Opportunities to Enhance Prevention-Related Competencies in Graduate Medical Education in Psychiatry: A Position Statement of the Prevention Committee of the Group for the Advancement of Psychiatry

Abstract

The field of psychiatry has adopted a renewed emphasis on applying a public health approach to mental health care. A fundamental principle in public health is to focus on the prevention of illnesses and the promotion of well-being. Psychiatry has long stressed the importance of prevention and mental health promotion with every significant stride that is made in research and policy arenas, particularly in the areas of national and international policy, but also in everyday psychiatric practice (1). The recent passage of the Patient Protection and Affordable Care Act has the potential to attract even greater attention to issues of prevention and mental health promotion in psychiatry and throughout medicine. However, even with an increased understanding of the importance of these interventions, few psychiatrists are properly equipped with a foundation of knowledge in the prevention of mental illnesses and the promotion of mental health (2). Currently, the timing is ideal for reframing the importance of wellness and prevention in residency training programs, preparing psychiatrists with the necessary skills to practice prevention- and health promotion-minded psychiatry. The Group for the Advancement of Psychiatry (GAP) Prevention Committee recommends expanded training in the prevention of mental illnesses and the promotion of mental health in psychiatry residency training through three specific interventions: 1) creating a patient care-based preventive psychiatry rotation; 2) adding didactic curricula that address specific topics in mental illness prevention and mental health promotion; and 3) providing specialized training in systems-based practice aspects of mental health promotion and mental illness prevention. Psychiatrists can effectively highlight prevention of mental disorders and promotion of mental wellness by serving as advocates, technical advisors, program directors, researchers, and preventive care providers in various settings (3). Residency training is an ideal starting point to move forward in the dissemination of prevention and mental health promotion principles. The Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for graduate medical education in psychiatry set the training standards by which all U.S. psychiatrists become proficient practitioners. The Council clearly defines the specialty of psychiatry as “a medical specialty focused on the prevention, diagnosis, and treatment of mental, addictive, and emotional disorders” (4). As the Prevention Committee of GAP, we are indeed pleased and encouraged to see that the specialty is defined first and foremost by an emphasis on prevention. However, we believe that even more specific, well-defined competencies will increase the relevant knowledge and experience base for all psychiatrists. Among the six ACGME competencies (patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice) prevention is mentioned in two competency areas. There is a focus on prevention when describing components of medical knowledge within the didactic curriculum, and an expectation that residents “advocate for the promotion of mental health and the prevention of disease” from a systems-based practice perspective (4). We believe that additional competency domains would benefit from more clearly defined prevention- and promotion-related training goals. In particular, we will outline our position on the expansion of training (and the expansion of actual program requirements) with regard to three competency domains: patient care, medical knowledge, and systems-based practice.