Child and adolescent psychiatry: which knowledge and skills do primary care physicians need to have? A survey in general practitioners and paediatricians

Abstract

Primary care physicians (PCPs) play a key role in the initial assessment and management of children and adolescents with mental health problems. However, it is unclear whether current medical education curricula sufficiently equip PCPs for this task. The aim of this study was to investigate, which child and adolescent psychiatry (CAP)-related skills and knowledge PCPs say they require in their daily practice. A questionnaire was generated, employing a modified two-step Delphi approach. Besides socio-demographic items, the questionnaire contained 17 CAP-related knowledge items and 13 CAP-related skills items, which had to be rated by importance in daily practice. The questionnaire was distributed to 348 office-based paediatricians and 500 general practitioners (GPs) in Germany. The overall return rate was 51.3% (435/848). Regarding CAP-related knowledge, both paediatricians and GPs rated somatoform disorders and obesity as highly important for daily practice. Moreover, paediatricians also deemed regulatory disorders during infancy (e.g. crying, sleep disorders) as important, while GPs assessed knowledge on paediatric depression as relevant. For paediatricians and GPs, the most relevant CAP-related skills were communicating with children and adolescents and their parents. Additionally, paediatricians rated differentiating between non-pathologic and clinically relevant behaviour problems very relevant, while GPs considered basic psychotherapeutic skills essential. The CAP-related knowledge and skills perceived relevant for doctors in primary care differ from the majority of current medical school CAP curricula, which cover mainly typical, epitomic CAP disorders and are predominantly knowledge-oriented. Therefore, medical education in CAP should be amended to reflect the needs of PCPs to improve healthcare for children and adolescents with mental health problems.

Teaching undergraduate medical students Child and Adolescent Psychiatry (CAP): a Delphi study on curriculum content

“…This may increase to 50% in the future given recent political pressures in the UK to increase the numbers of students going into primary care [19]. Similar conclusions are also made in a CAP curriculum review in a Canadian medical school [20] as well in several other studies examining which topics should be included in a CAP curriculum [6, 13, 21].…”

“…paediatricians, have been reported to have difficulty identifying and managing psychiatric disorders presenting in CYP [2–4] and that newly qualified GPs feel unprepared, particularly in relation to CAP [5]. Is has been suggested that the care of CYP with psychiatric problems could be improved by adapting undergraduate education to reflect the future needs of doctors working in primary care [6]. These findings support the need for all medical students to have a foundation in Child and Adolescent Psychiatry (CAP) regardless of their future career choices [7, 8].…”

“We’re in Good Hands There.” - Acceptance, Barriers and Facilitators of a Primary Care-based Health Coaching Programme for Children With Mental Health Problems: A Qualitative Study (Prima-quo)

“…It allows and structures the approach, may it be in the diagnostics itself in the practice, but also for the diagnosis and, nally, in the decision whether we want and we are able to continue the treatment in the practice. (Transcription of Interview partner D14 (PAED), p. 1, lines [12][13][14][15][16] PAR and ADOL felt that their PAED allocated a large part of his consultation time to their problems. This was perceived as an indication of high quality of care.…”

“…It has been argued that these referral rates are too high because even less severely affected children are referred to specialists although they would not necessarily need specialised care. Time restrictions in primary care practices as well as lack of specialised mental health training for paediatricians have been identi ed as potential reasons for constantly high referral rates (12,13). As a consequence of referral to specialized services, a number of barriers may impede or delay timely access to professional assessment and therapy.…”

GPs’ and child and adolescent psychiatry specialists’ experiences of joint consultations in the GP’s office: a qualitative study

“…Alexander and Heikkinen have both displayed that GPs perceive their skills in child psychiatry as somewhat inadequate [ 7 , 8 ]. The need for increased knowledge and skills among the GPs in this field is addressed several in other papers [ 3 , 9 , 11 , 13 ]. It is therefore important to gain more knowledge as to how GPs’ competence and skills can be further developed.…”