The ability to detect mental disorders varies greatly among general practitioners in primary health care. The aim of this study was to determine the factors underlying the differences between general practitioners in the ability to recognize mental disorders in Finnish patient populations. The group studied consisted of 1000 randomly selected adult patients of primary care facilities in the city of Turku. The Symptom Checklist (SCL-25) was used as the reference method in the identification of psychiatric cases. According to the SCL-25, one fourth of the sample had mental disorders. A good recognition ability was associated with postgraduate psychiatric training and qualification as a specialist in general practice. Surprisingly, Balint group training, which is a method intended to improve the ability of general practitioners to manage their patients' mental health problems, was associated rather with poor than good detection ability.
In Canada, the qualification of physicians is the jurisdiction of the College of Family Physicians and the Royal College of Physicians and Surgeons. The Colleges have promoted the training of "generalists" in family medicine and "sophisticated generalists" among the traditional specialties, and the development of subspecialties has not been encouraged. Nevertheless, due to the increasing number of family physicians and specialists practicing a range of new subspecialties, including addiction medicine, the College of Family Physicians has recognized special interest or focused practices, whereas the Royal College has recognized, in psychiatry, 3 subspecialties (child, geriatric, forensic) requiring an extra year of training and may offer others a diploma recognition. These new opportunities will shape the training requirements of addiction medicine leading to available certification through the International and American Medical Societies of Addiction Medicine.
In recent years physicians have become increasingly involved in the decision-making and policy-making processes in hospitals and other health service organizations. Consequently, there is a growing awareness of the need for specialized education programs for physicians who have managerial responsibilities. While education programs in management for physicians have been available in Britain and the United States for a number of years, relatively few programs have existed in Canada. Typically, physicians who have assumed administrative positions either within the medical staff organization or within the hospital's management structure have received no formal training in management. This article examines reasons for the increased demand for management education for physicians in Canada, specific needs of physicians in the area of management education, and the assessment of needs for management education programs.
General practitioners are the psychiatrists' most important coworkers in the treatment of depressive disorders. A high degree of knowledge about this illness in this group of doctors is of decisive importance. However, the value of postgraduate educational programs for general practitioners has been questioned. The Swedish Committee for the Prevention and Treatment of Depression (PTD) offered an educational program on symptoms, etiology, diagnosis, prevention and treatment of depression to all general practitioners on the Swedish island of Gotland. Lectures on suicide, depressive illness in childhood and in old age and psychotherapy of depressive states were also given. In several control periods data were collected on suicides, referrals to the local psychiatric department, emergency admissions, the quantity of sick leave used and the quantity of inpatient care due to depression. Even the prescription of psychopharmacological drugs on the island was investigated. Overall, the results indicated that general practitioners gratefully accepted the educational program and achieved increasing competence and stringency in treating and preventing depressive states. The program was associated with decreases in the use of psychiatric inpatient care and the sick leave frequency of depressed patients. The possibility of preventing suicides was positively influenced.
BACKGROUND: The department of psychiatry of the University Hospital of North Norway in Tromsø sought to improve suicide prevention skills among medical students through a workshop on applied suicide intervention skills training (ASIST). MATERIAL AND METHODS: Over the course of the academic year 1998/99, 76 medical students attended workshops. Results were assessed through focus group interviews. RESULTS: By the end of the workshop, students reported more professional confidence and better skills in suicide intervention. They found it very useful to get this opportunity to role-play situations and receive feedback on their own behaviour. Working with suicidal patients is a great and challenging responsibility and students were well aware of the importance of paying attention to the boundaries between one's professional and one's private life. They reported that they saw the benefits of working with caregivers from other professions. CONCLUSION: The workshop appears to enhance suicide intervention skills and will continue to be a part of the clerkship in psychiatry at the University of Tromsø.