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Teaching Psychiatry in Primary Care Residencies: Do Training Directors of Primary Care and Psychiatry See Eye to Eye?

Received April 23, 2007; revised August 5, 2007; accepted August 22, 2007. Drs. Leigh and Mallios are affiliated with the Department of Psychiatry at the University of California, San Francisco; Dr. Stewart is affiliated with the Department of Pediatrics at University of California, Davis. Address correspondence to Hoyle Leigh, M.D., University of California, San Francisco, Department of Psychiatry, UCSF Fresno, 155 N. Fresno St., Fresno, CA 93701; hoyle.leigh{at}ucsf.edu (e-mail).

OBJECTIVE: This study compares the views of psychiatry residency training directors about psychiatry and mental health training in the primary care programs in their institutions with those of the primary care residency training directors. METHODS: A 16-item questionnaire surveying specific areas of training and perceived adequacy of current teaching was distributed to 1,544 U.S. primary care and psychiatry program directors. RESULTS: The response rate was 53%. Among psychiatry training directors, 85% responded that psychiatry training in their primary care programs was minimal to suboptimal, while 68% of family practice training directors responded that their psychiatry training was optimal to extensive. Among psychiatry training directors, 89% were dissatisfied with the psychiatry training in their primary care programs, and only 8% were satisfied. In contrast, almost half of primary care training directors were satisfied. However, within the primary care programs, there was a marked difference between family practice (majority satisfied) and the rest (internal medicine, obstetrics and gynecology, pediatrics, mostly unsatisfied). All primary care and psychiatry training directors agreed that most basic psychiatric skills and diagnoses were taught in the primary care programs. For all skills and syndromes examined, psychiatry training directors consistently and significantly rated the training to be less adequate than did primary care training directors. There was general agreement that primary care physicians should be able to treat most uncomplicated cases in patients with psychiatric disorders, and some but not other psychiatric conditions. CONCLUSION: Psychiatry and primary care training directors, except in family practice, generally agree that psychiatry training in primary care programs is inadequate and should be significantly enhanced. There should be more communication between psychiatry and primary care training programs for optimal curriculum development.

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