Academic journal article Mental Health Aspects of Developmental Disabilities

Educating Psychiatric Residents in Intellectual Disability: Does Exposure during Residency Affect Attitudes toward Persons with Intellectual Disability?

Academic journal article Mental Health Aspects of Developmental Disabilities

Educating Psychiatric Residents in Intellectual Disability: Does Exposure during Residency Affect Attitudes toward Persons with Intellectual Disability?

Article excerpt

We evaluated the attitudes of psychiatric resident graduates and current psychiatry residents, regarding community living for individuals with intellectual disability. Thirty-two graduates, and 17 current psychiatric residents, of a single residency program were surveyed regarding their attitudes toward community living for individuals with intellectual disability. All graduates had completed a three month, half-time residency rotation in intellectual disability. The Community Living Attitudes Scale-Mental Retardation version, Short Form (CLAS-MR) was administered by mail to the graduates, and in person to current residents. Twenty-one of 32 (66%) of graduates, and 16/17 (94%) of current residents completed surveys. On the CLAS-MR, 7/17 (41%) questions demonstrated statistically-significant differences between the two resident groups. For two of the four CLAS-MR subscales (Empowerment and Sheltering), there were statistically significant differences between resident graduates and current residents. It is important to expose psychiatric residents to persons with intellectual disability during residency training because it is associated with subsequent attitudes that favor the empowering, and oppose the sheltering, of these patients. Keywords: intellectual disability, psychiatry residency education, attitude scales, psychiatric, diagnosis, community inclusion

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"We like to imagine ... that psychiatry will sometime in the future give mental deficiency the attention that she is so much in need of." (13) Eighty years later, the field still struggles to provide psychiatrists with knowledge and experience in working with individuals with intellectual disabilities. (17) A number of hypotheses have been offered to explain this relative lack of psychiatric expertise in intellectual disability, including avoidance, lack of education, (8 3,9,12) and little exposure to persons with intellectual disability. (10,15) As a result, there is consensus among both psychiatrists in practice, and many in academic settings, that the exposure and education of psychiatrists in the field of intellectual disability, and in the dual diagnosis of intellectual disability and psychiatric illness in particular, is inadequate. (1,2)

Many reports in the area of intellectual disability education for psychiatrists postulate that the lack of sufficient educational opportunity may lead psychiatric graduates to avoid the field following completion of residency. Similarly, it 8,14 may be that this inadequate exposure during residency produces not only a lack of confidence in this clinical area, but may also contribute to lasting attitudes about persons with intellectual disability and mental health problems.

In a pivotal study, Ouellette-Kuntz et al. (11) studied the attitudes of senior psychiatric residents across Canada, regarding their ideas about the inclusion and empowerment of persons with intellectual disabilities living in the community. The authors utilized the Community Living Attitude Scale (CLAS), a 17 item scale which characterizes community attitudes across four subscales (Empowerment, Similarity, Exclusion, and Sheltering). The authors noted 7 that, although most resident respondents endorsed the concept of Empowerment of individuals with intellectual disability, they also favored Sheltering, reflecting a possible ambivalent attitude toward the inclusion of persons with intellectual disability in community settings.

The Department of Psychiatry at the Case School of Medicine/MetroHealth program has provided a required rotation in Dual Diagnosis (intellectual disability and mental illness) Psychiatry for PGY-IV residents over the last 10 years. Two original goals of the dual diagnosis 16 rotation were to enhance the clinical competence of psychiatrists (resident graduates) in providing service to individuals with intellectual disability, and to hopefully increase the willingness, comfort, and perhaps number of psychiatrists providing such service at the local level. …

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