Strategic implementation of child and adolescent psychiatry training in Chinese residency programs: an exploratory survey

Abstract

Background

The workforce shortage in child and adolescent psychiatry (CAP) in China greatly restricts patients’ access to child and adolescent mental health services (CAMHS). Implementing CAP training within general or adult psychiatry programs may offer a viable solution; however, such programs are underdeveloped in China. The aim of this study was to gather empirical evidence regarding CAP training needs within Chinese psychiatry residency programs.

Method

An exploratory survey was administered online to psychiatry residents and their mentors to assess the application of CAP in clinical practice, satisfaction with existing CAP training, and attitudes towards the expansion of such training. The data were analysed using descriptive statistics, the Mann‒Whitney U test, the t-test, and the χ2 test to explore demographic differences and responses.

Results

A total of 230 residents (response rate = 54.76%) and 241 mentors (response rate = 53.79%) provided effective responses. A significant majority of both residents (201, 87.39%) and mentors (216, 89.63%) reported frequent engagements with pediatric mental health patients. Additionally, a considerable portion in both groups (70.43% of the residents and 59.34% of the mentors) indicated experiencing moderate to high stress levels in their work with these patients, primarily due to inadequate training in CAP. Only 37.39% of the residents and 21.99% of the mentors expressed satisfaction with current training offerings. Notably, substantial support exists among both residents (77.82%) and mentors (85.89%) for expanding CAP training programs.

Conclusions

This study highlights a critical gap in CAP expertise among psychiatry professionals in China, mirrored by general dissatisfaction with existing training frameworks. There is strong, evidence-based support for the expansion of CAP training within residency programs, which is imperative to bolster the competence of CAMHS providers.

Clinical trial number

Not applicable.

Introduction

The mental health of children and adolescents has become a global public crisis [1]. In recent decades, psychiatric epidemiology has demonstrated that many mental disorders begin in childhood and adolescence, with a significant global prevalence and comorbidity [2, 3], leading to an approximately decade-long reduction in life expectancy compared with that of the general population [4]. In China, the prevalence of mental disorders among school-aged children has reached as high as 17.5% (95% CI: 17.2–18.0) [5], representing a major contributor to disability-adjusted life years (DALYs) from noncommunicable diseases among youth [6]. In response, the Chinese government has launched the Healthy China Action (2019–2030) plan, which aims to enhance the prevention and control of child and adolescent mental disorders [7]. Despite these efforts, the dearth of specialized CAP services poses a substantial barrier to the effective implementation of these policies [8], underscoring the urgent need for expanded CAMHS to deliver timely and appropriate interventions [2].

Child and adolescent psychiatrists are integral to CAMHS, offering comprehensive biopsychosocial support to young patients and their families. Systematic training in CAP, typically spanning 4–6 years, is crucial for developing a well-rounded approach to mental health care [9]. In addition to specialists, there is a pressing need to extend training opportunities to general psychiatrists, adult psychiatrists, pediatricians, primary care professionals, other specialty physicians, nurses, social workers, and other health care professionals [9]. This multidisciplinary expansion is essential, particularly as general psychiatrists and adult psychiatrists frequently encounter young patients presenting with mental health issues that may stem from early-life stress or neurodevelopmental disorders [10, 11].

The CAP study of training in Europe (CAP‑STATE) advocates for substantial CAP experience for adult psychiatrists, including training on the normal and abnormal developmental behaviours of children and adolescents [12]. A survey encompassing 17 countries and areas revealed that CAP rotations were available for trainees during general psychiatry residency in 12 countries, with durations ranging from 2 to 6 months. Additionally, some trainees have opportunities for CAP electives abroad [13]. In China, a 3-year psychiatry residency training is necessary for medical students to become psychiatrists [14]. The standardized psychiatry training program consists of 9-month rotations in internal medicine, 18-month clinical rotations in psychiatric inpatient services (including 12 months in acute psychiatric wards and 6 months in low-acuity/rehabilitation wards), 3 months in psychiatric outpatient clinics and/or emergency units, and 3 months of elective rotations. Subspecialty training modules, such as CAP or geriatric psychiatry, remain elective components rather than mandated curricular requirements. Moreover, there is a noticeable absence of surveys or policies specifically addressing CAP training during residency, highlighting a significant gap in training and policy implementation.

To fill this gap, this study aimed to explore (1) the current application of CAP in general clinical practices, (2) satisfaction with existing CAP training within psychiatry residency programs, and (3) attitudes towards the expansion of CAP training within these programs. Both residents and their mentors, who play pivotal roles in the training process, were surveyed to gather comprehensive perspectives [15]. This study aimed to provide evidence-based insights into the current state of CAP training in China and identify strategic measures to enhance its integration into psychiatry residency programs, thereby significantly bolstering the resources of China’s CAMHS.

Methods

Participants and procedure

The survey was distributed to residents and mentors at province-level psychiatry training bases across 14 provincial administrative divisions in China. These sites were purposively selected from hospitals accredited by the Chinese Medical Doctor Association, prioritizing those with established research collaboration agreements to ensure methodological feasibility. The survey was posted twice on the training site-specific announcement group from 27 August to 28 September 2024. The survey was delivered electronically, and participants provided responses once they received the survey link, either on their mobile phones by scanning a QR code or on a computer by logging into a website. Each survey was completed in approximately 10 to 15 min.

Ethical considerations

This study was conducted with the approval of the medical ethics board of the Peking University Sixth Hospital [(2024) Ethics review number (68)]. All methods adhered to the guidelines and regulations outlined in the Declaration of Helsinki. Informed consent was obtained electronically, ensuring volunteer participation and data confidentiality. Data collection was limited to those participants who provided informed consent. The survey results were analysed separately to ensure the anonymity and confidentiality of personal information.

Measurements

The questionnaire was developed via a rigorous two-stage process. First, an expert panel of psychiatrists, medical educators, and researchers specializing in CAP and general psychiatry refined its content, wording, and structure. Then, a pilot study with 10 residents and 10 mentors under anonymized confidentiality evaluated comprehensibility, pinpointed ambiguities, and gauged completion time. Findings informed targeted revisions, ensuring the questionnaire’s validity and reliability for research.

As a result of these comprehensive refinement efforts, a 21-item questionnaire was developed to assess the perceptions of psychiatry residents and their mentors in various domains. Demographic information (age, sex, ethnicity, information on residency training status, and economic burden) was initially collected; followed by a multiple-choice section with a scoring system to assess participants’ current application of CAP in clinical settings, their satisfaction with the current CAP training within the psychiatry residency programs, and their attitudes towards expanding CAP training. The respondents rated each factor on a Likert scale ranging from 0 to 5 (0=“absolutely not important/disagree”; 5=“very important/agree”), with scores of 3 or higher reflecting moderate to high agreement. Likert-scale responses were subsequently treated as continuous variables, allowing for the calculation of mean ratings and standard deviations for each question.

Statistical analysis

The raw data from the survey responses were imported into SPSS 27.0. Descriptive statistics, including means and percentages, were calculated for the demographic variables. Frequencies, means with standard deviations, and medians with interquartile ranges were calculated for descriptive data. The Mann‒Whitney U test was applied to compare continuous variables between groups because of their nonnormal distribution, whereas t tests were employed for normally distributed variables. The χ² test was used for categorical variables between different groups.

Results

Demographic information

A total of 230 residents (response rate = 54.76%) and 241 mentors (response rate = 53.79%) provided effective responses. Residents were distributed across postgraduate years (PGY) 1 (94, 40.87%), 2 (69, 30.00%), and 3 (67, 29.13%), with ages ranging from 25 to 48 years and a mean age of 26.04 ± 2.88 years. The majority held a bachelor’s degree (142, 61.57%) and had received residency training in a psychiatric hospital (196, 85.22%). Additionally, most residents (197, 85.65%) had not yet specialized in a subspecialty. Mentors ranged in age from 28 to 63 years, with a mean age of 41.06 ± 5.95 years. The majority were from psychiatric hospitals (223, 92.53%), specialized in general psychiatry (162, 67.22%), and were attending psychiatrists (128, 53.11%). The locations of the responders’ residency training sites were distributed mainly in north and east China. A significant difference in the distributions of specialties between the residents and mentors was observed (χ² = 360.572, p < 0.001). A summary of the relevant demographic data is presented in Table 1.

Table 1.

Summary of the demographics of the survey respondents

		Residents (N = 230)	Mentors (N = 241)
Gender (Male)		67 (29.13%)	73 (30.29%)
Ethnic Group (Han)		222 (96.52%)	236 (97.93%)
Degree
	Bachelor’s Degree	142 (61.74%)	71 (29.46%)
	Master’s Degree	77 (33.48%)	120 (49.79%)
	Doctor’s Degree	11 (4.78%)	50 (20.75%)
Residency Hospital
	Psychiatric Hospital	196 (85.22%)	223 (92.53%)
	Generic Hospital	34 (14.78%)	18 (7.47%)
Location of Residency Training Sites
	East China	56 (24.35%)	99 (41.08%)
	North China	88 (38.26%)	126 (52.82%)
	Central China	33 (14.35%)	8 (3.32%)
	South or Southwest China	53 (23.04%)	8 (3.32%)
Specialty
	Unspecified Specialization	197 (85.65%)	—
	General Psychiatry	19 (8.26%)	162 (67.22%)
	Child and Adolescent Psychiatry	10 (4.35%)	23 (9.54%)
	Sleep Medicine	2 (0.87%)	19 (7.88%)
	Geriatric Psychiatry	1 (0.43%)	14 (5.81%)
	Addictive Psychiatry	1 (0.43%)	11 (4.56%)
	Emergency Psychiatry	—	6 (2.49%)
	Rehabilitation Psychiatry	—	5 (2.07%)
	Consultation Liaison Psychiatry	—	1 (0.41%)
Married		24 (10.43%)	211 (87.55%)
With Child(ren)		8 (3.48%)	203 (84.23%)
Current Economic Burden
	None	47 (20.43%)	41 (17.01%)
	Low level	77 (33.48%)	97 (40.25%)
	Mid-level	67 (29.13%)	86 (35.68%)
	High-level	39 (16.96%)	17 (7.05%)

Application of CAP in clinical settings

Both residents (201, 87.39%) and mentors (216, 89.63%) reported that they had opportunities to work with children and adolescents with mental disorders, with no significant difference noted between the two groups (χ² = 0.579, p = 0.447). The top three diseases they experienced included emotional disorders, schizophrenia and other psychotic disorders, and mental disorders in young adults. Alarmingly, the mentors reported that they had more opportunities to treat patients with behavioural disorders (t = 2.852, p = 0.005) and with feeding and eating disorders (t = 2.002, p = 0.046). The differences in the rating scores between groups did not exist after controlling for specialty (see Fig. 1).

Fig. 1.

Opportunities to Work with Children and Adolescents in Clinical Settings^a Note. CAP: child and adolescent psychiatry. ^a The results represent differences between the two groups without controlling for the individual’s specialty

Only 7 of the mentors reported that they did not have the chance to use CAP-related knowledge because they were in the geriatric psychiatry major. Moreover, 153 residents (66.52%) and 120 mentors (49.79%) reported utilizing CAP-related knowledge in their clinical practice at a moderate or higher frequency. A significantly greater proportion of CAP-related knowledge was reported by residents than by mentors (χ² = 13.517, p < 0.001), but the differences disappeared after controlling for the individual’s specialty (p = 0.993). The most frequently used CAP-related knowledge in clinical settings was clinical communication with patients and families, with mean scores of 3.67 ± 1.09 for residents and 4.01 ± 0.89 for mentors. Overall, the scores scaled by the mentors in each domain were significantly higher than those of the residents (p < 0.05), but the differences in the rating scores between groups did not exist after controlling for the specialty. The detailed results are presented in Table 2.

Table 2.

Applications of CAP-Related knowledge in clinical Settings^a

	Residents (N = 153)	Mentors (N = 120)	t value	p value
Identification of Emotional Disorders	3.62 ± 1.03	4.08 ± 0.87	3.951	< 0.001
Clinical Communication with Patients and Families	3.67 ± 1.09	4.01 ± 0.89	2.840	0.005
Decision of Treatment Plans	3.51 ± 1.01	3.89 ± 0.89	3.325	0.001
Diagnosis and Dfferential Diagnosis	3.54 ± 1.01	3.84 ± 0.97	2.521	0.012
Psychopathology of Psychiatric Disorders	3.37 ± 1.04	3.63 ± 1.05	2.100	0.037
Psychological Measurement and Assessment	3.27 ± 1.11	3.60 ± 1.05	2.518	0.012
Knowledge Related to Neurodevelopmental Disorders	2.55 ± 1.05	2.86 ± 1.22	2.256	0.025

Note. CAP: child and adolescent psychiatry. ^a The results presented differences between the two groups without controlling for the individual’s specialty

A total of 162 of the residents (70.43%) and 143 of the mentors (59.34%) reported experiencing moderate to high levels of stress when working with children and adolescents. A significantly greater proportion of residents reported feeling stressed compared to mentors (χ² = 6.352, p = 0.012), but the differences disappeared after controlling for the individual’s specialty (p = 0.125). When assessing the sources of this stress, both residents and mentors cited feelings of exhaustion associated with working with children and their families as the most significant factor (residents: 3.75 ± 0.94, mentors: 3.46 ± 0.98). Additionally, residents reported higher levels of stress regarding lack of CAP clinical skills (t=-2.128, p = 0.035), atypical clinical manifestations (t=-2.132, p = 0.034), and difficulty in treatment (t=-2.846, p = 0.005) compared to mentors, and statistically significant differences were noted after controlling for the individual’s specialty (see Table 3).

Table 3.

Sources of stress reported when working with children and adolescents

	Residents (N = 162)	Mentors (N = 143)	t value	p value
Lack of CAP Knowledge	2.98 ± 0.87	2.66 ± 1.01	-2.930	0.004
Lack of CAP Clinical Skills	3.10 ± 0.87	2.47 ± 1.09	-5.539	< 0.001#
Complex Etiology and Comorbidities	3.22 ± 0.92	2.94 ± 1.03	-2.436	0.015
Atypical Clinical Manifestations	3.40 ± 0.88	3.18 ± 0.95	-2.096	< 0.001#
Difficulty in Treatment	3.43 ± 0.90	2.97 ± 1.03	-4.104	0.037#
Exhaustion when Working with Children and Their Families	3.75 ± 0.94	3.46 ± 0.98	-2.645	0.009

# p-values remained significant after controlling for the individual’s specialty

Satisfaction with the current CAP training within psychiatry residency programs

Among the 230 residents, 162 (70.43%) reported that they received CAP training during residency training, with the majority (155, 95.68%) acquiring this training through inpatient rotations. A similar pattern was observed for the mentors, as 90.09% (191 out of 212) reported that their mentees were able to receive CAP training during their inpatient rotations. However, satisfaction with the current CAP training and teaching within the residency program was relatively low, with only 86 (37.39%) of the residents and 53 (21.99%) of the mentors expressing satisfaction.

Moreover, self-reported teaching ability in CAP education was also low, with 109 mentors (45.23%) being dissatisfied with their skills. In addition, 207 mentors (85.89%) emphasized that enhancing the capabilities of CAP education among general psychiatry instructors is moderately to highly necessary, particularly in the theoretical and practical teaching domains, with rating scores of 3.99 ± 0.84 and 4.08 ± 0.80, respectively.

Attitudes of expanding CAP training in residency programs

Among the respondents, 179 residents (77.82%) and 207 mentors (85.89%) expressed moderate to strong support for expanding CAP training within residency programs, with a greater proportion of mentors expressing support (χ² = 5.177, p = 0.023); however, the differences disappeared after controlling for the individual’s specialty (p = 0.170). They particularly emphasized the importance of knowledge in psychopharmacology and other somatic treatments (residents: 4.06 ± 0.89, mentors: 4.13 ± 0.86), psychotherapy (residents: 3.98 ± 0.84, mentors: 4.03 ± 0.89), and CAP medical knowledge (residents: 3.81 ± 0.94, mentors: 3.99 ± 0.90), with these areas receiving the highest scores in that order. Notably, significant differences in the demand for knowledge domains such as developmental-behavioural paediatrics and clinical neuroscience were noted between residents and mentors, with mentors showing a higher level of demand, even after controlling for the individual’s specialty (see Fig. 2).

Fig. 2.

Expected Knowledge When Expanding CAP Training Note. CAP: child and adolescent psychiatry

With respect to the format of preferred CAP training, lectures, and advocacy for the CAP specialty, theoretical CAP learning using both online and in-person formats was rated the most favourable (see Table 4).

Table 4.

Preferred format of CAP training

	Residents (N = 179)	Mentors (N = 207)
Lectures and Advocating for CAP Specialty	3.86 ± 0.90	4.04 ± 0.94
Online Resources for Self-Learning	3.86 ± 1.01	4.01 ± 0.98
In-person Theoretical CAP Learning	3.65 ± 1.02	3.96 ± 0.89
Workshops or Seminars on CAP	3.65 ± 0.93	3.87 ± 0.93
Self-Study and Peer-Learning Groups	3.44 ± 1.11	3.85 ± 1.02
Expanding Ward Rotation in the CAP	3.50 ± 1.01	3.75 ± 1.02
Basic CAP-related knowledge Learning from Other Mentors	3.79 ± 0.91	3.59 ± 1.12

Note. CAP: child and adolescent psychiatry

Discussion

This study is the first comprehensive exploration in China of the current application of CAP in clinical settings, the stress experienced by clinicians when working with children and adolescents, and attitudes towards the expansion of CAP training within residency programs. The key findings were as follows: (1) both residents and mentors frequently engage with children and adolescents with mental disorders but report significant stress due to inadequate CAP training and challenging clinical communications; (2) there is notable dissatisfaction with the current CAP training programs among both residents and mentors; and (3) there is strong support for the expansion of CAP training within residency programs, reflecting a recognized need for enhanced educational frameworks.

Application of CAP in clinical settings

A previous national survey indicating that 89% of child and adolescent psychiatric care is provided by adult psychiatrists, highlights an unmet demand for CAP expertise for general psychiatrists [16]. The high prevalence of CAP-related clinical engagement and knowledge utilization found in our study aligns with these findings. Additionally, the ranked frequency of diseases encountered in our survey corresponds to the prevalence and life burden distribution in youth [17–19].

The findings indicated that mentors who regularly work with children and adolescents reported a significantly greater frequency of engaging with patients presenting with behavioural disorders and feeding or eating disorders. This pattern likely reflects the mentors’ areas of specialization; indeed, the differences between groups diminished when controlling for specialty areas. Similar observations were noted concerning CAP-related knowledge. In China, mentors supervise residents primarily in both inpatient and outpatient settings, focusing on subspecialties and catering to specific patient demographics. For example, mentors specializing in eating disorders or behavioural disorders are more frequently involved with children and adolescents, reflecting higher prevalence rates and a typical age of onset for these conditions [20, 21]. Conversely, most of the residents (197, 85.65%) have not yet chosen a specialty, potentially limiting their exposure to and experience with these complex cases. This disparity suggests a need for broader training opportunities that enable residents to gain experience across a wider range of disorders at an earlier stage in their professional development.

Both residents and mentors reported experiencing stress when working with children and adolescents with mental disorders, particularly when they were feeling exhausted from interactions with their children and their families. This stress can be attributed to multiple factors. First, the mental health of children is closely related to that of their parents, and CAMHS frequently provides services to families where parents themselves may suffer from mental illness [22]. Moreover, parents of children with mental disorders often experience greater parenting stress than do those with typically developing children [23, 24], which can negatively impact parent‒child dynamics and exacerbate children’s mental symptoms [25]. Such complexities not only make the treatment process more challenging but also contribute to professional burnout, as care extends beyond the individual to the entire family. Additionally, the frequent need for clinical communication with patients and their families is associated with increased exhaustion among clinicians. Furthermore, residents’ elevated stress levels attributed to insufficient CAP competencies likely stem from structural deficiencies in China’s residency curricula. These findings highlight the urgent need for enhanced CAP training, with a particular focus on equipping residents with clinical competencies to manage complex cases effectively.

Satisfaction with the current CAP training in psychiatry residency programs

The low satisfaction and limited CAP training diversity in residency training programs underscores the urgency to reform China’s CAP training framework. While inpatient rotations dominate current programs, exclusive reliance on inpatient rotations may not provide comprehensive CAP training experience. Crucially, such rotations often overlook the importance of systematic didactic instruction and exposure to outpatient, school-based, and community-based settings, where CAP skills are equally essential [26].

The reported inadequacy of CAP pedagogy within residency programs is further compounded by mentors’ self-identified limitations in teaching competencies, which reflects a critical need for faculty development. To address this, a more comprehensive and inclusive teaching approach is essential for CAP mentorship development, such as curriculum design, systematic teaching strategies to ensure comprehensive knowledge transfer, and robust supervision mechanisms to provide timely feedback and guidance. Additionally, it is necessary to provide targeted training for general psychiatry mentors to enhance their CAP education capabilities, particularly in theoretical and practical teaching domains, as highlighted in our findings. These adjustments could address existing dissatisfaction and better prepare residents for the varied demands of CAP.

Attitudes of expanding CAP training in residency programs

The attitudes towards expanding CAP training in residency programs were positive, and the respondents emphasized critical aspects for enhancing future CAP training. They underscored the importance of psychopharmacology, somatic treatments, psychotherapy, and CAP-specific medical knowledge as the most beneficial. This focus aligns with the gaps in CAP clinical skills and knowledge, which participants identified as a source of stress when working with children and adolescents.

Additionally, mentors reported a greater need for didactics in developmental-behavioural paediatrics and clinical neuroscience than the residents, reflecting a recognition of the importance of these disciplines for comprehensive psychiatric training. In the context of CAP‑STATE, Barrett et al. suggested that an understanding of neuropsychiatric developmental disorders is increasingly recognized as important for all trainees [12]. The mentors’ demands were consistent with the findings, suggesting that CAP training should encompass a broad range of competencies to address the complex needs of children and adolescents with mental disorders [27, 28]. Despite the focus on expanding competencies, the core aim of CAP training in residency programs remains the development of foundational knowledge and skills. This training is crucial not only for preparing trainees to support adults with neuropsychiatric developmental disorders but also for enhancing care for children and adolescents who may not have access to specialists.

In China, the age threshold for accessing adult psychiatric services is set at 14 years; however, obtaining access to specialized child and adolescent psychiatrists remains a significant challenge, often owing to a scarcity of resources within CAMHS [29]. This factor underscores the necessity for general psychiatrists and adult psychiatrists to acquire the skills that they need to support young patients with mental disorders and improve the quality of care. Child and adolescent psychiatrists can play a pivotal role in this context, providing consultations and guidance to adult psychiatrists in identifying and managing youth with mental illness [30].

Strategies for CAP training implementation in residency programs

Based on the responders’ preferences, strategies for CAP training implementation in residency programs are proposed. In the short term, priority should be given to integrating evidence-based theoretical modules into curricula, combined with structured clinical exposure including video-based case observations and supervised inpatient/outpatient rotations. The IACAPAP e-Textbook [31] and mhGAP training manuals [32] can serve as foundational resources for culturally adapted CAP curriculum development, supplemented by local case studies. A focus group composed of respondents with high needs is an effective approach to facilitate in-depth exchanges of experiences and insights. Also, we propose establishing a standardized cross-disciplinary framework, such as shared digital platforms for case libraries and simulation modules for residents in remote training sites. Interdisciplinary collaboration, especially with pediatric departments can also strengthen clinical exposure and collaboration [33]. Moreover, CAP teaching capacity-building for general psychiatry mentors is crucial to bridging pedagogical competency gaps, and evidence-based training frameworks integrating multidisciplinary knowledge should be prioritized to enhance their CAP educational competencies [34]. Long-term strategies focus on institutionalizing CAP training through policy reforms, including mandating CAP rotations in residency programs under the Healthy China 2030 Plan [35], and establishing a national certification system. Institutional support from the National Health Commission and academic leadership will ensure the scalability and cultural adaptation of these initiatives.

Limitations

This study has certain limitations that should be noted.

First, while the participants’ response rates (54.76% for residents and 53.79% for mentors) align with typical online survey benchmarks [36], the potential selection bias must be considered. Individuals with stronger opinions on CAP may have been more likely to respond, risking an overrepresentation of polarized viewpoints. Furthermore, these findings may reflect only a subset of psychiatric residents in China, as training sites were predominantly concentrated in capital cities or major urban centers, with a disproportionately high proportion of respondents affiliated with specialized psychiatric hospitals. Consequently, the training and working conditions in smaller cities and general hospitals remain underexamined, which may constrain the generalizability of our results. To address these limitations, future surveys should adopt stratified sampling strategies to ensure proportional representation across geographic regions, hospital tires, and institutional types, thereby enhancing both the validity and ecological representativeness of the research.

In addition, owing to the sample size of each subspecialty, hierarchical analysis was not conducted for a deeper exploration of the differences in CAP training expansion during residency training. CAP is one of several subspecialties, including addiction psychiatry, consultation-liaison psychiatry, forensic psychiatry, geriatric psychiatry, and sleep medicine. Residents should have an equal chance to rotate through each subspecialty as an elective during their residency training, as early exposures to the specialty represent influencing factors for future career choices [37]. Future research should also expand this survey to pediatric residency programs, aiming to identify interdisciplinary training gaps and facilitate collaborative curriculum development between psychiatry and pediatrics.

Finally, this study used a quantitative research design, which provides basic information for future CAP training implementation in residency training programs. However, incorporating qualitative research designs or questionnaires with open-ended questions might offer a deeper exploration of the current status and future directions for CAP training expansion within the current residency training framework. In addition, an evaluation of the competencies among residents and mentors based on the milestones is needed for a comprehensive assessment of their current training status and future program effectiveness, and this evaluation should be conducted in future surveys [27, 28].

Conclusion

In conclusion, this study initially explored attitudes towards the expansion of CAP training within psychiatry residency programs in China, focusing on both residents’ and mentors’ perspectives. The findings reveal that both groups support the expansion of CAP training, highlighting the clinical importance of engaging with children and adolescents with mental health disorders and the associated stress due to perceived exhaustion during clinical communication and a lack of CAP expertise. Moreover, dissatisfaction with the current CAP training framework was noted. This study provides evidence-based support for future initiatives aimed at expanding CAP training within psychiatry residency programs and lays the groundwork for addressing both knowledge gaps and skills deficits, thereby reducing professional stress among providers in CAMHS.

Author contributions

Meirong Pan (ORCID: 0009-0008-0883-3118) conceived study design and performed data collection, extraction and analysis, and drafted the paper. Ni Tang performed data collection, extraction and analysis. Yujia Qiu reviewed the paper. Xinxin Yue performed data collection. Hui Wang performed data extraction. Qingjiu Cao performed data extraction and reviewed the paper. Tianmei Si (ORCID: 0000-0001-9823-2720) conceived study design and performed data collection, extraction and analysis, drafted and reviewed the paper. All authors reviewed the final manuscript.

Funding

This work was supported partly by the China Medical Board (Grant #22–494; #23–537) & Postgraduate Medical Education Research Project of Peking University Health Science Center (2024ZP01).

Data availability

The raw data analysed during the current study will be made available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study has been approved by the Ethics and Clinical Research Committees of Peking University Sixth Hospital [(2024) Ethics review number (68)] and was performed in accordance with the Declaration of Helsinki with the Medical Research Involving Human Subjects Act (WMO). Informed consent was obtained electronically from all participants prior to the survey, and participation was voluntary. No identifiable information was accessed during the data analysis.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.