Using Collaboration Essentials
The findings of these pilot studies suggest that a case-based teaching system within a collaborative office rounds setting is well received and has significant potential to foster mutual collaboration between pediatric and psychiatry residents.
As one of the facilitators stated at one of the Collaboration Essentials programs, “By the end, the residents were talking about calling each other if they need help from colleagues.” This Collaboration Office Rounds Case Manual is designed to facilitate the implementation of this program into all pediatrics and child psychiatry residency training programs. The American Academy of Pediatrics recently renewed its commitment to the prevention, early detection, and management of behavioral, developmental, and social problems as an important focus in pediatric practice (AAP, 2001). The policy statement on “the new morbidity revisited” notes that “the cooperation of pediatric residency directors, educators, practicing pediatricians, and developmental and behavioral pediatricians will be required for training residents and experienced pediatricians.” The recent Task Force on The Future of Pediatric Education II (2000) noted the importance of establishing collaborative working relationships. The use of the Collaboration Essentials program within individual training institutions offers pediatric programs a vehicle to approach these critical aims.
The Accreditation Council for Graduate Medical Education (ACGME) mandated that all residency review committees incorporate the general core competencies into their requirements (Sexson et al., 2001). One of these areas is system-based practice that involves the treatment of children with medical or psychiatric problems within the context of multiple complex systems. The Psychiatry Residency Review Committee mandated that child and adolescent psychiatry programs develop this competency effective January 1, 2001 (Sexson et al., 2001). Psychiatry residents are expected to demonstrate the ability to work in a mutually respectful manner, while displaying knowledge of the diverse systems involved in the treatment of children and adolescents, integrating multiple systems of care in treatment planning, collaborating in a shared treatment plan, and advocating for children and adolescents in various systems of care. They are expected to demonstrate skills in communicating with and providing consultation to multiple systems (Sexson et al., 2001). This program offers child and adolescent psychiatrists another venue for learning important system-based practice principles.
Phillips et al. (1998) outlined the problems pediatricians face when referring patients for mental health services; these are related to access to care, quality of providers and service, attitudes of patients and providers, and lack of adequate communication. They underscored the utility of developing and maintaining a relationship with mental health referral sources. Fritz (2003) commented on the general similarities and differences between the two disciplines. These researchers noted that both pediatricians and child and adolescent psychiatrists have a professional life devoted to children, tend to be more liberal politically, and have lower incomes than other physicians. At the same time, they stated that child psychiatrists tend to be more reflective, tolerant of anxiety, pessimistic about childhood, and interested in psychopathology and private facilitation while pediatricians are more practical, assuring, optimistic about childhood, and interested in normal development and public advocacy. Fritz (2003) also stressed that recognizing these differences as real, permanent, and desirable is important for successful collaboration. Both research groups highlighted the value of developing strong relationships between the two specialties as well as the need for joint child advocacy efforts.
The Collaboration Essentials program offers trainees an innovative opportunity to better appreciate each other’s approaches and thoughts early in their careers, which can go a long way toward facilitating mutual understanding and, ultimately, toward improving patient care. The cases that follow are designed to not only educate residents about substance abuse, depression, and chronic physical illnesses, but also to allow residents to experience successful collaboration first hand. We urge programs across the United States to incorporate this curriculum into their training.