Do regulated resident working hours affect medical graduate education? Trends in the American psychiatry board pass rates pre- and post-2003 duty hours regulations.

Aims and method To assess trends of the American Board of Psychiatry and Neurology examination pass rates before and after the 2003 duty hours regulations (DHR). We obtained the pass rates for part I and II for years 2000-2010. Data were divided pre-DHR (2000-2003) and post-DHR (2007-2010). Results During the pre-DHR period, first- and multiple-attempt group pass rates were 80.7% and 39.0% which changed in the post-DHR period to 89.7% and 39.1% respectively. Similarly for the part II exam, the pre-DHR first- and multiple-attempt group pass rates were 60.2% and 43.5% respectively, which increased to 78.7% and 53.8%, among the post-DHR group. Overall, there was a significant increase in the first-attempt candidates pass rates for parts I and II, whereas multiple-attempt candidates did not benefit as strongly. Clinical implications The results suggest that the 2003 DHR may have had a positive impact on examination-based medical knowledge in psychiatry.

Helping international medical graduates engage in effective feedback.

OBJECTIVE: Timely, specific, behaviorally-based feedback is a cornerstone of medical education. The authors review basic tenets of effective feedback delivery in the context of potential challenges faced by (non-United States) international medical graduates (IMGs). METHOD: The authors provide a brief summary of the elements of effective feedback, with illustrations of potential barriers for IMGs. RESULTS: Many IMGs were trained in a hierarchical system, where feedback was delivered publicly, in a manner associated with shame and embarrassment. These experiences, combined with the challenge of functioning in a second language and anxieties over exposing weaknesses, present some barriers that make it more difficult for them to participate in feedback inquiry, self-reflection, and reciprocal feedback. CONCLUSIONS: These challenges can be mitigated by acknowledging the anxieties that learners may have, fostering a learning culture that values feedback as an expected and important part of all learning, ensuring that all (learners and supervisors) are trained in feedback skills, and clear setting of expectations.

Systems-based aspects in the training of IMG or previously trained residents: comparison of psychiatry residency training in the United States, Canada, the United Kingdom, India, and Nigeria.

OBJECTIVES: International medical graduates (IMGs) account for a significant proportion of residents in psychiatric training in the United States. Many IMGs may have previously completed psychiatry residency training in other countries. Their experiences may improve our system. Authors compared and contrasted psychiatry residency training in the U.S. to that of Canada, the United Kingdom, India, and Nigeria. The study also highlights the systems-based features that may have an impact on the adaptation of IMGs (especially previously-trained) to U.S. psychiatry residency. METHODS: Individuals who are familiar with psychiatry residency training in the United States and were previously trained in other countries synthesized information available on websites, official documents, and previous literature, as well as their experiences with past training. RESULTS: Psychiatry residencies vary considerably in all five countries in terms of the duration of training, curriculum, clinical experience, psychotherapy training, research experience, supervision, and evaluation processes. Residency training in the U.S., Canada, and the U.K. is well-structured and has more psychotherapy training. The U.K. has enhanced exposure to community psychiatry. The U.K., India, and Nigeria have increased emphasis on psychopathology. Training in India and Nigeria has a higher quantity of clinical work, less record-keeping, less emphasis on patient autonomy, and a mandatory prospective clinical research requirement. CONCLUSIONS: The provision of services and training is substantially influenced by national mental health policies, culture, and local traditions. Despite numerous commonalities, there are some differences in psychiatry training among all five countries. Awareness of these differences in education, systems, and interactions may help psychiatric educators to understand IMGs (especially those previously-trained) as they adapt to U.S. training.

Protecting the residency training environment: a resident's perspective on the ethical boundaries in the faculty-resident relationship.

OBJECTIVE: This article explores ethical complexities that underlie resident-faculty relationships. The faculty-resident relationship is as complex as that between a therapist and his or her patient, but it has been far less well studied. METHODS: From data obtained from psychiatry residents and faculty members regarding their experiences in this relationship, the authors present five vignettes that illustrate unethical conduct in the faculty-resident relationship. RESULTS: Ethical lapses described in this article are problematic for two reasons: first, personal and professional harm may come to individual residents who find themselves interacting with an errant faculty member; and second, ethical lapses have the potential to damage the overall training environment itself. Once the terms of the faculty-resident relationship are discussed and accepted by all participants, unintentional or inadvertent ethical problems will be prevented, and residents will be in a position to identify faculty behaviors that do not conform to these agreed-upon expectations. CONCLUSIONS: This article highlights the importance of incorporating education about ethical responsibilities and faculty-resident boundaries into the training curriculum. The authors offer suggestions for understanding faculty members' responsibilities to residents in their training programs.