Clinical skills verification in general psychiatry: recommendations of the ABPN Task Force on Rater Training.

OBJECTIVE: The American Board of Psychiatry and Neurology (ABPN) announced in 2007 that general psychiatry training programs must conduct clinical skills verification (CSV), consisting of observed clinical interviews and case presentations during residency, as one requirement to establish graduates' eligibility to sit for the written certification examination. To facilitate implementation of these requirements, the ABPN convened a task force to prepare training materials for faculty and programs to guide them in the CSV process. This article reviews the specific requirements for the CSV experience within general residency programs, and briefly describes the recommendations of the task force for faculty training and program implementation. METHODS: Materials prepared by the ABPN Task Force include background information on the intent of the observed interview, a literature review on assessment methods, aids to train faculty in direct observation of clinical work, directions for effective feedback, notes regarding special issues for cross-cultural trainees, clarification of performance standards, and recommendations for structuring and conducting the assessments. RESULTS: Recommendations of the task force include the use of a variety of clinical settings for CSV assessments, flexibility in the duration of CSV interviews, use of formative and summative feedback after each CSV assessment, and frequent use of the CSV across all years of training. Formal faculty training is recommended to help establish performance parameters, increase interrater reliability, and improve the quality of feedback. CONCLUSIONS: The implementation of the CSV process provides psychiatry training programs with an excellent opportunity to assess how interviewing skills are taught and evaluated. In the process, psychiatry educators have an opportunity to establish performance parameters that will guide the training of residents in patient interaction and evaluation.

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.

Residency programs and psychotherapy competencies: a survey of chief residents.

OBJECTIVE: To survey chief residents' opinion about various aspects of psychotherapy competency determination. METHODS: Chief residents of various psychiatry residency programs were surveyed. RESULTS: One hundred two chief residents were surveyed. Seventy two (70.58%) completed the survey. Eighty four percent of the respondents reported that they were aware of the competencies. The number of patients required for competency determination in five areas of psychotherapy varied widely among the programs. Global assessment by psychotherapy supervisors was the most commonly used method of competency determination (61%). Nineteen (26%) chief residents opined that not all the faculty members involved in teaching and assessing competencies are qualified to do so. Only 23 (31%) of respondents reported that competency criteria were well integrated into the residency curriculum. CONCLUSION: The little consistency in psychotherapy competency determination across various programs, the differential preparedness of programs for competencies and the lack of consistent integration of competencies into residency curricula call for development and implementation of more uniform assessment methods. This variability also calls into question the decision to establish a standard in five areas of psychotherapy competency.

Teaching residents and program directors about physician impairment.

OBJECTIVE: Residents are at a higher risk than the general population for the development of stress-related problems, depression, or suicide. The authors describe a curriculum for educating PGY-1s and residency program directors about physician impairment. METHODS: A resident wellness program was established with the goals of preventing resident suicide, encouraging acceptance of treatment where appropriate, preventing self-prescribing, and aiding in stress management. RESULTS: The curriculum was rated highly by residents in the areas of program content and usefulness. CONCLUSIONS: Residents are receptive to education on physician impairment. Institutional support is necessary for effectively addressing these concerns with trainees.