;
Address correspondence to Julia A. McMillan, MD, 105 Ridgewood Rd, Baltimore, MD 21210. E-mail: jmcmill@jhmi.edu
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Marshall Land, Jr, MD;
Marshall Land, Jr, MD
bUniversity of Vermont College of Medicine, Burlington, Vermont and Consultant for Maintenance of Certification and Strategic Planning, American Board of Pediatrics; and
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Laurel K. Leslie, MD
Laurel K. Leslie, MD
cTufts University School of Medicine, Boston, Massachusetts, and Vice President for Research, American Board of Pediatrics
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Address correspondence to Julia A. McMillan, MD, 105 Ridgewood Rd, Baltimore, MD 21210. E-mail: jmcmill@jhmi.edu
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2017) 139 (1): e20162141.
Article history
Accepted:
October 21 2016
Citation
Julia A. McMillan, Marshall Land, Laurel K. Leslie; Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action. Pediatrics January 2017; 139 (1): e20162141. 10.1542/peds.2016-2141
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My initial response after reading the articles by Raval and Doupnik and McMillan et al in the January issue of the Pediatrics was 'deja vu all over again!' Haggerty et al coined the term 'new morbidity' in Pediatrics in 1975 (Haggerty et al Child Health and the Community New York, John Wiley and Sons, 1975), suggesting that there was a major shift in the kinds of problems pediatricians would be seeing because of advanced care and technology. he specifically identified developmental and mental health, complex care, educational challenges and substance abuse among others. Dreyer reinforced these issues with a call to action in a 2009 commentary about the 'not so new morbidity' (Dreyer B Acad Ped 2009; 9: 206-8). Here we are years later and we are seeing the same calls for a complex issue that needs immediate fixing, and concerns that not enough is being done. I would suggest we have major problems because 1) current faculty do not have the training and knowledge to fix the developmental and mental health needs of children and adolescents. Therefore, in any solution they also need training to be bale to role model how to approach patients with these issues. 2) I am not aware the the reimbursement issue for delivering care in these areas has been fixed. If pediatricians are not going to be appropriately reimbursed for providing this complex care, oft after usual office hours, why would they want to take care of these patients versus referring them? Altruism only goes so far. 3) Current residents who identify primary care as their main interests MUST experience more than a month or two in these specialties if they are to master (EPAs) the milestones in them. They spend far too much time because of patient care needs for the hospital in intensive care units when they could be learning about common problems they will facing in practice. 4) We need to develop more simulations to give trainees opportunities in a safe simulated environment to practice their knowledge and skills in acting for children with mental health and development problems. 5) Let's get serious about interdisciplinary teams and use those as training and patient care options. Finally, this is a crisis......let's fix it sooner than later.