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Biomedical subjects

J Boker

Publications and source records attributed to J Boker.

5 recordsLinked to original sources

Teaching psychiatry to non-psychiatrists: I. The application of educational methodology.

It is becoming increasingly clear that psychiatric and psychosocial needs of medical patients are not being adequately met. This need has led to an increasing emphasis on the psychiatric education of nonpsychiatrists, at varying levels of experience. Given the many problems involved in these educational efforts as well as the paucity of evaluation studies and the uncertainty of results, the authors argue that the systematic application of empirically validated educational principles may lead to greatly improved effectiveness. In this first section of a two-part series, the authors review educational methodology as it relates to the development of training objectives, the selection of teaching procedures, and the use of evaluation techniques. Part two presents a detailed "model" curriculum for primary care residents, developed according to the principles of educational methodology.

Attitude of Health Personnel

An oral examination of the psychiatric knowledge of medical housestaff: assessment of needs and evaluation baseline.

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and "psychogenic" pain. The standardized simulations were punctuated by standardized "open" questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized ad "good," "adequate," "inadequate," or "poor," in terms of "what an internist needs to know." Blind raters of the exam achieved an interrater reliability of 0.08. The results indicate major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were "good," where as 42% were "inadequate" or "poor". For example, 88% of the doctors could not name three factors that help distinguish organic from "functional" psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.

Adult

Psychiatric education for primary care: a pilot study of needs of residents.

The study reported here documents a variety of psychiatric educational needs of residents in internal medicine. By studying 150 medical outpatients, the authors found that 59 percent of the patients had probable emotional disorders, 48 percent suffered from significant symptoms of depression, negative life events and low social support were significantly associated with both probable emotional disorder and depressive symptoms, only 20 percent of the patient charts contained psychiatric diagnoses, 78 percent of the charts contained no mental status data, patients on the average could report only 56 percent of their diagnoses and 60 percent of their management plans, and 70 percent of the patients reported that they were not asked about personal problems. These results have formed the basis for a psychiatric educational program in internal medicine at the University of Alabama in Birmingham and will serve as pretraining comparison data for the evaluation of outcome.

Female

Psychiatric education improves internists' knowledge: a three-year randomized, controlled evaluation.

Trainees were randomized into four groups: (1) control; (2) consult; (3) liaison; or (4) consult-plus-liaison to evaluate the psychiatric knowledge gained after two different training programs for primary care residents. Consult was a 1-month rotation on the Psychiatry Consultation Service. Liaison consisted of 31-hour workshops over 1 year. Consult-plus-Liaison refers to both training programs, experienced in consecutive years. An oral examination was administered before and after training. The analysis of variance and tests of simple effects revealed significant training effects for both groups. The effect size of training was greater for residents exposed to both programs, compared with either one alone. The two different training programs were both effective in improving the psychiatric knowledge of primary care residents and exposure to both programs proved superior to either one alone.

Adult