How psychiatry residents perceive clinical teaching effectiveness with or without direct supervision

Abstract

Aims: Psychiatry residents' outpatient clinic supervision may be with direct observation of clinical cases (D), without direct observation (WDO) or a mixture of both (M). This study explored residents’ perceptions of clinical teaching effectiveness under these supervision frameworks. Methods: A survey was conducted amongst residents who completed their third-year training. Cleveland Clinic's Teaching Effectiveness Instrument (CCTEI) was used to capture their perception of various domains of clinical teaching effectiveness. Content analysis of their qualitative feedback was used to establish the major categories of supervision perception. Results: 42 out of 60 residents responded. Fewer residents received DO and M compared to WDO. More residents preferred DO. There was no statistical difference in the total CCTEI scores for the three supervision formats. Qualitative content analysis revealed categories surrounding strengths of DO and WDO as well as weaknesses of DO. Although DO allowed timely feedback, addressed patient safety and increased residents’ confidence, it was perceived to be stressful, requiring more resources and inhibited independent learning. WDO was commended for its support of autonomous learning, less anxiety-provoking and contributed to better patient rapport. Conclusion: There was no statistical difference in clinical teaching effectiveness of the three supervisory frameworks. Previous studies showed DO to be anxiety-provoking with concerns of compromised autonomous learning. This study uncovered similar themes, but residents still preferred DO. It highlighted the residents’ perception of the importance of timely feedback, patient safety and instilling confidence with DO.