Cincinnati Children's Hospital
Background: Pediatric mental health issues are increasing exponentially. Pediatricians are in a unique position to address these issues as they arise, but many report they are inadequately prepared to approach behavioral and mental health (B/MH) problems. Underscoring the importance of this area, the American Board of Pediatrics has defined B/MH as one of only 17 foundational entrustable professional activities (EPAs) for general pediatric practice.
Aim: We sought to explore the facilitators and barriers associated with implementing and assessing the B/MH EPA among pediatric residency programs in order to identify best practices and potential solutions to common barriers.
Methods: In this qualitative interview study, 18 key faculty members from 4 residency programs with three years’ experience implementing and assessing their residents on the B/MH EPA were purposively sampled. Semi-structured interviews were conducted with each participant, and interviews were coded utilizing a thematic analysis.
Results: Five themes emerged from the thematic analysis: (1) who is responsible for B/MH training (local champion, program director, resident, national organization)?; (2) local context can serve as a barrier or facilitator; (3) B/MH may require longitudinal, integrated, and multi-disciplinary training; (4) B/MH specialists: indispensable, yet a hurdle to training?; and (5) resident and faculty confidence and skill impact B/MH training.
Conclusion: The need for robust training to prepare pediatric residency graduates to meet the needs of patients with B/MH problems has never been greater. This study provides important insights about curricular gaps in particular. These should inform future directions focused on addressing this need.
