Needed: More Residency Training Programs for Eating Disorders

A national survey reveals surprisingly limited training opportunities.

Despite the fact that eating disorders have the highest patient mortality rate of all psychiatric disorders, a survey of residency training programs pointed to a serious lack of training programs in the US (Int J Eat Disord Jul 22. doi: 10.1002/eat.22335 [Epub ahead of print]).

According to the results of a national survey by researchers at Hershey Medical Center, Hershey, PA, there is a surprising lack of experience with eating disorders among general psychiatrists, and research with psychiatry residents suggests that they have insufficient training and a lack of information about recognizing and treating eating disorders (Eat Discord 2006; 14:323). Patients with undiagnosed eating disorders may contact their primary care physicians first, and there may be as much as a 5-year lag between a patient’s first office visit and a diagnosis of an eating disorder.

Fauzia Mahr, MD, and colleagues at the Hershey Medical Center sent electronic surveys to 1248 training coordinators across five major disciplines; coordinators from 637 of these programs (72.3%) responded to the electronic questionnaire. Among the medical specialties offering rotations, only 3 internal medicine programs offered a scheduled rotation and 13 offered an elective rotation. Only 11 pediatric programs offered a scheduled rotation, while 10 others offered an elective rotation. In general psychiatry, 12 programs offered a scheduled rotation in eating disorders and 24 offered an elective program. Twelve of the child and adolescent psychiatry programs had rotations, and 13 offered an elective rotation. Only 4 family medicine residency training programs offered rotations, and 21 offered elective rotations.

The “dosage” of training, when training was offered at all, was small; in some cases the rotation involved only a few hours of training each week. Four internal medicine programs offered rotations shorter than a month, and 8 programs had month-long rotations. Overall, the larger residency programs offered greater opportunities for eating disorders training.

Some suggestions for improvement

Thus, it appears that lack of training is the norm rather than the exception. Dr. Mahr and the study team suggest innovative strategies, such as massive open online courses, simulated patient encounters, web-based curricula, and collaborative learning experiences across disciples, and resources like the Academy of Eating Disorders website, as well as brief training seminars.