531081 research-article2014
APY0010.1177/1039856214531081Australasian PsychiatryHickie et al.
Australasian
Psychiatry
Teaching and Training
Psychiatry trainees confidence as teachers, perceptions of supervisor support and opportunities for further training
Australasian Psychiatry 2014, Vol 22(3) 292–295 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214531081 apy.sagepub.com
Catherine Hickie Hunter New England Training in Psychiatry, Hunter New England Local Health District, Newcastle, NSW, and; Conjoint Senior Lecturer, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
Louise Nash Brain and Mind Research Institute, The University of Sydney, Australia; and Health Education and Training Institute, New South Wales Health, Gladesville Hospital, Sydney, NSW, Australia
Brian J Kelly School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
Terry J Lewin School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
Abstract Objective: To investigate psychiatry trainees’ confidence in their role as teachers, their perceptions of support and preferences for a program to support this role. Methods: Psychiatry trainees in New South Wales (NSW) (Australia) in the first three years of psychiatry training (N = 118) were invited to complete a survey which included demographic data, self-assessment of teaching confidence and perceptions of support for teaching. Results: A total of 63% (N = 74) agreed to participate. Overall, 62% percent of participants regarded teaching as an important part of their role, 46% felt supported in the role by their training supervisors, but only 18% regularly discussed their teaching role in routine supervision. Conclusions: Psychiatry trainees viewed teaching as part of their role. They reported a low level of formal training in teaching skills and perceived a low level of support from supervisors. Registrar training needs to address trainees’ competencies in a range of teaching skills along with supervisor support. Further research is required to assess the impact of a teaching program on teaching performance and learner outcomes. Keywords: Education, medical, psychiatry
T
he teaching role is important for psychiatry trainees and for psychiatrists. Psychiatry trainees provide a significant part of medical students’ clinical teaching as well as educating patients, family, peers and health colleagues from other disciplines. The training years provide an opportunity to learn the requisite teaching skills.1 In the authors’ experience, psychiatry trainees regularly provide formal small group learning (tutorials) to students, journal article discussion groups for peers and psychiatrists, case-based discussions for multidisciplinary colleagues and have medical students attached to them on clinical placements. We have previously written about the importance of trainees as clinical teachers of medical students.2 However, little is known about
the current status of teaching and support for psychiatry trainees in the Australian context in this domain. We investigated trainees’ confidence in the clinical teaching tasks they commonly encounter, their perceptions of the role of teacher, support for this role and preferences for further teaching. We aimed to use these findings to inform the development and implementation of a Corresponding author: Catherine Hickie, Senior Staff Specialist, HNET Psychiatry, Hunter New England Local Health District, PO Box 833, Newcastle, NSW, 2300, Australia. Email: [email protected]
292 Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
Hickie et al.
program to support competence in common teaching roles. The first phase, exploring trainees’ experiences and perceptions, is reported here.
medical degree from outside Australia, most commonly India and Sri Lanka (18% of total sample). Teaching experience and teaching confidence
Method The authors developed a survey for psychiatry trainees which included demographic background and four short questionnaires. The first was adapted from a 10 item selfassessment questionnaire developed by Spickard et al.3 to measure skills in establishing a positive learning environment for students and skills in providing feedback; responses were sought on a 9 point scale. The second was a 14 item self-assessment questionnaire rated on a 4 point scale and developed by the authors; 12 items measured confidence in teaching medical students and 2 items assessed perceived supervisor support for the role. The third and fourth questionnaires related to participants broader teaching experience, including teaching students, peers and other health professionals. The third was a seven item questionnaire which listed a range of common teaching activities undertaken by junior doctors (for example, presenting at a case conference and leading a journal article discussion) and participants were asked to answer ‘Yes’, ‘No’ or ‘Not Sure’ to indicate experience for each teaching activity. The final questionnaire was a nine item list of topics that could be covered in teaching workshops the authors planned to deliver. The topics covered skills that underpin teaching activities—ranging from the practical such as ‘literature searching skills’ to the complex ‘assessing medical student performance”. Participants were asked to tick ‘Yes’ or ‘No’ against each item in this list to indicate interest in further skills training. Psychiatry trainees were invited to take part in the study during their usual Royal Australian and New Zealand College of Psychiatrists (RANZCP) Fellowship Program accredited formal education course (FEC) lectures in February 2012. It is mandatory for trainees in their first, second and third year to attend a FEC and there are only two accredited courses in New South Wales (NSW). We chose this selection method to maximise involvement of NSW basic trainees. The questionnaire was emailed to all trainees who could not attend in person on the day. Data were analysed using SPSS (version 20; SPSS, Chicago, IL, USA). Ethics approval was granted by both the Hunter New England and NSW Institute of Psychiatry Human Research ethics committees. Informed consent was given.
Results
Respondent characteristics A total of 118 trainees were invited to take part in the study and 74 agreed to participate (63% participation rate). Overall, 45% (33 / 74) of respondents were first year trainees, 27% (20 / 74) were second year trainees and 28% (21 / 74) were third or later year trainees. From the sample, 35% (26 / 74) were over 35 years and 61% (45 / 74) were female. In total, 42% had their primary
A total of 96% of trainees (71 / 74) reported having medical students with them on clinical placements; 87% (64 / 74) had led a case-based discussion, 70% (52 / 74) had led a small group teaching session, 66% (49 / 74) had led a journal article discussion and 55% (41 / 74) had given a lecture. Only 20% (15 / 74) reported formal training in how to teach. In order to explore potentially meaningful clusters among these responses, a factor analysis was applied to the 14 self-assessment ratings of skills/confidence as teachers (using a principal component analysis, with an oblique rotation). Three factors were identified, accounting for 62% of the item variance. Scores on these factors were then calculated by averaging the ratings for the items assigned to each factor (see Table 1): factor 1—confidence in informal teaching settings (six items); factor 2—confidence in teaching specific clinical tasks (psychiatric assessment) (three items); and factor 3—confidence in formal teaching roles (five items). Table 1 summarises responses to the individual items about teaching confidence and provides aggregate comparisons between first year trainees and those in later years of the program. Almost two-thirds (62%, 44 / 71) of trainees viewed teaching as an important part of their role (responding ‘mostly’ or ‘always’ to the relevant question). Only 46% (33 / 71) reported being supported by their supervisors to undertake teaching, and 18% (13 / 72) reported having discussed their teaching role in supervision. Overall, the trainees were least confident in their ability to teach in formal teaching settings such as lectures and small group teaching (tutorials) (mean rating = 2.18, SD = 0.56), followed by informal teaching of colleagues or peers such as small group case-based discussions and journal article discussions (mean rating = 2.52, SD = 0.55), and they were most confident when teaching about psychiatric assessments (mean rating = 2.85, SD = 0.55). Paired t-test comparisons between these three sets of teaching settings/tasks were all statistically significant (p < 0.001). First year trainees were also significantly less confident in their ability to teach psychiatric assessments. Trainees’ preferences for specific training topics are described in Table 2. Assistance in ‘assessing medical students’, responding to the ‘problem student’ and ‘giving a lecture’ were most frequently endorsed overall. First year trainees endorsed assessing students and working with students in clinical settings more often, and giving a lecture less often than later year trainees.
Discussion The majority of psychiatry trainees in our sample reported that teaching was part of their role. The more senior trainees were most confident teaching history taking and 293
Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
Australasian Psychiatry 22(3)
Table 1. Confidence as teachers Current Skills/ Confidence Item
Mean Rating % Rating Mostly (3) or Always (4)
First Year Trainees Later Year Trainees Overall
1a. Giving feedback to students 1b. Commenting on student case presentation 1c. Giving a case presentation 1d. My approach to difficulties with students 1e. Support from supervisors to undertake teaching 1f. Leading a journal club discussion 2a. Teaching how to take a psychiatric history 2b. Teaching how to conduct a mental state examination 2c. My role as a teacher/ educator 3a. Teaching as important part of role 3b. Running a tutorial 3c. Teaching while on call 3d. Running a lecture 3e. Discussing teaching role in supervision aSignificant
Confidence Factors – Means (SD)
2.77
66%
Factor 1: Informal Teaching Settings
2.74
62%
2.46 (0.58)
2.58
58%
2.42
42%
2.35
46%
2.28
35%
3.03
79%
Factor 2: Mental Health Assessments Teacher
2.96
77%
2.67a (0.61)
2.58
56%
2.79
62%
Factor 3: Formal Teaching Roles
2.20 2.13 2.10 1.74
34% 30% 27% 18%
2.08 (0.54)
2.57 (0.52)
3.00 (0.46)
2.27 (0.56)
2.52 (0.55)
2.85 (0.55)
2.18 (0.56)
difference between trainee sub-groups, p < 0.01 (controlling for gender and age category).
mental state examination, and trainees overall were least confident in teaching while on call and taking a lead role in teaching tasks (e.g. giving a lecture or running a tutorial or journal article discussion). Only 20% of respondents reported formal training in how to teach. This is in contrast to North America where a majority of psychiatry training programs offer training in teaching skills.4 We prompted participants with a list of possible topics for development of their teaching skills to inform our development of teaching workshops. There were significant differences in responses depending on the number of years in RANZCP training, for example 85% of first year trainees endorsed ‘Working with medical students in clinical settings’ as a topic for further training compared with only 56% of more senior trainees, suggesting that experience in the role brings confidence but also that a separate program is needed for first year trainees on this topic.
Other topics such as ‘How to give feedback’ and ‘The problem student’ were endorsed by all trainees independent of years of RANZCP training. The topic ‘The problem student’ was deliberately open to capture the broad range of behaviours and attitudes encountered in both student and trainee. We anticipate trainees’ views of what constitutes a ‘problem’ in a student encounter will alter with experience. The RANZCP training program mandates one hour of general supervision (in addition to psychotherapy supervision) per week from the psychiatrist supervisor.5 However only 46% of the sample perceived their supervisors to be supportive of the trainee’s teaching role and even fewer reported that they discussed the teaching role in supervision. This may be addressed within the new RANZCP competency-based training framework6 which identifies a specific competency in teaching skills.
294 Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
Hickie et al.
Table 2. Percentage of trainees interested in skills training by topic Topics Suggested
First Year Trainees Later Year Trainees Overall
N (/33)
%
N (/41)
%
N (/74)
%
Assessing medical student performance (OSCE, case presentations and write ups) The problem student How to give a lecture How to run a tutorial Working with medical students in clinical settings How to give feedback Teaching interviewing skills to medical students Literature searching skills PowerPoint presentation skills
27
82%
28
68%
55
74%
22 20 21 28 22 24 21 16
67% 61%a 64% 85%a 67% 73% 64% 49%
32 34 31 23 27 24 26 15
78% 83% 76% 56% 66% 59% 63% 37%
54 54 52 51 49 48 47 31
73% 73% 70% 69% 66% 65% 64% 42%
aSignificant
difference between trainee sub-groups, p < 0.05.
An acknowledged limitation of our study is that our sample was only NSW-based trainees. Also, supervisors were not included in the study; hence, we are unable to compare and contrast their views on this issue.
broader sweep of psychiatrists in teaching to teach. Studies linking learner outcomes to specific teacher competencies are needed.
The findings suggest teaching roles and challenges are not routinely taught or discussed in the FECs or in supervision. Trainees identified areas for more instruction and support, such as responding to a ‘problem student’, which would be appropriate to address in supervision as well as more broadly in a teaching skills workshop. Observation of the supervisor’s teaching and feedback from the supervisor to the trainee on their teaching skills are mechanisms to address these needs. In addition, a range of instruments exist for assessing trainee performance in teaching skills, e.g. Objective Structured Teaching Encounter (OSTE).7,8 It is also important to consider that supervisors themselves may not feel confident in their own teaching skills and hence also need support in the task.
Acknowledgements
Although not explored in this study previous research among medical students also supports the importance of face-to-face clinical teaching, and qualities of clinical teachers in shaping the views and attitudes of medical students to psychiatry,9 hence emphasising the importance of facilitating trainees’ teaching roles.
Conclusion Psychiatry trainees see teaching as part of their role and welcome a program to improve their skills. The results of this study suggested that a program to increase teaching competencies should take a multipronged approach providing formal instruction on how to teach for all trainees, encouraging psychiatrists to promote discussion of teaching experiences in supervision and engaging a
We would like to thank the RANZCP trainees who participated in this study, Dr Helen Proskurin who provided a trainee’s perspective in the development phase of some items in the questionnaire, Fiona Kelly at Hunter New England Training Psychiatry who provided administrative assistance and the Australasian Psychiatry reviewers whose useful comments have been incorporated into the final paper.
Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Post RE, Quattlebaum RG and Benich JJ. Residents as teachers curricula: a critical review. Acad Med 2009; 84: 374–380. 2. Hickie C, Nash L and Kelly B. The role of trainees as clinical teachers of medical students in psychiatry. Australasian Psych 2013 21: 583–586. 3. Spickard A, Corbett E and Schorling J. Improving residents’ teaching skills and attitudes toward teaching. J Gen Intern Med 1996; 11: 475–480. 4. Morrison EH, Friedland JA, Boker J, et al. Residents as teachers training in US residency programs and offices of graduate medical education. Acad Med 2001; 76(suppl): S1–S4. 5. Royal Australian and New Zealand College of Psychiatrists Fellowship Program, https:// www.ranzcp.org/Files/ranzcp-attachments/PreFellowship/2012-Fellowship-Program/ RPP-TRAINING.aspx (2012, accessed 13 December 2013). 6. RANZCP, https://www.ranzcp.org/Files/ranzcp-attachments/PreFellowship/2012-Fellowship-Program/Professional-presentation-WBA.aspx (2012, accessed 13 December 2013). 7. Coverdale JH, Ismail N, Mian A, et al. Toolbox for evaluating residents as teachers. Acad Psych 2010; 34: 4. 8. Trowbridge RL, Snydman LK, Skofield J, et al. A systematic review of the use and effectiveness of the objective structured teaching encounter. Med Teacher 2011; 33: 8930–903. 9. Lampe L, Coulston C, Walter G, et al. Up close and personal: medical students prefer face-to-face teaching in psychiatry. Australasian Psych 2010; 18 (4): 354–360.
295 Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
APY0010.1177/1039856214531081Australasian PsychiatryHickie et al.
Australasian
Psychiatry
Teaching and Training
Psychiatry trainees confidence as teachers, perceptions of supervisor support and opportunities for further training
Australasian Psychiatry 2014, Vol 22(3) 292–295 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214531081 apy.sagepub.com
Catherine Hickie Hunter New England Training in Psychiatry, Hunter New England Local Health District, Newcastle, NSW, and; Conjoint Senior Lecturer, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
Louise Nash Brain and Mind Research Institute, The University of Sydney, Australia; and Health Education and Training Institute, New South Wales Health, Gladesville Hospital, Sydney, NSW, Australia
Brian J Kelly School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
Terry J Lewin School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
Abstract Objective: To investigate psychiatry trainees’ confidence in their role as teachers, their perceptions of support and preferences for a program to support this role. Methods: Psychiatry trainees in New South Wales (NSW) (Australia) in the first three years of psychiatry training (N = 118) were invited to complete a survey which included demographic data, self-assessment of teaching confidence and perceptions of support for teaching. Results: A total of 63% (N = 74) agreed to participate. Overall, 62% percent of participants regarded teaching as an important part of their role, 46% felt supported in the role by their training supervisors, but only 18% regularly discussed their teaching role in routine supervision. Conclusions: Psychiatry trainees viewed teaching as part of their role. They reported a low level of formal training in teaching skills and perceived a low level of support from supervisors. Registrar training needs to address trainees’ competencies in a range of teaching skills along with supervisor support. Further research is required to assess the impact of a teaching program on teaching performance and learner outcomes. Keywords: Education, medical, psychiatry
T
he teaching role is important for psychiatry trainees and for psychiatrists. Psychiatry trainees provide a significant part of medical students’ clinical teaching as well as educating patients, family, peers and health colleagues from other disciplines. The training years provide an opportunity to learn the requisite teaching skills.1 In the authors’ experience, psychiatry trainees regularly provide formal small group learning (tutorials) to students, journal article discussion groups for peers and psychiatrists, case-based discussions for multidisciplinary colleagues and have medical students attached to them on clinical placements. We have previously written about the importance of trainees as clinical teachers of medical students.2 However, little is known about
the current status of teaching and support for psychiatry trainees in the Australian context in this domain. We investigated trainees’ confidence in the clinical teaching tasks they commonly encounter, their perceptions of the role of teacher, support for this role and preferences for further teaching. We aimed to use these findings to inform the development and implementation of a Corresponding author: Catherine Hickie, Senior Staff Specialist, HNET Psychiatry, Hunter New England Local Health District, PO Box 833, Newcastle, NSW, 2300, Australia. Email: [email protected]
292 Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
Hickie et al.
program to support competence in common teaching roles. The first phase, exploring trainees’ experiences and perceptions, is reported here.
medical degree from outside Australia, most commonly India and Sri Lanka (18% of total sample). Teaching experience and teaching confidence
Method The authors developed a survey for psychiatry trainees which included demographic background and four short questionnaires. The first was adapted from a 10 item selfassessment questionnaire developed by Spickard et al.3 to measure skills in establishing a positive learning environment for students and skills in providing feedback; responses were sought on a 9 point scale. The second was a 14 item self-assessment questionnaire rated on a 4 point scale and developed by the authors; 12 items measured confidence in teaching medical students and 2 items assessed perceived supervisor support for the role. The third and fourth questionnaires related to participants broader teaching experience, including teaching students, peers and other health professionals. The third was a seven item questionnaire which listed a range of common teaching activities undertaken by junior doctors (for example, presenting at a case conference and leading a journal article discussion) and participants were asked to answer ‘Yes’, ‘No’ or ‘Not Sure’ to indicate experience for each teaching activity. The final questionnaire was a nine item list of topics that could be covered in teaching workshops the authors planned to deliver. The topics covered skills that underpin teaching activities—ranging from the practical such as ‘literature searching skills’ to the complex ‘assessing medical student performance”. Participants were asked to tick ‘Yes’ or ‘No’ against each item in this list to indicate interest in further skills training. Psychiatry trainees were invited to take part in the study during their usual Royal Australian and New Zealand College of Psychiatrists (RANZCP) Fellowship Program accredited formal education course (FEC) lectures in February 2012. It is mandatory for trainees in their first, second and third year to attend a FEC and there are only two accredited courses in New South Wales (NSW). We chose this selection method to maximise involvement of NSW basic trainees. The questionnaire was emailed to all trainees who could not attend in person on the day. Data were analysed using SPSS (version 20; SPSS, Chicago, IL, USA). Ethics approval was granted by both the Hunter New England and NSW Institute of Psychiatry Human Research ethics committees. Informed consent was given.
Results
Respondent characteristics A total of 118 trainees were invited to take part in the study and 74 agreed to participate (63% participation rate). Overall, 45% (33 / 74) of respondents were first year trainees, 27% (20 / 74) were second year trainees and 28% (21 / 74) were third or later year trainees. From the sample, 35% (26 / 74) were over 35 years and 61% (45 / 74) were female. In total, 42% had their primary
A total of 96% of trainees (71 / 74) reported having medical students with them on clinical placements; 87% (64 / 74) had led a case-based discussion, 70% (52 / 74) had led a small group teaching session, 66% (49 / 74) had led a journal article discussion and 55% (41 / 74) had given a lecture. Only 20% (15 / 74) reported formal training in how to teach. In order to explore potentially meaningful clusters among these responses, a factor analysis was applied to the 14 self-assessment ratings of skills/confidence as teachers (using a principal component analysis, with an oblique rotation). Three factors were identified, accounting for 62% of the item variance. Scores on these factors were then calculated by averaging the ratings for the items assigned to each factor (see Table 1): factor 1—confidence in informal teaching settings (six items); factor 2—confidence in teaching specific clinical tasks (psychiatric assessment) (three items); and factor 3—confidence in formal teaching roles (five items). Table 1 summarises responses to the individual items about teaching confidence and provides aggregate comparisons between first year trainees and those in later years of the program. Almost two-thirds (62%, 44 / 71) of trainees viewed teaching as an important part of their role (responding ‘mostly’ or ‘always’ to the relevant question). Only 46% (33 / 71) reported being supported by their supervisors to undertake teaching, and 18% (13 / 72) reported having discussed their teaching role in supervision. Overall, the trainees were least confident in their ability to teach in formal teaching settings such as lectures and small group teaching (tutorials) (mean rating = 2.18, SD = 0.56), followed by informal teaching of colleagues or peers such as small group case-based discussions and journal article discussions (mean rating = 2.52, SD = 0.55), and they were most confident when teaching about psychiatric assessments (mean rating = 2.85, SD = 0.55). Paired t-test comparisons between these three sets of teaching settings/tasks were all statistically significant (p < 0.001). First year trainees were also significantly less confident in their ability to teach psychiatric assessments. Trainees’ preferences for specific training topics are described in Table 2. Assistance in ‘assessing medical students’, responding to the ‘problem student’ and ‘giving a lecture’ were most frequently endorsed overall. First year trainees endorsed assessing students and working with students in clinical settings more often, and giving a lecture less often than later year trainees.
Discussion The majority of psychiatry trainees in our sample reported that teaching was part of their role. The more senior trainees were most confident teaching history taking and 293
Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
Australasian Psychiatry 22(3)
Table 1. Confidence as teachers Current Skills/ Confidence Item
Mean Rating % Rating Mostly (3) or Always (4)
First Year Trainees Later Year Trainees Overall
1a. Giving feedback to students 1b. Commenting on student case presentation 1c. Giving a case presentation 1d. My approach to difficulties with students 1e. Support from supervisors to undertake teaching 1f. Leading a journal club discussion 2a. Teaching how to take a psychiatric history 2b. Teaching how to conduct a mental state examination 2c. My role as a teacher/ educator 3a. Teaching as important part of role 3b. Running a tutorial 3c. Teaching while on call 3d. Running a lecture 3e. Discussing teaching role in supervision aSignificant
Confidence Factors – Means (SD)
2.77
66%
Factor 1: Informal Teaching Settings
2.74
62%
2.46 (0.58)
2.58
58%
2.42
42%
2.35
46%
2.28
35%
3.03
79%
Factor 2: Mental Health Assessments Teacher
2.96
77%
2.67a (0.61)
2.58
56%
2.79
62%
Factor 3: Formal Teaching Roles
2.20 2.13 2.10 1.74
34% 30% 27% 18%
2.08 (0.54)
2.57 (0.52)
3.00 (0.46)
2.27 (0.56)
2.52 (0.55)
2.85 (0.55)
2.18 (0.56)
difference between trainee sub-groups, p < 0.01 (controlling for gender and age category).
mental state examination, and trainees overall were least confident in teaching while on call and taking a lead role in teaching tasks (e.g. giving a lecture or running a tutorial or journal article discussion). Only 20% of respondents reported formal training in how to teach. This is in contrast to North America where a majority of psychiatry training programs offer training in teaching skills.4 We prompted participants with a list of possible topics for development of their teaching skills to inform our development of teaching workshops. There were significant differences in responses depending on the number of years in RANZCP training, for example 85% of first year trainees endorsed ‘Working with medical students in clinical settings’ as a topic for further training compared with only 56% of more senior trainees, suggesting that experience in the role brings confidence but also that a separate program is needed for first year trainees on this topic.
Other topics such as ‘How to give feedback’ and ‘The problem student’ were endorsed by all trainees independent of years of RANZCP training. The topic ‘The problem student’ was deliberately open to capture the broad range of behaviours and attitudes encountered in both student and trainee. We anticipate trainees’ views of what constitutes a ‘problem’ in a student encounter will alter with experience. The RANZCP training program mandates one hour of general supervision (in addition to psychotherapy supervision) per week from the psychiatrist supervisor.5 However only 46% of the sample perceived their supervisors to be supportive of the trainee’s teaching role and even fewer reported that they discussed the teaching role in supervision. This may be addressed within the new RANZCP competency-based training framework6 which identifies a specific competency in teaching skills.
294 Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
Hickie et al.
Table 2. Percentage of trainees interested in skills training by topic Topics Suggested
First Year Trainees Later Year Trainees Overall
N (/33)
%
N (/41)
%
N (/74)
%
Assessing medical student performance (OSCE, case presentations and write ups) The problem student How to give a lecture How to run a tutorial Working with medical students in clinical settings How to give feedback Teaching interviewing skills to medical students Literature searching skills PowerPoint presentation skills
27
82%
28
68%
55
74%
22 20 21 28 22 24 21 16
67% 61%a 64% 85%a 67% 73% 64% 49%
32 34 31 23 27 24 26 15
78% 83% 76% 56% 66% 59% 63% 37%
54 54 52 51 49 48 47 31
73% 73% 70% 69% 66% 65% 64% 42%
aSignificant
difference between trainee sub-groups, p < 0.05.
An acknowledged limitation of our study is that our sample was only NSW-based trainees. Also, supervisors were not included in the study; hence, we are unable to compare and contrast their views on this issue.
broader sweep of psychiatrists in teaching to teach. Studies linking learner outcomes to specific teacher competencies are needed.
The findings suggest teaching roles and challenges are not routinely taught or discussed in the FECs or in supervision. Trainees identified areas for more instruction and support, such as responding to a ‘problem student’, which would be appropriate to address in supervision as well as more broadly in a teaching skills workshop. Observation of the supervisor’s teaching and feedback from the supervisor to the trainee on their teaching skills are mechanisms to address these needs. In addition, a range of instruments exist for assessing trainee performance in teaching skills, e.g. Objective Structured Teaching Encounter (OSTE).7,8 It is also important to consider that supervisors themselves may not feel confident in their own teaching skills and hence also need support in the task.
Acknowledgements
Although not explored in this study previous research among medical students also supports the importance of face-to-face clinical teaching, and qualities of clinical teachers in shaping the views and attitudes of medical students to psychiatry,9 hence emphasising the importance of facilitating trainees’ teaching roles.
Conclusion Psychiatry trainees see teaching as part of their role and welcome a program to improve their skills. The results of this study suggested that a program to increase teaching competencies should take a multipronged approach providing formal instruction on how to teach for all trainees, encouraging psychiatrists to promote discussion of teaching experiences in supervision and engaging a
We would like to thank the RANZCP trainees who participated in this study, Dr Helen Proskurin who provided a trainee’s perspective in the development phase of some items in the questionnaire, Fiona Kelly at Hunter New England Training Psychiatry who provided administrative assistance and the Australasian Psychiatry reviewers whose useful comments have been incorporated into the final paper.
Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Post RE, Quattlebaum RG and Benich JJ. Residents as teachers curricula: a critical review. Acad Med 2009; 84: 374–380. 2. Hickie C, Nash L and Kelly B. The role of trainees as clinical teachers of medical students in psychiatry. Australasian Psych 2013 21: 583–586. 3. Spickard A, Corbett E and Schorling J. Improving residents’ teaching skills and attitudes toward teaching. J Gen Intern Med 1996; 11: 475–480. 4. Morrison EH, Friedland JA, Boker J, et al. Residents as teachers training in US residency programs and offices of graduate medical education. Acad Med 2001; 76(suppl): S1–S4. 5. Royal Australian and New Zealand College of Psychiatrists Fellowship Program, https:// www.ranzcp.org/Files/ranzcp-attachments/PreFellowship/2012-Fellowship-Program/ RPP-TRAINING.aspx (2012, accessed 13 December 2013). 6. RANZCP, https://www.ranzcp.org/Files/ranzcp-attachments/PreFellowship/2012-Fellowship-Program/Professional-presentation-WBA.aspx (2012, accessed 13 December 2013). 7. Coverdale JH, Ismail N, Mian A, et al. Toolbox for evaluating residents as teachers. Acad Psych 2010; 34: 4. 8. Trowbridge RL, Snydman LK, Skofield J, et al. A systematic review of the use and effectiveness of the objective structured teaching encounter. Med Teacher 2011; 33: 8930–903. 9. Lampe L, Coulston C, Walter G, et al. Up close and personal: medical students prefer face-to-face teaching in psychiatry. Australasian Psych 2010; 18 (4): 354–360.
295 Downloaded from apy.sagepub.com at Purdue University on June 18, 2015
