Assessing a Revised Curriculum to Improve the Assessment and Management of Psychiatric Crises in an Outpatient Family Medicine Residency Clinic

There are few trainings for primary care physicians (PCPs) on how to navigate a psychiatric crisis (such as suicidal ideation, homicidal ideation, psychosis, and/or intoxication that impairs decision making capacity) in the outpatient setting. We previously published an approach to fill this gap and now report the results of our efforts to improve the curriculum and assess if confidence was maintained over time. Four, 1-h didactic sessions on screening and logistically managing patients in need of inpatient or outpatient psychiatric care were created. Objectives were based on the complexities of state law, institutional policy, and expert opinion. All 15 residents in a family residency program participated in the didactic series. Resident confidence to complete all aspects of these scenarios was measured by questionnaire before (Time 1), immediately after (Time 2), and 5 months after completion of the didactic series (Time 3). From Time 1 to Time 3, resident confidence significantly increased for 10/17 (58%) aspects of assessing and managing psychiatric crises (all P < .017). There was no evidence that confidence for any measure decreased from Time 2 to Time 3. The revised curriculum increased family medicine resident confidence to assess and manage outpatient psychiatric crises 5 months after the training was completed.