A Four Factor Model of Systems-Based Practices in Psychiatry (original) (raw)
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Academic Psychiatry, 2019
Objective This multisite study examines how clinical competency committees in Psychiatry synthesize resident assessments to inform milestones decisions to provide guidelines that support their use. Methods The study convened training directors and associate training directors from three psychiatry residency programs to examine decision-making processes of clinical competency committees. Annual resident assessments for one second year and one third year resident were used in a mock clinical competency committee format to assign milestones for two consecutive reporting periods. The committees reflected on the process and rated how the assessment tools impacted the assessment of milestones and evaluated the overall process. The authors compared reliability of assessment between the mock committees and examined both reliability of end of rotation assessments and their composite scores when combined with clinical skills evaluations. Results End of rotation evaluations were the most informative tool for assigning milestones and clarifying discrepancies in performance. In particular, the patient care and medical knowledge competencies were the easiest to rate, while the systemsbased practice and practice-based learning and improvement were the most difficult. Reliability between committees was low although higher number of available evaluations improved reliability in decision-making. Conclusions The results indicate that the medical knowledge and patient care competencies are the easiest to rate and informed most by end of rotation evaluations and clinical skills examinations. Other evaluation tools may better capture performance on specific sub-competencies beyond workplace-based assessment, or it may be helpful to reconsider the utility of how individual sub-competencies are evaluated.
Southern Medical Journal, 2009
To assert the importance of the use of the healthcare matrix formulation for competency assessment in psychiatry residency training. Methods: We present a case from our inpatient psychiatric facility and format it in the form of the healthcare matrix, which was developed at Vanderbilt University incorporating the Institute of Medicine 'aims' and the Accreditation Council for Graduate Medical Education 'core competencies'. We also analyze the healthcare matrix and elucidate its use in clinical practice. Results: The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care, like the one in our psychiatric setting, and allows us to learn from the shortcomings in order to improve. Conclusion: The optimal utilization of this tool in the competency assessment of psychiatry residents has an enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format.
2015
This thesis is an empirical approximation from the Science and Technology Studies to the lessons that psychiatry residents experience during their training regarding standardized classifications (DSM and ICD). Initially the Science and Technology Studies’ literature concerning scientific training and standards is discussed; posteriorly this discussion is used to understand the ethnography of a psychiatry training program in which particular ways of understanding psychiatric standards are learned; finally, future directions of research are outlined to continue the work on the relationships between Science and Technology Studies, scientific training and psychiatric standards
Response to ?training residents for community psychiatric practice?
Community Mental Health Journal, 1993
There is a critical need for more psychiatrists capable of community psychiatry practice, and effective residency education in community psychiatry is crucial to fill this need. In addition to developing residency curricula in community psychiatry, there are some additional steps that we believe are necessary to fill the need for psychiatrists capable of community psychiatry practice. (1) We need a process to get more training programs to implement good curricular suggestions. (2) We need to appreciate that many of our graduates will work in systems that have a limited view of the role of a psychiatrist, and we need to train residents to be able to enter a clinical setting and develop an effective role for themselves. (3) Quality training experiences in community psychiatry should encourage more graduates to work with seriously ill persons in community settings. In order for this to happen, however, we need to deal with a problem more general than adopting curricular suggestions: that of attracting professionals to work with poor, disenfranchised, low-status individuals. (4) Finally, we need to appreciate that there are major conflicts between the attitudes and roles needed to be a successful community psychiatrist and the attitudes and roles taught throughout the rest of medical education, from medical school through residency.
Academic Psychiatry, 2021
Objectives Gaps in psychiatrists' competence can interfere with the delivery of optimal patient care, particularly when these gaps have not been identified. This study aimed to assess the perceived and unperceived continuing professional development needs of psychiatrists practicing in Quebec, Canada. Methods The authors sent an online cross-sectional survey (2018) to members of the 'Association des médecins psychiatres du Québec' and collected data on unperceived needs via the critical incident method (focused on managing challenging clinical cases/situations). Data were analyzed using descriptive statistics, chi-squared tests, thematic analysis, and triangulation of data. Two coders independently analyzed qualitative data. Results Of 1150 eligible psychiatrists, 187 (16%) completed the survey. Over half were female (58%), caring for adult patients (60%), and practiced in a university hospital (49%). Top perceived and unperceived learning need areas were neurodevelopmental disorders and psychopharmacology. Three hundred forty-three factors influencing the management of reported challenges were classified as case complexity (53%), patient (22%), environment (19%), and lack of knowledge (4%). Consultation with colleagues (49%) was the most frequently accessed resource for approaching challenging cases. During the previous year and across both self-directed and group learning activities, respondents reported engaging more frequently in in-person than online activities. Conclusions A comprehensive needs assessment integrating perceived and unperceived needs is the cornerstone for planning relevant continuing professional development. The critical incident method is a useful tool to assess psychiatrists' unperceived needs. Critical reflection after solving complex clinical cases might provide an opportunity to optimize psychiatrists' selection of relevant continuing professional development.