Postgraduate Training In Psychiatry Research Articles

Psychiatric training for the next generation

SummaryRecent concerns about the future of psychiatry have led to various calls for action. We argue that an overhaul of postgraduate training in psychiatry is the necessary first step to ensuring a strong future for the profession. Central to these improvements are reaffirming the ideals of psychiatric training, ensuring appropriate prominence of crucial knowledge and skills in the curriculum and providing tailored training placements with an emphasis on excellence. It is imperative that short-term service-provision need does not adversely have an impact on the training that is needed to ensure excellent patient care for the future. We urge the College to continue to work closely with psychiatric trainees to secure their future.

Views of general practitioners in Grampian about undergraduate psychiatric teaching

This paper reports the free-text responses of general practitioners (GPs) in the Grampian area to a questionnaire about their experiences of undergraduate psychiatry teaching. Most respondents were senior GPs whose undergraduate training had taken place a number of years ago. Respondents varied in their perceptions of the quality of their psychiatric teaching. However, they reported common themes such as the bias of undergraduate teaching towards disorders which are less relevant to their practice, and the benefits of postgraduate training in psychiatry. We suggest that medical schools need to bear the needs of the non-psychiatrist in mind when developing curricula in psychiatry.

Simulation in psychiatric teaching

SummaryThe use of simulated patients in medicine offers students a standardised learning experience and a reproducible way of exploring attitudes and teaching communication skills. This would seem to be particularly relevant to psychiatry with its focus on attitudes and interpersonal skills, but doubts have been raised about the utility of simulated patients in teaching skills such as empathy and the generalisability of this learning to the real world. This, tempered with cost implications, may have limited the use of simulated patients to assessment through objective structured clinical examinations rather than to teaching and to learning. This article examines the educational advantages and disadvantages of the use of simulated patients in psychiatric teaching and argues that their judicious use complements undergraduate and postgraduate training in psychiatry. The article offers practical tips on writing simulated patient scenarios to deliver specific learning objectives and discusses the potential use of novel simulation techniques in psychiatric education.

Psychiatry training in Europe: Views from the trenches

Background: In the majority of European countries, postgraduate psychiatry training schemes are developed and evaluated by national bodies in accordance with national legislation. In order to harmonise training in psychiatry across Europe, the European Union of Medical Specialists (UEMS) issued a number of recommendations for effective implementation of training programs in psychiatry.Aims: To describe the structure and quality assurance mechanisms of postgraduate psychiatric training in Europe.Method: The European Federation of Psychiatry Trainees (EFPT) conducted a survey, which was completed by the representatives of 29 member national psychiatric associations.Results: In most countries (N = 19), the duration of the training programme is 5 years or more. Twenty-six countries have adapted a basic training programme that includes the ‘common trunk’ (according to UEMS definition) or a modified version of it. In 25 countries, trainees are evaluated several times during their training with a final exam at the end. In 25 countries, official quality assurance mechanisms exist. However, results demonstrate great variations in their implementation.Conclusions: Overall, psychiatric training programmes and assessment methods are largely compatible with one another across Europe. Quality assurance mechanisms, however, vary significantly. These should receive adequate attention by national and international educational policy makers.

Editorial introductions

Editorial introductions

Current position of psychiatry in UK foundation schools

Aims and methodWe report an audit of the provision of psychiatric postgraduate education within the foundation programme and psychiatry specialty programmes in the UK. Our primary measure was the number of foundation posts in psychiatry. Our audit standard was that all foundation doctors should receive programmed training in psychiatry via a psychiatry foundation post.ResultsWe found a total of 413 foundation posts in psychiatry in 21 out of 22 foundation schools in England. This figure is only a fifth of that required to meet the audit standard. There is training capacity for 500 core trainees and 460 higher trainees in psychiatry per year. Currently, 13.6% of specialists other than general practitioners on the General Medical Council registers are psychiatrists.Clinical implicationsThe provision of programmed postgraduate training in psychiatry in UK foundation schools is inadequate. The training needs of all doctors, the mental healthcare needs of all patients, and recruitment to psychiatry are all likely to suffer as a consequence.

Closing the treatment gap

Byline: M. Thirunavukarasu The importance of mental health in the global health scenario has been amply demonstrated. Worldwide, community-based epidemiological studies have estimated that lifetime prevalence rates of mental disorders in adults are 12.2-48.6%, and the 12-month prevalence rates are 8.4-29.1%. [sup][1] In India, the prevalence of mental illness has been estimated to be around 7.3%. [sup][2] Neuropsychiatric disorders account for about 10.8% of the global burden of disorders in the country. [sup][3] As per the Government of India's National Commission on Economics and Health Report of 2005, the prevalence of serious mental illness in the Indian population is at least 6.5%, which, by a rough estimate, would be 71 million people. [sup][4] Despite these unnerving statistics, the treatment gap, as measured by the absolute difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder, has been found to be very high. A large multicountry survey supported by the WHO showed that 35-50% of the serious cases in developed countries and 76-85% in the less-developed countries had received no treatment in the previous 12 months. [sup][5] One of the major reasons attributed to such a wide treatment gap is the problem of inadequate resources, which is more apparent in developing countries like India. In India, inadequacy exists for infrastructure as well as for human resources. This has been made apparent by the statistics provided by the WHO Mental Health Atlas, [sup][6] as summarized in [Table 1]. For example, India has 0.20 psychiatrists per 10,000 population. This can be compared with the ideal of 1 per 10,000 population. [sup][7]{Table 1} The inadequacy has been reported not only in the form of quantity but also in the quality of mental health services. Human rights violations in mental health institutions have been widely criticized as well. The National Human Rights Commission Report [sup][8] (1999) highlights these issues. The report mentions that many institutions still retained a prison-like structure and ambience and prison-like practices such as roll-call and lining up for handover still existed. Exclusively closed wards existed in 59% of the hospitals examined. The building maintenance was unsatisfactory in many hospitals with leaking roofs, eroded floors, overflowing toilets and broken doors. The overall ratio of beds to patients was 1:1.4, indicating that many patients slept on the floor. Some hospitals had no toilets and patients urinated and defecated in the cell, and archaic practices like shaving heads (for both male and female patients) and wearing uniforms were still prevalent. [sup][9] Bridging the GAP These deficits in the quantity and quality of mental health services have not been ignored and steps have been taken to bridge the treatment gap, especially to decrease the deficits in human resources. This has been attempted through the National Mental Health Program (NMHP), which envisages integration of mental health care with general health services, especially at the primary care level. Although the District Mental Health Program (DMHP), the basic unit of the NMHP, was launched with huge fanfare, the program failed to gain the desired momentum, and progress has been very slow. Stagnation in sectors like Departments of Psychiatry in medical colleges and mental hospitals has not only robbed the DMHPs of vital managerial support but had also led to an attitude of indifference and apathy among mental health professionals. [sup][10] Even if properly implemented, this program would have the disadvantage that it may have a long latency time before having the desired effect. Other innovative strategies have also been proposed to improve the gap, like starting short-duration courses for post-graduate training in psychiatry through distance learning. These may improve the quantity of mental health resources at the cost of quality. …

Psychiatry in Britain, c. 1900

At this period, British psychiatrists practised in a climate of opinion that was deeply pessimistic, influenced by the views of Henry Maudsley and by the accumulation in asylums of incurable patients. The inflexible Lunacy Act of 1890 tended to encourage chronicity. The terminology both of mental illness and of the doctors who dealt with it was uncertain. Management of these disorders was intimately involved with the operation of the Poor Law. Neurology, on the other hand, carried high prestige and advanced clinically; many patients with neurotic disorders came under the care of neurologists. Postgraduate education and training in psychiatry was practically non-existent, as was academic psychiatry, in contrast notably to Germany, though there was a small professional organization.

Postgraduate training in psychiatry in India.

This review traces the evolution of modern medical education in India on the one hand and the formation of the Indian Psychiatric Society and the progress of postgraduate psychiatric education on the other hand, all in the context of Indian psychiatry. The topic is covered under the headings standard of psychiatric education, the goals, competencies required, impact of psychiatric disorders, relation of medicine to psychiatry, and the directions for the future of postgraduate psychiatric training.

Postgraduate trainees as simulated patients in psychiatric training: Role players and interviewers perceptions

BackgroundTeaching skills to enhance competence in clinical settings need to have a focus on learning how to do. This paper describes the subjective experiences and feedback of trainees who participated in a teaching technique using postgraduate trainees as simulated patients.Materials and MethodsThe Objective Structured Clinical Assessment and Feedback was employed for training using trainees as simulated patients and interviewers. This exercise is performed in front of consultants and peers who subsequently provide feedback about the content and process using a structured format. In order to assess the subjective experience of the interviewer and the role players they were requested to provide structured feedback on several aspects. The trainee role player provided feedback on comfort in playing the role, need for further inputs, satisfaction regarding role play, satisfaction with the interview, and the overall effect of the activity. The trainee interviewer gave feedback on his/her level of comfort performing in front of a peer group, being watched, and evaluated in a group.ResultsThe feedback forms from 15 sessions were analyzed. Only two of the role players indicated that they felt very uncomfortable while the rest reported comfort. Twelve of the 15 trainees who simulated patients felt they needed more inputs to improve the clarity of the role play; however they all reported feeling satisfied with the role play or interview. The feedback from the interviewers indicated that most were comfortable in all aspects, i.e. conducting the interview, performing in front of a group, being evaluated, and given feedback in front of a group.ConclusionThe trainees report indicates that those simulating patients need more clarity on their roles and majority had no discomfort performing in front of a group. Interviewers were satisfied and comfortable with all aspects. On the whole, simulated interviews and role plays were found to be an acceptable teaching method by postgraduate psychiatry trainees.

Burnout in Dutch postgraduate trainees in psychiatry

Burnout in Dutch postgraduate trainees in psychiatry

Bullying of Trainee Psychiatrists in Pakistan: A Cross-Sectional Questionnaire Survey

Bullying is widely prevalent in health care organizations and medical institutions. It leads to stress, anxiety, depression, sickness absences, and intention to leave the job. This issue has not been studied widely and thoroughly in most developing countries. The authors surveyed all postgraduate psychiatry trainees in the College of Physicians and Surgeons, Pakistan, with a cross-sectional questionnaire. In addition to sociodemographic data, the questionnaire included a bullying scale that asked whether the respondents had experienced in the preceding 12 months any of the 21 bullying behaviors listed and who had perpetrated the bullying. Out of 84 psychiatry trainees registered with the College of Physicians and Surgeons in May 2007, 60 participated in the survey. Eighty percent of participating trainees reported experiencing at least one bullying behavior in the preceding 12 months. There was no significant association between likelihood of experiencing bullying and any of the sociodemographic variables. However, in view of the small number of psychiatry trainees in Pakistan, this finding needs to be interpreted cautiously. Consultants were the most likely perpetrators of bullying. Most postgraduate psychiatry trainees in Pakistan have experienced bullying. Measures need to be taken to increase awareness of what constitutes bullying and how it affects its victims. It may be necessary to introduce antibullying policies at least at the organizational level.

Competency based training in Irish psychiatry.

The goal of undertaking postgraduate training in psychiatry is to become a competent specialist, and the educational model under which one is trained and assessed is crucial in achieving this goal. Over the years, traditional training models have emphasised what trainees know, over a given period of time, with outcomes assessed mainly by simple recall of knowledge. While these traditional approaches have met with varying levels of success, they are less than optimal when the goal is to train individuals to perform specific, job-related skills. This recognition has led to a global move towards competency based training models where the focus of training and assessment is the mastery of specific knowledge and skills as well as the conduct of the doctor in day-to-day clinical situations. In this article, a general overview of competency-based training in psychiatry is followed by a review of recent developments in Ireland in a global context.

Roadmap to Indian psychiatry.

Byline: E. Mohandas Introduction We are responsible for what we are, and whatever we wish ourselves to be, we have the power to make ourselves. If what we are now has been the result of our own past actions, it certainly follows that whatever we wish to be in future can be produced by our present actions; so we have to know how to act . - Swami Vivekananda With all its alluring contrasts and remarkable features, India has a grand heritage of 34,000 years. Down the traditional lane, it has evolved into a pluralistic, multilingual, and multiethnic society. It is quite striking that while India is the second-most populous country, it has the largest democracy in the world. The second fastest growing economy and the third largest military force are also her golden quills. Seventy-four per cent of the 1.14 billion population of India live in rural areas. India has 28 states, seven union territories, 612 districts, and 6, 38,365 villages. The fact that there are 22 official languages in a single country is ample evidence for the heterogeneous nature of the society it represents. Having a literacy rate of about 64.8%, India has 80 million internet users. With all this, I do not mean to say that India is not without its lacunae. Even while India is the world's twelfth largest economy, we cannot close our eyes to the grim truth that 22% of the population exists below the poverty line.[sup] [1],[2],[3] With regard to the academic scene, India is proud to have 289 institutions providing undergraduate medical training (196 MCI recognized, 77 MCI permitted, and 16 in the danger zone). The postgraduate training in psychiatry includes Doctor of Medicine (MD) (83 centers, 159 seats), Diploma in Psychological Medicine (DPM) (46 centers, 107 seats), and Diplomate of National Board (22 centers, 36 seats). Strikingly, 25% of the medical colleges in India do not have a Psychiatry Department.[sup] [4],[5],[6] Apparently, there are only around 4000 psychiatrists in India to serve the five crore mentally ill population currently. Mental Health Scenario in India Obviously, in a vast country like India, the threat posed by the psychiatric and behavioral disorders is just inexplicable. A meta-analysis of 13 epidemiological studies consisting of 33,572 persons reported a total morbidity of 58.2 per 1000. Another meta-analysis of 15 epidemiological studies reported a total morbidity of 73 per 1000.The saddest aspect is that the bulk of the affected falls in the 15 to 45 year age group. The existing facilities in the country fall short of the required norms, which makes the situation still worse. The number of psychiatric beds in the country is only about 0.2 per 1, 00,000 population and there are only two psychiatrists per 10 lakh population. The major share of psychiatric facilities lies with the government sector (especially mental hospitals), which is centered on certain areas of particular states. The psychiatric services have not yet been integrated into the primary health care system and this leaves large populations in dire need of such facilities, with no hope of effective treatment. Therefore, they seek help from the private sector and there are no clear policies regarding treatment of the mentally ill in the private sector. A significant population in India cannot afford private hospital care and the insurance system in the country is in its infancy. The rehabilitation of psychiatric patients is also given little importance in the existing mental health framework. The integration of psychiatric services to primary care needs a public-private partnership to enable comprehensive mental health care.[sup] [7],[8],[9],[10] Indian Psychiatric Society Evolution Our society sprouted from the Indian Association for mental hygiene founded in 1929 by Berkeley Hill. In 1935, the Indian division of the Royal Medico-Psychological Association (RM-PA) was formed, due to the efforts of Dr. …

Objective standardized clinical assessment with feedback: Adapting the objective structured clinical examination for postgraduate psychiatry training in India

The objective structured clinical examination (OSCE) is used commonly for assessment of psychiatry trainees but has been used less for teaching. AIM AND SETTING: This study describes the adaptation of the OSCE method for training purposes in a postgraduate psychiatry training center in India and the initial findings with regard to trainee performance. The adapted method was called the objective structured clinical assessment with feedback (OSCAF). The adaptation included several steps--modifying existing OSCE patterns for language and cultural appropriateness, using supervised roleplaying instead of standardized or simulated patients and evolving an assessment method (14-item checklist) that would generate feedback. This exercise was conducted in front of a group of multidisciplinary peers and supervisors. Descriptive statistics and ANOVA were used. Analysis of the performance based on the 14-item checklist assessing common elements of any patient-related interaction in 34 different OSCAF tasks indicated the following: less-than-satisfactory (<75%) performances in the following areas--assuring confidentiality (73.5%), assessing comfort (62%), summarizing (60%), closure (62%) and checking whether the 'patient' had understood what was being communicated (42%). Based on the nature of clinical situations, performances on some specific and difficult OSCAF situations were found to be inadequate and indicated need for further training. We have been able to demonstrate OSCAF to be a convenient, cost-effective training method in psychiatry, with limited demands on resources; however, further refinements in ratings and feedback methods and studies on effectiveness may enhance its utility.

Handbook for Psychiatric Trainees - Dinesh Bhugra &amp; Oliver Howes, Royal College of Psychiatrists, 2008, £15.00 pb, 332 pp. ISBN 978-1-90467-134-3

This book aims to provide an overview of every aspect of a trainee’s journey through postgraduate training in psychiatry. The diverse and varied chapters cover many topics I wish I had been able to easily read about before my first day as a psychiatric trainee, such as managing difficult clinical

Postgraduate training in psychiatry: essential information for trainees and trainers

Postgraduate training in psychiatry: essential information for trainees and trainers

An Integrative Approach to Cultural Competence in the Psychiatric Curriculum

As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country. The authors conducted a systematic review of cultural competence by searching databases including PubMed, PsycINFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate "integrative" approach with a mindful, balanced emphasis on both generic and specific cultural competencies. Learning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (CanMEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program's emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive. The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

Evaluation of postgraduate studies in Czech Republic: Current situation and perspectives

Background and Aims:In an effort to acquire detailed overview regarding postgraduate training in psychiatry together with gaining opinions on the present and ideal postgraduate programm, our Young Psychiatrists Section in Czech Republic decided to undertake a survey.Methods:The questionnaire was addressed to all current PhD students in the field of psychiatry and to those who finished the studies previously, maximum 10 years ago. We distributed the questionnaires via mail and e-mail to all 7 psychiatric clinics and put it also on our website. 32 participants from 5 institutions responded. The questionnaire encompasses questions related to the metodology of the project, tutor engagement, working schedule, financial situation and other funding oportunities. Second part contained requests on various aspects of ideal training programm.Results:The majority of the participants is satisfied with tutor involvement (92%) and the metodology of the project (85%) but less with the financial support of the project (69%) and time devoted to work on it (69%). The ideal organization of the PhD programm should be in blocks (81%), for a certain period of time for PhD project and the rest for clinical work.Conclusions:The survey revealed some weak spots of our contemporary PhD studies programm in Czech Republic, e.g. lack of time for working on PhD project and poor funds for covering it. Beside various models for organizing postgraduate studies, PhD students are in sum mainly satisfied with it. Suggestions on ideal organisation of the programm are meant to serve as potential models for consideration.

The future of post-graduate training in psychiatry in Ireland: an address to the Irish Psychiatric Training.

The future of post-graduate training in psychiatry in Ireland: an address to the Irish Psychiatric Training.