Competency of Future Pediatricians Caring for Children With Behavioral and Mental Health Problems

Abstract

BACKGROUND AND OBJECTIVES:There is an urgent need to prepare pediatricians to care for children with behavioral and mental health (B/MH) conditions. In this study, we evaluate the perceived competence of pediatric residents and recent graduates in the assessment and treatment of B/MH conditions, characterize variation in competence across residency programs, and identify program characteristics associated with high competence.METHODS: Cross-sectional survey of applicants for the initial certifying examination in pediatrics. Questions were focused on (1) who should be competent in B/MH skills, (2) institutional support around B/MH training, and (3) perceived competence in 7 B/MH assessment skills and 9 treatment skills. Competence was rated on a 5-point scale, and high levels of assessment and treatment competence were defined as scores of $4. Composite measures for B/MH assessment and treatment were calculated as mean scores for each domain. We examined variation in residents' self-reported competence across programs and used linear regression to identify factors associated with high levels of competence at the program level.RESULTS: Of applicants, 62.3% responded to the survey (n = 2086). Of these, 32.8% (n = 595) reported high competence in assessment skills and 18.9% (n = 337) in treatment skills. There were large variations in reported competence across programs. Respondents from smaller programs (,30 trainees) reported higher competence in assessment and treatment than those from large programs (P , .001).CONCLUSIONS: Current and recent pediatric trainees do not report high levels of perceived competence in the assessment and treatment of children with B/MH conditions. The substantial variation across programs indicates that the pediatric community should create standards for B/MH training.WHAT'S KNOWN ON THIS SUBJECT: Pediatric residents have historically reported low competence in assessing and treating behavioral and mental health conditions. In 2009, the American Academy of Pediatrics published mental health competencies for pediatric primary care, incentivizing improvements in pediatric training.WHAT THIS STUDY ADDS: As of 2018, pediatric trainees still report low competence in the assessment and treatment of children with behavioral and mental health conditions. Trainees at smaller programs report higher competence, although substantial variation exists across all residency program sizes.

Addressing the Behavioral and Mental Health Educational Gap in Pediatric Residency Training

“…[8][9][10][11] Over 90% of survey respondents agreed or strongly agreed that their training program was committed to ensuring that graduating residents can address B/MH problems. 1 Rates of perceived competence in screening have slowly increased, with 52% of this sample reporting very good or excellent competence in diagnosing depression, for example, compared to 32% reported in a 2007 national survey. 1,12 Increases in treatment competence have been smaller but still present.…”

“…In the study "Competency of Future Pediatricians Caring for Children With Behavioral and Mental Health Problems" in this issue of Pediatrics, Green et al 1 describe the continued deficit in pediatric resident competence in assessing and treating behavioral and mental health (B/MH) conditions based on survey questions asked during the 2018 initial pediatrics certifying examination application. B/MH concerns in pediatric practice are rising in prevalence.…”

“…The responses indicate a strong agreement by resident respondents that competence in each of these areas regarding B/MH concerns is important not only for residents entering primary care (.98% agreeing or strongly agreeing with each skill) but also for those entering subspecialty fellowships (.95% for assessment, referral, and/or comanagement by subspecialists). 1 Slightly less (86%) agreed that subspecialists required competence in treatment of B/MH conditions. 1 These data support B/MH training as important education for pediatric subspecialists in addition to general pediatricians.…”

“…1 Slightly less (86%) agreed that subspecialists required competence in treatment of B/MH conditions. 1 These data support B/MH training as important education for pediatric subspecialists in addition to general pediatricians. 5 The opportunity to include B/MH training in the educational curriculum of subspecialty fellows aligns with current ABP initiatives focused on supporting the emotional health of children with chronic illness and their families.…”

“…In this survey, smaller programs fared as well, if not better, in achieving resident competence in both the assessment and treatment of common B/MH conditions. 1 Although access to B/MH resources and specialized faculty is not specifically addressed here, this has been a barrier voiced by many program directors, particularly those of smaller programs. [8][9][10][11] However, if residents and primary care physicians in some settings must take more primary responsibility of these diagnoses because of fewer mental health providers, then an increased perception of competency in assessment and treatment in these smaller programs seems logical.…”