To the Editor: Symptoms or behaviors related to psychiatric disorders are increasingly seen in patients presenting for evaluation in our emergency departments (1). Emergency medicine residents in teaching hospitals are often required to assess acutely behaviorally disturbed individuals and evaluate their eligibility for involuntary commitment.

Unfortunately, formal residency training in the management of acute psychiatric emergencies occurs in only 24% of emergency medicine residencies (2), resulting in inadequate instruction in the commitment process (3). Recent research has demonstrated that in up to one-third of cases, the commitment recommendation of the psychiatric consultant is discordant with that of the emergency medicine resident (4). The generalizability of this educational need may be highlighted by suboptimal practices that have been also noted by psychiatric residents (5).

After discussions held between the departments of psychiatry and emergency medicine, we developed an educational presentation based on the Georgia commitment statute, and concurrently constructed a survey of residents' training and attitudes. Through an interdepartmental collaboration, the web- and e-mail accessible educational presentation was provided to the Emory emergency medicine residents on rotation at the Grady Memorial Hospital Emergency Department (slides available on request) (6). The web-based survey and questionnaire tool was also completed by the residents to ascertain baseline attitudes and intervention outcomes. Completion of the presentation and survey was incentivized by the Department of Emergency Medicine with a 1-hour resident learning credit. This project was specifically aimed at quality- and safety-improvement and did not require IRB approval.

The education intervention was administered over a 2-week time period in June 2011 to ensure that even the most junior residents had almost 12 months of experience. The intervention included a 20-slide presentation outlining information regarding psychiatric assessment in the emergency department, Georgia state statutes, specific hospital protocols, and examples of correctly and incorrectly completed commitment documentation.

We obtained 34 responses from a total of 59 residents (57.6% response rate). A substantial number of respondents were noted as having no training in commitment statues or documentation completion at the time of the survey (26.5%), and a further proportion described their training as poor or very poor (6%). Residents almost universally recognized that understanding these statutes and being able to accurately complete the needed documentation was important for patient care (100% agreement), important for medico-legal reasons (100% agreement), and an important part of training (97% agreement).

The presentation was well received by the participants, with its quality rated as very good (52.9%), or good (47.1%) by the emergency medicine residents. Also, the usefulness and the scope of information provided were rated as good, or very good, by 100% and 93.9% of participants, respectively. After the presentation, 100% of respondents noted both improved confidence and knowledge when assessing patients for involuntary commitment and completing the legal documentation.

This project suggests that, in view of the significant national need for psychiatric training for emergency medicine residents, computer-delivered training modules may be an efficient method of providing the necessary training for emergency medicine residents. Such learning methods may be particularly advantageous for emergency medicine residents who have variable shift timetables. Also, although this study did not specifically monitor outcomes in practice, it provides preliminary data that can be used to develop future studies in this area. Such studies may assess the usefulness for annually-updated training modules or the incorporation of multimedia, including videos and interactive scenarios. Although this study focused on residents, future studies are also needed to explore the educational needs of primary care providers and emergency room attending physicians in general hospital settings.