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. 2018 Aug;63(8):513-525.
doi: 10.1177/0706743718772520.

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

Nadiya Sunderji  1   2   3 , Allyson Ion  4   5 , Dan Huynh  6 , Paul Benassi  3   7   8 , Abbas Ghavam-Rassoul  9   10   11 , Adriana Carvalhal  12
Affiliations

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

Nadiya Sunderji et al. Can J Psychiatry. 2018 Aug.

Abstract
in English, French

Objective: Integrated or collaborative care is a well-evidenced and widely practiced approach to improve access to high-quality mental health care in primary care and other settings. Psychiatrists require preparation for this emerging type of practice, and such training is now mandatory for Canadian psychiatry residents. However, it is not known how best to mount such training, and in the absence of such knowledge, the quality of training across Canada has suffered. To guide integrated care education nationally, we conducted a systematic review of published and unpublished training programs.

Method: We searched journal databases and web-based 'grey' literature and contacted all North American psychiatry residency programs known to provide integrated care training. We included educational interventions targeting practicing psychiatrists or psychiatry residents as learners. We critically appraised literature using the Medical Education Research Study Quality Instrument (MERSQI). We described the goals, content, and format of training, as well as outcomes categorized according to Kirkpatrick level of impact.

Results: We included 9 published and 5 unpublished educational interventions. Studies were of low to moderate quality and reflected possible publication bias toward favourable outcomes. Programs commonly involved longitudinal clinical experiences for residents, mentoring networks for practicing physicians, or brief didactic experiences and were rarely oriented toward the most empirically supported models of integrated care. Implementation challenges were widespread.

Conclusions: Similar to integrated care clinical interventions, integrated care training is important yet difficult to achieve. Educational initiatives could benefit from faculty development, quality improvement to synergistically improve care and training, and stronger evaluation. Systematic review registration number: PROSPERO 2014:CRD42014010295.

Objectif:: Les soins intégrés ou collaboratifs constituent une approche fondée sur de solides données probantes et largement pratiquée pour améliorer l’accès à des soins de santé mentale de grande qualité dans les soins de première ligne et d’autres contextes. Les psychiatres nécessitent une préparation à ce nouveau type de pratique, et cette formation est désormais obligatoire pour les résidents en psychiatrie canadiens. Cependant, on ne connaît pas encore la meilleure manière d’organiser cette formation, et à défaut de cette connaissance, la formation pancanadienne a souffert. Afin de guider l’éducation en soins intégrés à l’échelle nationale, nous avons mené une revue systématique des programmes de formation publiés et inédits.

Méthode:: Nous avons cherché les bases de données des publications et la littérature « grise » sur le Web, et communiqué avec tous les programmes nord-américains de résidence en psychiatrie qui offrent la formation en soins intégrés. Nous avons inclus les interventions éducatives ciblant les psychiatres actifs ou les résidents en psychiatrie comme apprenants. Nous avons fait une évaluation critique de la littérature à l’aide de l’instrument de qualité de l’étude de recherche en formation médicale (MERSQI). Nous avons décrit les buts, le contenu et le format de la formation, ainsi que les résultats catégorisés selon le niveau d’impact de Kirkpatrick.

Résultats:: Nous avons inclus 9 interventions éducatives publiées et 5 inédites. Les études étaient de qualité faible à modérée et reflétaient un biais de publication possible à l’égard de résultats favorables. Les programmes comportaient communément des expériences cliniques longitudinales pour les résidents, des réseaux de mentorat pour les psychiatres actifs, ou de brèves expériences didactiques, et étaient rarement orientés vers les modèles de soins intégrés les mieux soutenus empiriquement. Les problèmes de mise en œuvre étaient répandus.

Conclusions:: À l’instar des interventions cliniques de soins intégrés, la formation en soins intégrés est importante mais difficile à réaliser. Les initiatives éducatives pourraient profiter du développement du corps professoral, de l’amélioration de la qualité afin d’améliorer de façon synergique les soins et la formation, et d’une évaluation plus forte.

Keywords: collaborative care; continuing medical education; family medicine; graduate medical education; integrated care; interprofessional relations; mental health; primary care; psychiatry; shared care.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA diagram.
See this image and copyright information in PMC

References

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