To the Editor: We were pleased to see the Educational Resource Column by Dobbins et al. (1) describing a model of collaborative education between family medicine residents and child psychiatrists. As two residents with a keen interest in the delivery of mental health services in a primary-care setting, we avidly read this article. The detailed description of the procedural role of the consultant and the format of the conference will likely help psychiatrists and family physicians involved in trainee education develop similar case-based conferences. This is important, as family physicians and pediatricians commonly diagnose and treat psychiatric disorders in children and adolescents because of their ongoing relationships with young patients and their families, and the shortage of child psychiatrists (2). Furthermore, team-based care and consultation with co-located specialists may become more common in accountable care organizations or patient-centered medical homes (3).

In recent years, professional organizations such as the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Academy of Pediatrics (AAP) have begun to address the need for primary care-based mental health services. For example, in 2005 the AAP obtained an Improving Mental Health in Primary Care Through Access, Collaboration, and Training (IMPACT) grant to address this matter (4). The AAP began developing continuing medical education, webinars, electronic discussion forums, and regional and national meetings for pediatricians and other primary-care professionals (4). Horwitz et al. (5) surveyed 1,000 graduating pediatric residents in 2007 (and achieved a 63.8% response rate) to determine the pediatricians' self-rated competence in diagnosing and treating common psychiatric disorders and the amount of training they received during residency to manage such problems. Although they found that 86% of respondents received the ACGME-required amount of training in developmental and behavioral pediatrics (4 weeks) or more, only 42%, 24%, and 17% of respondents reported high competence in diagnosing ADHD, depression, and anxiety, respectively (5). Even fewer respondents reported high competence about their ability to treat these disorders: 26% for dosing ADHD medications and 7% for dosing antidepressant/anxiety medications. This study suggests that the current mandatory training in the diagnosis and treatment of children's mental health problems during pediatrics residencies does not translate into self-perceived clinical competence.

Although Continuing Medical Education programs are being developed to educate practicing physicians about the diagnosis and treatment of psychiatric disorders in a primary-care setting, few educational programs exist to teach residents in primary-care disciplines about the diagnosis and treatment of psychiatric disorders (6). The evolving models of healthcare delivery, shortage of child psychiatrists, and reported training deficiencies in pediatric residents, make it vital to transform the training of pediatric and family medicine residents so that they can proficiently deliver mental health services to children and adolescents. This Educational Resource Column (1) describes an innovative way for educators to implement practical case-based training in psychiatric diagnosis and treatment.