Emergency psychiatry training and the decision to hospitalize : a longitudinal study of psychiatric residents.

To assess the impact of a 6-month emergency psychiatry training program on emergency psychiatric decision making, we studied 577 emergency psychiatric patient evaluations conducted by 15 first-year psychiatry residents. By their fifth month of training, the residents' rates of emergency patient hospitalization declined from 33% to 19%. For residents in the early training phase, various clinical features, including psychosis, thought disorder, schizophrenic diagnosis, dangerousness, and overall symptoms, were associated with higher rates of patient hospitalization. By the end of training, only dangerousness and overall symptoms remained significantly related to the hospitalization decision. Specific training in emergency psychiatry may affect psychiatric decision-making practices as early as the first year of residency training.