• The comprehensive experience for all residents should include … acute psychiatric, behavioral, and psychosocial problems (p. 19).
• Residents should demonstrate knowledge and skill in management of psychosocial problems that affect children with complex chronic disorders and their families (p. 23).
• Residents should be able to serve as a member of a multidisciplinary team “since no one individual has all the needed expertise to attend to the medical, psychological, and social needs of patients” (p. 42).
Approximately 3 percent of questions on the general pediatrics certifying examination pertain to psychosocial issues and problems, such as family issues, chronic illness, and handicapping conditions (ABP, 2007). ABP emphasizes that there are many other aspects of psychosocial health services that subspecialty trainees need to learn that cannot be tested in a multiplechoice examination, but could be learned through clinical training during residency.12
Psychiatry Residency Training Program Because psychiatric services are by definition psychosocial health services, the written and oral examinations given by the American Board of Psychiatry and Neurology (ABPN) can reasonably be expected to address psychosocial health services.13 For these clinicians, a greater issue is the extent to which psychiatrists are knowledgeable about and qualified to address the effects of acute or chronic illness on mental health. Accordingly, program requirements in psychiatry state that clinical education should give residents experience in “the diagnosis and management of mental disorders in patients with multiple comorbid medical disorders” and “opportunities to apply psychosocial rehabilitation techniques and to evaluate and treat differing disorders in a chronically ill patient population” in a variety of clinical settings (ACGME, 2007b:15,16). However, such experiences may be inadequate to prepare psychiatrists to care for individuals with serious complex health conditions. As noted in Chapter 6, in 2003 ABMS approved a new subspecialty in psychosomatic medicine to address in particular the care of the “complex medically ill” (Lyketsos et al., 2001:5).
12Personal communication, James Stockman, MD, ABP, October 9, 2006, and Jean Robillard, MD, ABP Sub-Board of Pediatric Hematology-Oncology, October 12, 2006.
13Although this may not ensure that psychiatrists have competency in all aspects of psychosocial health services such as communication skills, assessment of social issues affecting the patient, competency working with an interdisciplinary team, or implementation of the psychosocial plan.