522530 research-article2014

APY0010.1177/1039856214522530Australasian PsychiatryFletcher et al.

AP

Teaching and Training

Australasian Psychiatry 2014, Vol 22(2) 195­–199 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214522530 apy.sagepub.com

Reflections on training in psychiatry

Scott Fletcher  Research and Reporting Officer, Education and Training, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia Joanna MacDonald  Senior Lecturer, Department of Psychological Medicine, and Associate Dean Undergraduate Student Affairs, University of Otago, Wellington, New Zealand

Elaine Halley  General Manager, Education and Training, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia

Abstract Objective: There is limited information as to whether graduates from postgraduate specialist medical training programmes in Australia and New Zealand feel prepared for practice, and none regarding the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) training programme. The aims of this study were: to assess the effectiveness of the RANZCP training programme in producing psychiatrists who feel prepared for their roles; and to obtain Fellowship applicants’ perceptions of the training programme. Methods: Applicants for Fellowship (i.e. trainees who had successfully completed RANZCP training) were invited to complete an anonymous online survey that assessed their preparedness for practice and their impressions of the training programme, supervision, training specialties and course content. Results: The response rate was 66% from 101 applicants. Fellowship applicants largely felt prepared for practice and had positive perceptions of the training programme. The majority stated that most of their learning goals were met, but continued training and ongoing learning was required. Areas for improvement included assessments, administration, the balance between service delivery and training, and ongoing training. Conclusions: Fellowship applicants largely felt confident in their ability to deliver psychiatric services and that the training programme was meeting their needs. Keywords:  training, preparation, reflection, learning goals, Fellowship

M

edical graduates during their first year post graduation often experience high levels of anxiety, which is not conducive to good performance in clinical posts.1–4 A study of medical graduates found that 41% felt unprepared for their first clinical posts.2,4 Similar studies have been conducted in the UK,5,6 Germany 7 and South Africa8 with medical graduates, and in Denmark/The Netherlands9 and Brazil10 focusing on postgraduate training. Studies that have examined psychiatric training in Australia and New Zealand have not specifically focused on reflections on training and the preparedness for practice, but on the perceived training needs of those still in training.11–14 Graduates’ preparedness for practice is a key element in measuring the effectiveness of a training programme. A comparison of new consultants from Denmark and the Netherlands found that investigating the transition to

consultant could provide insight into the gap between specific competencies and training needs.9 A study in Brazil concluded that the graduates’ perceptions of their competencies and preparedness to practise provided a useful assessment of the residency training programme.10 However, given the findings regarding the importance of context in the transition to specialist,9 it is important that we have studies of the Australasian psychiatric experiences. Therefore this study evaluated psychiatry Fellowship applicants’ perceptions of their preparedness for practice, and sought their reflections of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) training programme. Corresponding author: Dr Scott Fletcher, Royal Australian and New Zealand College of Psychiatrists, 309 La Trobe St., Melbourne, VIC, 3000, Australia. Email: [email protected]

195 Downloaded from apy.sagepub.com at FUDAN UNIV LIB on May 2, 2015

Australasian Psychiatry 22(2)

Methods

1.6% 4.8%

Sample

9.7%

The sample consisted of RANZCP trainees who had completed all training requirements and applied for admission to Fellowship (N=101). Procedures Fellowship applicants were sent an online survey and an information sheet outlining the study. The survey was voluntary and anonymous. Informed consent was provided through an information sheet and detailed survey instructions. As the study was part of a quality assurance and evaluation programme a review by a Human Research Ethics Committee (HREC) was not required. An experienced member of a HREC reviewed the study protocols and agreed that it met ethical guidelines.

83.9% Disagree

Neither Agree or Disagree

Agree

N/A

Figure 1.  Preparedness to practise.

Question development The questions were based on the goals and objectives of the RANZCP training programme and developed in consultation with the psychiatrists on relevant education committees. Pilot-testing with trainees and psychiatrists was used to improve question structure and content.

4.8%

14.3%

9.5%

The survey consisted of 39 items, including Likert scales and open text items (see Appendix 1).

15.9%

Analysis The data were analysed using Microsoft Excel 2007 and SPSS version 21. Content analysis was used to code the open-ended comments.15,16 Comments were initially open-coded line by line to extract key themes. From the initial coding a framework was developed and used to summarise the data to facilitate further understanding of the responses. Themes were cross checked with comments by all respondents to ensure accuracy.15,16

55.6% Very dissatisfied

Dissatisfied

Not sure

Satisfied

Very satisfied

Figure 2.  Overall satisfaction with the RANZCP training programme.

Results

Learning goals and future training

Applications for Fellowship were received from 101 trainees, with 66 completing questionnaires, providing a response rate of 66%. As only four New Zealand Fellowship applicants completed the survey, the results may be more reflective of Australian issues.

A quarter (25%) stated that all of their learning goals had been met, while the majority (56%) answered that most but not all of their learning goals were met by the training programme. Open comments on learning goals that were not met highlighted psychotherapies training, supervised research training, and exposure to different disorders as areas for further training.

Preparedness to practise

The majority of respondents (79%) agreed that they would consider additional education once they attained Fellowship. The most common areas for further education, in keeping with the above ‘gaps’, were psychotherapies training (40%) and management skills (23%). The completion of further formal training through the RANZCP advanced certificates was seen as a pathway to increase professional skills development (Figure 3).

Eighty-four per cent felt prepared for practice (Figure 1).

Satisfaction with training Seventy per cent of Fellowship applicants were satisfied or very satisfied with the training programme (Figure 2). 196

Downloaded from apy.sagepub.com at FUDAN UNIV LIB on May 2, 2015

Fletcher et al.

Reflections on the training programme Positive views on supervision arrangements, the decision to become a psychiatrist, experience in different areas and access to patients and health settings were found (Table 1). The majority agreed that part-time (63%) and break-in-training (82%) options met their needs.

Examinations produced more divergent comments, with a small majority agreeing that the examinations were fair (58%) and transparent (56%), while 23% disagreed that they were fair and 16% stated that they were not transparent. Further results are shown in Table 2.

Discussion This is one of the few studies to address postgraduate psychiatry trainees’ perceptions of their preparedness for practice in Australia and New Zealand. In keeping with the Danish study on new consultants,9,17 our graduates felt well-prepared for the ‘medical’ aspects of their role, but less so for the non-clinical tasks. Comparison with the Brazilian study10 is limited as their study, like ours, has a predominant focus on specialty-specific topics. However, their finding of a general satisfaction with clinical knowledge, but less so with areas of specific surgical knowledge resonates with our findings about general preparedness but concern about psychotherapy training.

Figure 3.  Future training considerations.

Postgraduate trainees feel considerably more prepared for their future roles than newly graduated doctors, of whom up to 41% felt unprepared for their first clinical post.2,3 Possible reasons for such a finding remain speculative. It could, for instance, simply reflect the greater age and maturity of postgraduate trainees. Equally, postgraduate training programmes allow more flexibility for trainees to progress at their own pace, which may mean that they attempt the various examination tasks when they feel ready. It could also be that these results reflect a robust examination system that only graduates trainees when they are ready to become psychiatrists. This is an area for further research.

Table 1.  Summary of results: supervision, clinical experiences, exams, and training – percentage Disagree In general, supervision provided to me during Basic Training was satisfactory. In general, supervision provided to me during Advanced Training was satisfactory. Training requirements were clear. The process for application for admission to Fellowship was clear. I had access to a diverse patient mix during my training. I gained experience in a range of health service settings during my training. The balance between clinical responsibilities and training activities allowed my training to progress. Part-time provisions met my needs. Break-in-training provisions met my needs.

Neither agree or Agree disagree

N/A

11.3%

3.2%

69.4%

16.1%

9.7%

4.8%

75.8%

9.7%

21.0% 21.0%

12.9% 12.9%

61.3% 64.5%

4.8% 1.6%

19.4% 11.3%

1.6% 9.7%

77.4% 75.8%

1.6% 3.2%

22.6%

9.7%

67.7%

0.0%

6.5% 3.2%

8.1% 3.2%

24.2% 29.0%

61.3% 64.5%

197 Downloaded from apy.sagepub.com at FUDAN UNIV LIB on May 2, 2015

Australasian Psychiatry 22(2)

Table 2.  Summary of results: relevant skills and experiences – percentage

College examinations were fair. College examinations were transparent. The Formal Education Course in Basic Training was satisfactory. The Formal Education Course in Advanced Training was satisfactory. My training experiences in psychotherapies were satisfactory. I gained experience in the areas of psychiatry I am most interested in. I felt generally well supported by my employer(s) throughout my training. I felt generally well supported by my DOT(s) throughout my training. The skills I have gained are applicable to my area of interest. I feel prepared for independent practice. I am satisfied with my choice to become a psychiatrist.

Disagree

Neither agree or Agree disagree

N/A

22.6% 16.1% 22.6%

19.4% 27.4% 17.7%

58.1% 56.5% 41.9%

0.0% 0.0% 17.7%

9.7%

6.5%

61.3%

22.6%

25.8% 9.7%

17.7% 12.9%

40.3% 77.4%

16.1% 0.0%

11.3%

22.6%

66.1%

0.0%

12.9%

14.5%

67.7%

4.8%

6.5% 4.8% 3.2%

6.5% 9.7% 1.6%

87.1% 83.9% 93.5%

0.0% 1.6% 1.6%

DOT: Director of Training

The findings are consistent with previous studies of RANZCP trainees in terms of their satisfaction with training13 and the need for further psychotherapies training.18 The results suggest areas for improvement, including the transparency of examinations, formal education courses, psychotherapies training and the balance between the clinical responsibilities and training. Changes to psychotherapies training, the formal education programmes and examinations are being addressed as part of the 2012 Fellowship Program (see www.ranzcp. org). However, the issue of transparency of examinations continues to be challenging. The balance between clinical responsibilities and training is more challenging, in that it is dependent on services as well as the College. It is, perhaps, inevitable in times of constrained funding for health services, which results in greater pressure on trainees to provide more service. However, it is appropriate that the RANZCP, through its various committee structures, continually advocates for trainees and training, so that it can continue to produce high-quality psychiatrists who feel prepared for their roles. The study had limitations. Only having one contact and no reminder emails to boost response rates may have affected the final number of completed surveys. The small sample size limited the ability to generalise the results. The timing of the study, that is, being completed by trainees who had applied for Fellowship, may have caused a halo effect due to the attainment of Fellowship. Furthermore, Fellowship applicants’ views of their competencies and limitations may change once they

gain further experience as psychiatrists. Revisiting these reflections at a later date may be beneficial to professional development and is an area for further research.

Conclusions Fellowship applicants largely felt confident in their ability to deliver psychiatric services and that the training programme was meeting their needs. The high level of satisfaction with the training programme was positive. The small number of new Fellows each year provides a restricted sample to draw from; however, the reflections and feedback provided allow the RANZCP to monitor and review areas of concern and areas that are working effectively. This also provides an important baseline against which the forthcoming changes to the training programme can be evaluated. Acknowledgement The authors would like to acknowledge the work of Dr Andrew Gosbell, former Director of Education at RANZCP, for his contributions and input into the early development of the admission to Fellowship project.

Disclosure SF and EH are employed by the RANZCP and JM is an active Chair of an Education Committee.

Ethical approval This paper complied with all ethical guidelines regarding research with human subjects. The paper was reviewed and approved by internal College Board/Committees, including Trainee representatives, and independently by an experienced member of a HREC.

198 Downloaded from apy.sagepub.com at FUDAN UNIV LIB on May 2, 2015

Fletcher et al.

References 1. Peterlini M, Tibério IFLC, Saadeh A, et al. Anxiety and depression in the first year of medical residency training. Med Educ 2002; 36: 66–72. 2. Cave J, Goldacre M, Lambert T, et al. Newly qualified doctors’ views about whether their medical school had trained them well: questionnaire surveys. BMC Med Educ 2007; 7: 38.

10. Millan T and de Carvalho KM. Satisfaction with ophthalmology residency training from the perspective of recent graduates: a cross-sectional study. BMC Med Educ 2013; 13: 75. 11. Kozlowska K, Nunn K and Cousens P. Adverse experiences in psychiatric training. Part 2. Aust N Z J Psychiatry 1997; 31: 641–652.

3. Goldacre M, Taylor K and Lambert T. Views of junior doctors about whether their medical school prepared them well for work: questionnaire surveys. BMC Med Educ 2010; 10: 78.

12. Kozlowska K, Nunn K and Cousens P. Training in psychiatry: an examination of trainee perceptions. Part 1. Aust N Z J Psychiatry 1997; 31: 628–640.

4. Tallentire VR, Smith SE, Skinner J, et al. The preparedness of UK graduates in acute care: a systematic literature review. Postgrad Med J 2012; 88(1041): 365–371.

13. Walter G, Rey JM and Giuffrida M. What is it currently like being a trainee psychiatrist in Australia? Australas Psychiatry 2003; 11: 429–434.

5. Illing J, Morrow G, Rothwell C, et al. Perceptions of UK medical graduates’ preparedness for practice: a multi-centre qualitative study reflecting the importance of learning on the job. BMC Med Educ 2013; 13: 1–12.

14. Malhi GS, Coulston CM, Parker GB, et  al. Who picks psychiatry? Perceptions, preferences and personality of medical students. Aust N Z J Psychiatry 2011; 45: 861–870.

6. Morrow G, Johnson N, Burford B, et al. Preparedness for practice: the perceptions of medical graduates and clinical teams. Med Teach 2012; 34: 123–135.

15. Patton MQ. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks, CA: Sage Publications Inc., 2001.

7. Ochsmann E, Zier U, Drexler H, et  al. Well prepared for work? Junior doctors’ selfassessment after medical education. BMC Med Educ 2011; 11: 99.

16. Dixon-Woods M, Agarwal S, Jones D, et al. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 2005; 10: 45–53B.

8. Green-Thompson L, McInerney P, Manning D, et al. Reflections of students graduating from a transforming medical curriculum in South Africa: a qualitative study. BMC Med Educ 2012; 12: 49.

17. Westerman M, Teunissen PW, van der Vleuten CPM, et al. Understanding the transition from resident to attending physician: a transdisciplinary, qualitative study. Acad Med 2010; 85: 1914–1919.

9. Westerman M, Teunissen PW, Jørgensen RL, et al. The transition to hospital consultant: Denmark and the Netherlands compared on preparedness for practice, perceived intensity and contextual factors. Med Teach 2013; 35: 481–489.

18. O’Connor D, Schweizer Y and Spratt C. Expanding psychiatry training: Australian specialists and trainees perceived gaps in experiences and settings. Australas Psychiatry 2009; 17: 506–508.

199 Downloaded from apy.sagepub.com at FUDAN UNIV LIB on May 2, 2015

Reflections on training in psychiatry.

There is limited information as to whether graduates from postgraduate specialist medical training programmes in Australia and New Zealand feel prepar...
1MB Sizes 2 Downloads 0 Views