Journal Article Annotations
2016, 4th Quarter
Annotations by Angela Camacho, MD; Diana M. Robinson, MD; and Jordan H. Rosen, MD
The finding: The authors conducted a survey of residents in a large psychiatry residency program from December 2014 to February 2015 to assess the relationship between lifelong learning and academic motivation as well as factors that influence learning practices. Intrinsic motivation was defined as pursuit for personal interest or enjoyment and extrinsic motivation is defined by a separable outcome, such as a reward or enhanced reputation. The findings confirmed prior research that resident intrinsic motivation was positively correlated with LLL. Interestingly, JeffSPLL scores for psychiatry residents at this institution were lower than scores reported in samples of practicing clinicians and medical students.
Strength and weaknesses: The authors discussed study limitations such as the longer psychiatry residency training period compared to the United States. Also, the study is based on a survey of a single residency program for a six-month period of time. However, the single program is Canada’s largest psychiatry residency program with 185 PGY1-5s and 19 different training sites which supports the generalizability of the findings to other programs and sites.
Relevance: This study is relevant because lifelong learning is a critical skill needed for long-term physician effectiveness and professional growth. Such studies are important to guide personal and curriculum development to foster developing lifelong learning.
The finding: The authors conducted a survey at a national review course in Canada from 2009 to 2011 to assess the educational exposure to forensic psychiatry that senior psychiatry residents receive prior to graduation and its effects on comfort with the field. The findings show that residents have a low exposure to common medicolegal topics. They are also more likely to have had didactic exposure as opposed to clinical exposure when they do have experience. Further, few residents reported comfort in forensic issues.
Positive correlations were found between forensic education and comfort with forensic cases in multiple environments. Exposure to forensic education also correlated with an interest in forensic matters, less negative attitudes around forensic topics, and less avoidance of the subspecialty as a career because of safety concerns. Direct clinical experience had higher positive correlations than didactic training.
Strength and weaknesses: The study is based on a single survey with moderate response rate in Canada conducted at a non-mandatory national review course. Canada has a longer psychiatry residency (5 years) than the US which suggests generalizability to US residencies in terms of limitations in their forensic training given decreased length of overall training time. However, programs were not contacted directly to confirm actual training experience of those surveyed, nor were specifics to exposure quantified (length of rotations, number of patients, etc.).
Relevance: Given increasing numbers of psychiatric patients interacting with the criminal justice system and an over-representation of the psychiatrically ill in both Canadian and US prisons, it is important that psychiatric residents receive more training in forensic issues to become comfortable treating individuals in these settings.
The finding: The authors conducted a survey of residents nationally with all the Canadian psychiatry residency programs from May 2014 through June 2014. They found that burnout was greater in the PGY-2 postgraduate year, and was associated with less contact with supervisors, and unhealthy coping strategies (alcohol drinking, excessive shopping, unhealthy eating). Burnout was not associated with age or gender. Of interest, they found a positive association between personal psychotherapy and burnout, which was interpreted as psychotherapy fostering personal awareness, and priming residents to recognize and acknowledge potentially troublesome symptoms. Alternatively, residents who experience burnout may be motivated to pursue personal therapy.
Strength and weaknesses: The authors discussed study limitations such as using a single burnout measure; however, it was a well-validated and reliable measure. Another limitation was the cross sectional nature of the study. It was a large study, that used well known and validated measures.
Relevance: Including education about burnout over the course of resident training, coupled with information about prevention and self-care, would be a valuable accompaniment to PGY-1 and PGY-2 curricula, to prepare residents for the psychological disruption that may occur in training. This will translate into better patient and physician care.