目的 基于住院医师规范化培训(简称住培)学员视角,初步评估儿科住培学员的儿童青少年精神病学培训现状,分析临床需求与培训缺口,为完善住院医师规范化培训体系提供参考。方法 采用问卷调查方法。2025年5月,采用方便抽样方法选取上海交通大学医学院3家住培基地的儿科、儿外科共154名住培学员为调查对象。问卷在参考国内外相关文献和住培大纲的基础上,经儿科、精神科和医学教育学专家咨询修订形成。问卷内容包括住培学员一般资料、儿童青少年精神病相关培训现状及其需求。采用卡方检验、t检验分析相关数据。结果 154名住培学员中,70.8%(109/154)的住培学员在轮转中遇到过儿童青少年精神心理障碍患者,第二年和第三年住培学员的接触比例更高。仅有21.4%(33/154)的住培学员接受过相关培训,且以理论授课为主[78.8%(26/33)]。58.4%(90/154)的住培学员接诊时感到压力,本科及以下学历住培学员的压力感受比例高于研究生学历的住培学员[67.2%(45/67)比51.7%(45/87)];女性住培学员的压力程度高于男性住培学员[(3.45±0.76)分比(2.92±0.86)分],其差异均具有统计学意义(均P<0.05)。88.3%(136/154)的住培学员认为需要增加儿童青少年精神心理障碍知识的培训,第二年和第三年住培学员的培训需求高于第一年住培学员,差异具有统计学意义(P=0.025)。在各种培训形式中,住培学员最认可的培训形式为“门诊/病房跟诊”[(3.73±0.96)分]。不同专业住培学员对培训形式需求存在差异:儿科专业住培学员更倾向于新增轮转[36.0%(40/111)]或“轮转+课程”[38.7%(43/111)],而儿外科专业住培学员则更倾向于在现有教学中增加相关内容[46.5%(20/43)],其差异具有统计学意义(P=0.035)。结论 儿科住培体系在儿童青少年精神病学领域存在明显不足:系统培训覆盖率较低,但住培学员在临床接触儿童青少年精神心理障碍患者的比例较高;大多数住培学员在接诊时感到信心不足与压力,对儿童青少年精神病学的住培需求较高。因此,建议在培训体系中系统融入儿童青少年常见精神障碍的识别、初步处理与转诊等核心知识与实践技能相关教学内容,并基于住培学员的年资与专业差异,建立分层递进的培训路径,同时强化临床实践与多学科协作,以期系统性提升儿科住培学员对常见儿童青少年精神心理障碍的识别、初步处理与规范转诊能力。
Objective From the perspective of standardized residency training (SRT) trainees, this study preliminarily aims to assess the current status of standardized child and adolescent psychiatry training for pediatric residents, analyze clinical needs and training gaps, so as to inform the improvement of the SRT system. Methods A questionnaire survey was conducted in May 2025 among pediatric and pediatric surgery residents from three SRT bases affiliated with Shanghai Jiao Tong University School of Medicine, selected by convenience sampling. The questionnaire was developed based on a review of domestic and international literature and SRT syllabi, and revised after consultation with experts in pediatrics, psychiatry, and medical education. It covered residents' general information, current training status, and needs regarding child and adolescent psychiatry. Data were analyzed using the chi-square test and t-test. Results A total of 154 residents participated in the study. A majority of 70.8% (109/154) residents had encountered children or adolescents with mental disorders during rotations, with higher exposure rates among second- and third-year trainees. Nevertheless, only 21.4% (33/154) had received relevant training, primarily through lectures (78.8%, 26/33), and 58.4% (90/154) felt stressed when managing such patients. The proportion reporting stress was higher among residents with a bachelor's degree or below (67.2%, 45/67) compared to those with postgraduate degrees (51.7%, 45/87), and stress levels were higher among female residents (3.45±0.76) than male residents (2.92±0.86), all P<0.05. In addition, 88.3% (136/154) believed that training in child and adolescent mental health knowledge should be increased, with second- and third-year trainees expressing stronger demand than first-year trainees (P=0.025). Among various training formats, ″outpatient/ward follow-up″ received the highest recognition score (3.73±0.96). Training needs differed by specialty: pediatric residents more frequently preferred adding new rotations [36.0%(40/111)] or ″rotations plus courses″ [38.7%(43/111)], while pediatric surgery residents were more inclined to enhance content within the existing curriculum [46.5%(20/43)], P=0.035. Conclusions This survey reveals significant deficiencies in child and adolescent psychiatry within the current pediatric SRT system: the coverage rate of systematic training is low, but the proportion of clinical contact with children and adolescents with mental and psychological disorders is high. Most resident physicians feel a lack of confidence and pressure when consulting such patients, and there is a high demand for residential training in child and adolescent psychiatry. Therefore, it is recommended to systematically integrate core knowledge and practical skills-such as the identification, initial management, and referral of common child and adolescent mental disorders—into the training curriculum. A tiered and progressive training pathway should be established based on trainees' seniority and specialty differences, coupled with strengthened clinical practice and multidisciplinary collaboration, to systematically enhance pediatric residents' competencies in recognizing, initially managing, and appropriately referring common child and adolescent mental health disorders.
[1] 静进. 当前儿童青少年心理健康状况解读与对策建议[J].中国学校卫生,2023,44(2):161-166,175. DOI: 10.16835/j.cnki.1000-9817.2023.02.001.
[2] 傅小兰, 张侃,陈雪峰,主编. 中国国民心理健康发展报告(2021～2022)[M]. 北京:社会科学文献出版社,2023:57-96.
[3] Wu JL, Pan J. The scarcity of child psychiatrists in China[J]. Lancet Psychiatry, 2019,6(4):286-287. DOI: 10.1016/S2215-0366(19)30099-9.
[4] 国家卫生健康委,国家中医药局,国家疾控局,等.关于开展“儿科和精神卫生服务年”行动(2025-2027年)的通知[EB/OL].(2025-04-08)[2026-01-18]. http://www.gov.cn/zhengce/zhengceku/202504/content_7021393.htm.
[5] Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in pediatrics [EB/OL]. [2025-10-14]. https://www.acgme.org/.
[6] Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health. Policy statement-The future of pediatrics: mental health competencies for pediatric primary care[J]. Pediatrics, 2009,124(1):410-421. DOI: 10.1542/peds.2009-1061.
[7] 潘美蓉, 唐妮, 王振, 等. 我国儿童青少年精神科专科医师培养:需求、挑战及思考[J].中国毕业后医学教育,2025,9(4):308-311,320. DOI: 10.3969/j.issn.2096-4293.2025.04.016.
[8] 潘美蓉, 岳鑫鑫, 唐妮, 等. 扩展中国儿童青少年精神科医师培养途径的必要性及思考[J].医学教育管理,2025,11(4):424-430. DOI: 10.3969/j.issn.2096-045X.2025.04.009.
[9] 方晖, 郑丹丹, 农玉贤, 等. 2014—2023年广西南宁某精神专科医院门诊儿童青少年精神心理障碍患者就诊疾病种类变化分析[J].中国临床新医学,2025,18(1):77-82. DOI: 10.3969/j.issn.1674-3806.2025.01.14.
[10] Foy JM, Green CM, Earls MF, et al. Mental health competencies for pediatric practice[J]. Pediatrics, 2019,144(5): e20192757.DOI: 10.1542/peds.2019-2757.
[11] Wright DR, Katon WJ, Ludman E, et al. Association of adolescent depressive symptoms with health care utilization and payer-incurred expenditures[J]. Acad Pediatr,2016,16(1):82-89. DOI: 10.1016/j.acap.2015.08.013.
[12] 喻月慧. 精神障碍患者共病管理问题研究现状及展望[J].中国卫生事业管理,2023,40(6):466-470.
[13] 刘晓阳.车祸所致脑外伤与创伤后应激障碍共病三例[D].杭州:浙江大学,2011.
[14] 郑秀秀.儿童过敏性鼻炎治疗前后对注意缺陷多动障碍的影响[D].温州:温州医科大学,2018.
[15] 姜荣环, 党卫民, 马弘, 等. 非精神科医生对抑郁障碍的识别和相关因素[J].中华内科杂志,2010,49(6):477-479. DOI: 10.3760/cma.j.issn.0578-1426.2010.06.007.
[16] Green C, Hampton E, Ward MJ, et al. The current and ideal state of mental health training: pediatric program director perspectives[J]. Acad Pediatr, 2014,14(5):526-532. DOI: 10.1016/j.acap.2014.05.011.
[17] Shahidullah JD, Forman SG, Lekwa AJ. Assessment and management of depression and suicidality: pediatric resident perspectives on training and practice[J]. Fam Syst Health, 2020,38(2):172-183. DOI: 10.1037/fsh0000484.
[18] Harris E, Bowden J, Greiner E, et al. Mental health training in pediatric residency: where can we go?[J]. J Pediatr, 2019, 211:4-6. DOI: 10.1016/j.jpeds.2019.05.075.
[19] McMillan JA, Land M, Tucker AE, et al. Preparing future pediatricians to meet the behavioral and mental health needs of children[J]. Pediatrics, 2020,145(1):e20183796. DOI:10.1542/peds.2018-3796.
[20] Hampton E, Richardson JE, Bostwick S, et al. The current and ideal state of mental health training: pediatric resident perspectives[J]. Teach Learn Med, 2015,27(2):147-154. DOI: 10.1080/10401334.2015.1011653.
[21] 玄迪, 孙婉彤, 刘博, 等. 住院医师规范化培训学员心理压力评估与影响因素研究[J].中国卫生产业,2025,22(3):69-71,94. DOI: 10.16659/j.cnki.1672-5654.2025.03.069.
[22] 肖铮, 张水华, 杨滨滨, 等. 住院医师规范化培训学员的心理压力分析及心理干预[J].中国继续医学教育,2018,10(18):3-5. DOI: 10.3969/j.issn.1674-9308.2018.18.002.
[23] 张萍, 朱宣, 陈蕾, 等. 巴林特小组结合人物“雕塑”在住院医师规范化培训中的运用[J].现代医药卫生,2017,33(2):291-293. DOI: 10.3969/j.issn.1009-5519.2017.02.050.
[24] Foy JM. Enhancing pediatric mental health care: algorithms for primary care[J]. Pediatrics: Official Publication of the American Academy of Pediatrics,2010,125(Suppl.3):S109-125. DOI:10.1542/peds.2010-0788F.
