Twenty-three first-year and twenty-one second-year students completed the elective. Pre- and post-test surveys were completed by 38 of 44 students (86.4%: 19 first-year and 19 s-year students). Eight of 10 items showed significant improvement post-elective with large effect sizes (Table 1). Students reported more awareness of local youth MH resources, familiarity with a biopsychosocial conceptual model, how to evaluate youth with MH concerns, how to identify common MH diagnoses in youth, how to assess youth with suicidal ideation, what CAP careers entail and their training pathway, and youth use of digital media. A minority of students endorsed feeling “confident” or “very confident” about assessing suicidal ideation pre-course, whereas a majority did so post-course (Fig. 1). Twelve students reported feeling “very confident” post-course versus none pre-course in identifying MH diagnoses in youth.

Results of pre (left) and post (right) course survey regarding comfort assessing youth with suicidal thoughts. N = 38

Two items showed no significant change. While interest in becoming a CAP increased slightly (d = 0.59, n.s.), perceptions of the difficulty in treating youth with mental illness remained essentially unchanged.

No significant differences were found between first and second-year students in baseline knowledge or confidence. Future studies should assess the optimal timing for this educational intervention.

This pilot study shows that a virtual CAP elective improves confidence in evaluating CAP disorders and suicidal ideation. Given suicide’s prevalence, teaching future physicians to assess suicidal patients is crucial. Students responded positively to didactics followed by simulated patient interviews, a method previously shown to enhance clinical skills [16,17,18]. Future studies should assess not only confidence but also knowledge retention and decision making.

Our findings align with prior studies showing brief interventions improve confidence [16], with longer postgraduate courses enhancing comfort [13]. Given the reliance on non-CAP practitioners for pediatric MH care, future studies should explore the most effective ways for increase PCP confidence.

Utilizing a biopsychosocial model improves health outcomes, yet many trainees struggle with its application [19]. Protocols are being developed to teach the biopsychosocial model to trainees evaluating certain medical conditions [20]. Future studies should continue to evaluate how education and application of patient conceptualization improves patient outcomes.

A newer concern in CAP is the increasing use of social media in children and adolescents [21]. Children and adolescents who spend more than 3 h per day on social media may be at an increased risk of MH problems [22], and a recent survey showed that teenagers spend an average of 4.8 h per day on social media [23]. Despite the perceived importance of counseling youth on social media usage, many practitioners do not feel comfortable in this area [24]. However, PCPs who have social media counseling training are more likely to counsel youth on social media use and subsequently improve youth online safety behaviors [25]. Our study revealed students had improved self-assessed understanding of how youth utilize social media. Future studies should evaluate how to improve medical students’ ability to counsel about usage concerns in youth on social media.

Given the burden of youth MH treatment on non-CAP practitioners, it is important that students and physicians are aware of resources to assist them in treating these patients. Our study showed improvement in awareness of local MH resources. National resources previously have been generated by the Association of Directors of Medical Student Education in Psychiatry [26] and the American Academy of Child and Adolescent Psychiatry (https://www.aacap.org/) and can be shared with students.

While interest in CAP did not increase significantly, a small rise in interest suggests that more exposure may enhance recruitment. While our study and others have shown improved knowledge of how to become a CAP physician, few methods have resulted in improved interest in entering the field [26,27,28]. Surveys of early career CAP attendings and CAP fellows suggest recruitment rates may increase with early career child psychiatry exposure, improved compensation, and incentives to address physician debt [29]. Future studies should continue to address and evaluate pre-existing barriers to CAP recruitment in medical school.

Confidence in assessing youth mental health disorders improved, though this did not reduce students’ perceived difficulty in treating them. Previous studies indicate that pre-clinical education can reduce mental health bias [30], warranting further exploration of medical students’ perceptions of youth mental health as a barrier to entering CAP.

Limitations of this study include a small sample size and lack of demographic information, making results difficult to generalize to other medical student populations. Since this course is voluntarily selected by students, students in the study may already have a general interest in MH, which could have impacted results. The 10-item survey was developed to examine each item separately rather than as a combined construct. Because of this, the instrument is not appropriate for traditional validation and reliability analyses. Additionally, this study evaluated self-reported change in confidence, which may not correspond with actual improvement in knowledge, effectiveness, or skill retention. Lastly, our study lacked long-term follow-up with students; therefore, it is unknown if students’ increased confidence persisted beyond the immediate post-course period or if the course influenced students’ long-term career outcomes.

In conclusion, this study demonstrated the feasibility and preliminary effectiveness of a virtual CAP elective for medical students. Participants reported increased confidence in evaluating and identifying CAP disorders, as well as in assessing youth with suicidal ideation. Incorporating high-yield topics and mock interviews into CAP curriculum development could further enhance students’ confidence in managing CAP-related disorders. This curriculum can be introduced early in medical school increasing exposure to an often-unknown specialty. Given the critical shortage of CAP physicians, equipping future physicians across all specialties with skills to evaluate and treat pediatric patients with mental health concerns is essential. Future research should focus on assessing knowledge acquisition, retention, long-term career trajectories, and sustained confidence in managing youth with mental illness and suicidality among participants in CAP electives.