Brief Communication
Senior Residents in Psychiatry: Views on Training in Developmental
Disabilities
Philip Burge, MSW, RSW1,
Hélène Ouellette-Kuntz, BScN, RN, MSc2,
Bruce McCreary, MD, FRCPC3,
Elspeth Bradley, PhD, MBBS, FRCPC, FRCPsych4,
Pierre Leichner, MD, FRCPC5
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Objectives: To determine the proportion of senior
residents who believed their education in the field of developmental
disabilities was adequate and to collect suggestions for improvements.
Method: We distributed a self-administered questionnaire
to senior residents prior to an annual voluntary preparatory
exam. Their views on training in developmental disabilities
and ideas about improving curricula were solicited in detail,
and their feedback results were analyzed.
Results: Of the 89 senior residents who attended the
exam, 60 (67.4%) completed the survey. This represents 29%
of the national complement. Most (85%) of the one-half who
reported receiving undergraduate training in developmental
disabilities felt the quantity was inadequate. Almost 90%
of those who did not receive training felt they should have.
Of respondents, 85% received residency training in dual diagnosis,
but most (59%) felt more curriculum time was needed.
Conclusions: Senior residents also desire curricular
enhancements that experts in developmental disabilities have
long recommended.
(Can J Psychiatry 2002;47:568–571)
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Funding and Support and Author
Affiliations
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Clinical Implications
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Given the continued emphasis on depopulating residential
institutions and the resultant increased reliance
on generic community-based psychiatric services,
enhancements in the training of future physicians
to understand the mental health needs of persons
with developmental disabilities are long overdue.
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Increased curriculum time at both the undergraduate
and postgraduate levels was the most frequent enhancement
that respondents recommended
Limitations
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Results may not be generalizable to all senior
residents, given the moderate response rate.
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Residents were given limited opportunities to respond
to open-ended questions, making it difficult to
determine what other factors residents may perceive
as necessary to improve training.
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Key Words: training, undergraduate, medical school,
residents, developmental disabilities, mental retardation,
dual diagnosis
Résumé
: Résidents seniors en psychiatrie : points de vue
sur la formation en matière de troubles du développement
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Traditionally, Canadian psychiatry residency programs have failed
to offer sufficient training related to the mental health needs
of persons with “developmental disabilities” (Note 1)
(1–6). As these individuals leave downsized or closed residential
facilities to move to the community, research points to an increased
reliance on community-based psychiatric services (7–9). The
need for a cadre of well-trained psychiatrists who understand the
mental health needs of persons with developmental disabilities is
paramount. Lack of new recruits, combined with retirement of current
specialists, contributes to the significant service gaps consumers
face (2).
Today only a handful of specialist psychiatry clinicians with faculty
appointments in Canada are available to train residents on how to
best serve people with a “dual diagnosis” (Note 2) (6).
This challenge is shared by psychiatry educators worldwide (10–14),
and the problem of limited curricular focus on developmental disabilities
is not confined to postgraduate programs. Several researchers have
drawn attention to the key role of undergraduate medical education
in the specialist’s overall education in developmental disabilities
(5,15–17).
Reports from around the world have criticized deficiencies in communicating
important information and values to future physicians (17–20).
In the past, research in Canada concluded that residents’
lack of interest in various subspecialties linked to insufficient
teaching. It has been recommended that training programs need to
place more emphasis on subspecialties with shortages in personnel,
including dual diagnosis (3,21). A recent examination of Canadian
residency curricula in developmental disabilities also exposed the
clear need for such enhancements (4).
While the work of Leichner (3,21) has documented Canadian residents’
general perception of inadequacy in developmental disabilities training,
the present study aimed to take a closer look at senior residents’
views with respect to their training’s adequacy in developmental
disabilities and to collect their suggestions for improvements.
Methodology
Survey Administration
A questionnaire was self-administered at the 16 training programs
on the occasion of the annual Canada-wide preparatory session for
the certification examination of the Royal College of Physicians
and Surgeons of Canada, held in late spring 1999.
Research Instrument
Residents received a questionnaire in the language of their choice
(French or English), that required about 25 minutes to complete.
This brief communication focuses on the responses in survey sections
that concerned respondents’ demographics, views on training
in developmental disabilities, and instructional improvements.
Survey Respondents
Of the 89 potential respondents, 60 agreed to complete our survey
and returned usable questionnaires (67.4%, 60/89). In total, information
from 29% of the national complement of senior residents was available
(60/208). Respondents ranged in age from 27 to 50 years (mean 33.83,
SD 5.72, n = 54), and 52% were women. Of 16 sites, 2 experienced
survey administration problems, making their questionnaires unusable.
Results
Undergraduate and Postgraduate Exposure
Almost one-half of the respondents (29, 48.3%) reported that they
had seen persons with developmental disabilities as patients in
their undergraduate medical training, usually during pediatric,
family medicine, emergency, or psychiatry rotations and, to a lesser
extent, during orthopedic rotations. Of the 45% who did not receive
training as undergraduates, 89.3% felt that there should have been
such training. Table
1 provides details of the perceived adequacy and quality of
the training in developmental disabilities in undergraduate and
residency programs.
Significantly more respondents (51/60, 85%) indicated that they
had received specific training in developmental disabilities in
their psychiatry residency than had those in their undergraduate
training. For most, the didactic teaching was part of the residents’
core instruction (that is, mandatory) (42/51, 82.4%). Of the respondents,
22 (22/51, 43.1%) who received specific training in developmental
disabilities in their psychiatry residency felt that it was good
preparation for other areas of psychiatry.
Clinical Experience
The number of patients with dual diagnosis seen in the previous
12 months of residency varied greatly from 0 to 100 (median, 2 patients).
Most had mild-to-moderate mental retardation.
An open-ended question on how the residency programs could better
prepare residents for serving this population included the following
responses (n = 39): offer more didactic instruction and more
clinical exposure, and involve experts as teachers or clinical supervisors.
Likewise, the responses offered specific ideas about the placing
and timing of these training experiences; namely, earlier in the
training program, during certain rotations, through the creation
of mini-rotations, and seeing patients with dual diagnosis across
all rotations in an integrated fashion.
Content of Teaching
Of the 10 topics presented in the survey, the 4 most commonly covered
topics during residency were diagnosis of developmental disabilities
(77%), diagnosis of comorbid mental disorders (dual diagnosis) (68%),
children with dual diagnosis (67%), and medication as an intervention
(for persons with dual diagnosis) (65%). For each of the 10 topics,
most respondents reported that they were either inadequately covered
or not covered at all. Table
2 lists the 10 key topics and trainee perceptions of “inadequacy.”
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