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Where Do Future Pediatricians Learn Behavioral and Mental Health Skills?

  • Cori M. Green
    Correspondence
    Address correspondence to Cori M. Green, MD, MS, 525 East 68th St, Box 139, New York, NY 10065
    Affiliations
    Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC
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  • JoAnna K. Leyenaar
    Affiliations
    Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC
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  • Brenda Nuncio
    Affiliations
    Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC
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  • Laurel K. Leslie
    Affiliations
    Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC
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      Abstract

      Objective

      This national study identified the rotations in which pediatric residents received training in the assessment and treatment of behavioral/mental health (B/MH) problems, and examined associations between learning B/MH skills during multiple clinical rotations and resident-reported interest in B/MH issues.

      Methods

      Cross-sectional survey of applicants for the initial American Board of Pediatrics certifying exam (62.4% response rate; 1555 eligible respondents). Respondents reported their overall interest in B/MH issues, and specified where they had received training in 7 B.M. assessment skills and 8 treatment skills. Logistic regression models were estimated to identify associations between learning B/MH assessment and treatment skills in multiple clinical rotations and resident-reported B/MH interest, adjusting for respondent characteristics.

      Results

      Respondents reported continuity clinic as the predominant site of B/MH learning, followed by development-behavioral and adolescent rotations. Multisite learning varied across B/MH skills, ranging from 45.1 % (n = 678) for using rating scales to titrate medications to 82.1% (n = 1234) for eliciting parent concerns. 946 (63.2%) reported having overall interest in B/MH issues. Adjusting for respondent characteristics, learning the majority of B/MH skills in >1 rotation was associated with an increased odds of B/MH interest for both assessment and treatment domains (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] 1.16–1.83 for assessment skills and aOR = 1.36, 95% CI 1.09–1.69 for treatment skills).

      Conclusions

      The majority of residents report learning B/MH skills in continuity clinic, with substantial variation in the proportion learning these skills in more than one rotation. Teaching B/MH skills during multiple clinical rotations may enhance resident interest in B/MH care delivery for children.

      Keywords

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