233 - Pediatric Subspecialty Care and Mental Health: Does Fellowship Training Need to Be Improved?

Poster Number: 233
Publication Number: 233.332

Rebecca D. Sanders, Emory University School of Medicine and Children's Healthcare of Atlanta, Decatur, GA, United States; Susie Buchter, Emory University School of Medicine, Atlanta, GA, United States; Richard Mink, The Lundquist Institute for Biomedical Innovation, Torrance, CA, United States

Background: The need for increased mental health training in general pediatrics is well-recognized. However, subspecialists are often the primary medical home for children with chronic conditions, a group at increased risk for mental health concerns. The role of subspecialists in providing pediatric mental health care and their training needs have not been characterized.

Objective: Describe the current extent and adequacy of mental and behavioral health training in pediatric fellowship, perceived training needs, and opportunities for improvement.

Design/Methods: Fellowship program directors (FPDs) and graduates who completed fellowship within the past 18-66 months across 16 subspecialties at one institution were invited to complete a web-based survey. Participants were asked about their attitudes regarding mental health care delivery by subspecialty physicians, the breadth of mental health conditions encountered in current practice, and the extent and perceived adequacy of mental health care training provided in fellowship.

Results: All FPDs (16/16) and 61% (80/132) of fellowship graduates responded to the survey. The majority of participants reported caring for patients with a broad array of mental health diagnoses (Fig 1). Nearly all respondents (95/96) believed mental health was an important aspect of care for children with chronic health conditions, and 88% (84/96) felt fellowship should include mental health training. Only 26% (25/96) thought that mental health is better addressed by primary care physicians. A majority of graduates (71%, 57/80) reported receiving no mental health training during fellowship and described themselves as not prepared to perform key mental health care tasks after fellowship training (Fig 2). However, FPDs’ most often rated current fellowship training in mental health as average or better. The mode of additional education most desired by both graduates (72%) and FPDs (75%) was clinical experience with a mental health provider.Conclusion(s): Mental health is viewed as an important part of subspecialty care, and most subspecialists provide mental health care to patients. However, graduates view their fellowship training on the topic as inadequate, in contrast to FPD’s perceptions. Although this was a single site study, it likely reflects conditions within the broader pediatric subspecialist community. Increasing time spent on mental health training in fellowship and additional clinical experience with mental health providers could help to improve mental health care for children.
Mental Health Diagnoses Encountered in Subspecialty CareFigure 1: Fellowship graduates were asked to select the mental health diagnoses of patients they cared for in practice; fellowship program directors were asked to select the mental health diagnoses of patients their fellows cared for in practice.
Perceived Adequacy of Mental Health Training in FellowshipFigure 2: Fellowship graduates were asked to rate their preparedness for common patient care tasks related to mental health, based on their experience in fellowship. Fellowship program directors were asked to rate their fellows' training in the same patient care tasks.