Advancing Integrated Care through Psychiatric Workforce Development: A Systematic Review of Educational Interventions to Train Psychiatrists in Integrated Care

Sunderji, Nadiya; Ion, Allyson; Huynh, Dan; Benassi, P; Ghavam-Rassoul, Abbas; Carvalhal, Adriana

doi:10.1177/0706743718772520

Cited by 26 publications

(20 citation statements)

References 42 publications

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“…Overall, the literature describing educational models for outpatient CL experiences is limited, with only 17 articles meeting the search criteria (Table 3). 18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] We found 10 articles describing individual integrated care programs 18,28,31,32,34,36,38,39,42 and 2 articles providing guidelines on core competencies for integrated care for trainees. 30,40 As shown in Table 2, the educational opportunities for integrated psychiatric care ranged from colocated services and collaborative care to dedicated outpatient psychiatric clinics for the medically ill. Only 3 of the articles describe training opportunities for advanced psychiatric trainees including 2 for CL fellows and one for child and adolescent fellows.…”

Section: Resultsmentioning

confidence: 99%

“…A recent systematic review evaluated 9 published and 5 unpublished interventions to train psychiatry residents in integrated care. 41 The outcomes in all of these interventions were variable and of low-to-moderate quality, and the main conclusions that could be drawn from the outcomes were successful buy-in to the integrated care model and positive learner experience in providing integrated care. 41 A summary of 5 psychiatry training programs that provided integrated care training for residents found that the success of such programs depended on the presence of a supervising psychiatrist with experience in integrated care, funding for faculty time, time within the residency program, office space within the clinical site, and a clinic "champion" who supports integrated care.…”

Section: Resultsmentioning

confidence: 99%

“…41 The outcomes in all of these interventions were variable and of low-to-moderate quality, and the main conclusions that could be drawn from the outcomes were successful buy-in to the integrated care model and positive learner experience in providing integrated care. 41 A summary of 5 psychiatry training programs that provided integrated care training for residents found that the success of such programs depended on the presence of a supervising psychiatrist with experience in integrated care, funding for faculty time, time within the residency program, office space within the clinical site, and a clinic "champion" who supports integrated care. 30 Overall, residents responded positively to the various integrated care experiences and viewed them as effective and relevant in preparing them for their future careers 34 and enhancing their learning on how to assess and manage complex medical-psychiatric patients.…”

Section: Resultsmentioning

confidence: 99%

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The Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of Consultation-Liaison Psychiatry Residency Education Subcommittee

et al. 2020

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Background: As mental health services in outpatient medical clinics expand, psychiatrists must be trained to practice in these settings. Objectives: The Academy of Consultation-Liaison Psychiatry residency education subcommittee convened a writing group with the goal of summarizing the current evidence about outpatient consultation-liaison psychiatry (CLP) training and providing a framework for CLP educators who are interested in developing outpatient CLP rotations within their programs. Method: MEDLINE (via PubMed), Embase, and PsycINFO (via OVID) were reviewed each from inception to December 2019, for psychiatric CLP services in ambulatory settings that involved residents or fellows. The CLP education guidelines were reviewed for recommendations relevant to outpatient CLP. We also searched MedEd portal for published curriculums relevant to CLP. The group held 2 conferences to reach consensus about recommendations in setting up outpatient CLP rotations. Results: Seventeen articles, 3 Academy of Consultation-Liaison Psychiatry-supported guidelines, and 8 online didactic resources were identified as directly reporting on the organization and/or impact of an outpatient CLP rotation. These manuscripts indicated that residents found outpatient CLP rotations effective and relevant to their future careers. However, the literature provided few recommendations for establishing formal outpatient CLP training experiences. Conclusions: Outpatient CLP rotations offer multiple benefits for trainees, including exposure to specific clinical scenarios and therapeutic interventions applicable only in the outpatient setting, increased continuity of care, and the unique experience of providing liaison and education to non-mental health providers. The article outlines recommendations and examples for developing outpatient CLP rotations which CLP educators can incorporate in their programs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of Consultation-Liaison Psychiatry Residency Education Subcommittee

et al. 2020

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“…Team instability and frequent staff turnover led to the loss of skills and knowledge hardwon over time [55]. Lack of involvement in some teams may have reflected little interest in the model or doubts about its capacity to improve skills [61]. Regarding the difficulty of managing patients without family doctors, the 2005-2010 Quebec MH Action Plan [65] had recommended two GP per 100,000 inhabitants in MH-PCT, but this target had not been reached.…”

Section: Discussionmentioning

confidence: 99%

“…At the systemlevel these included supportive legislative/policy environment [25,54], availability of appropriate resources [55], preexisting relationships between specialized MH services and primary care [22,56], and adequate incentives [25,[57][58][59]. Organizational-level issues included clinician acceptance of the model [60,61], team stability [55], organizational support [1,62,63], leadership [55,62], and feedback on model effectiveness [59]. Finally, individual-level concerns included interest among GP in MHD [1,25,59,63], and individual qualities of psychiatrists [58,60].…”

Section: Introductionmentioning

confidence: 99%

Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment

Grenier

Gentil

et al. 2021

BMC Fam Pract

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Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD). Methods Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted. Results Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support. Conclusion Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations.

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Consultation-Liaison Psychiatry and Psychosomatic Medicine: Where Do We Go from Here?

Leigh

2019

Global Psychosomatic Medicine and Consultation-Liaison Psychiatry

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Advancing Integrated Care through Psychiatric Workforce Development: A Systematic Review of Educational Interventions to Train Psychiatrists in Integrated Care

Cited by 26 publications

References 42 publications

The Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of Consultation-Liaison Psychiatry Residency Education Subcommittee

The Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of Consultation-Liaison Psychiatry Residency Education Subcommittee

Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment

Consultation-Liaison Psychiatry and Psychosomatic Medicine: Where Do We Go from Here?

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