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Effectiveness of the research day in psychiatric training: survey of consultant psychiatrists

Edward Myers Centre, Harplands Hospital, Hilton Road, Stoke on Trent, Staffordshire ST4 6RR, e-mail: dencko2001{at}yahoo.co.uk

Laofe O. Ogundipe, Consultant Psychiatrist

Integrated Drug and Alcohol Services, St George’s Hospital, Stafford

Declaration of interest

None.

	Abstract

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AIMS AND METHOD

We explored the views of consultant psychiatrists (trainers and non-trainers) on the effectiveness of the research day. We sent out postal questionnaires to consultant psychiatrists in general adult and old age psychiatry in the West Midlands to evaluate their own experience of the research day and how useful they felt it was.

RESULTS

The survey had a response rate of 72% (88 out of 122) and the majority of respondents had a positive view of their experience (31 trainers, 60%; 25 non-trainers, 69%). However, more consultant trainers (37, 71%) compared with non-trainers (15, 42%) felt that the research day in its current format should be modified.

CLINICAL IMPLICATIONS

The research day is useful for the training of specialist registrars and our study confirms this view from the consultants surveyed. Some improvement is required in order for specialist registrars to obtain optimal benefit. We make some suggestions for improving the day’s effectiveness.

	Introduction

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Specialist registrars (SpRs) in psychiatry, like most trainees in other medical specialties, are offered the opportunity to participate in research during their higher specialist training. They have a fifth of their time protected for initiating and carrying out research during their training. The Higher Specialist Training Committee (HSTC) of the Royal College of Psychiatrists requires ‘two sessions each week to be devoted to planning, conducting and communicating the outcome of a research project’ (Royal College of Psychiatrists, 1998). The compentency-based curriculum for specialist training in psychiatry which is soon to be approved by the Postgraduate Medical Education and Training Board (PMETB) outlines detailed expectations and assessment of research skills required during specialist psychiatric training (Royal College of Psychiatrists, 2006). Some psychiatrists believe that there is a gap between higher specialist training and needs of psychiatric services in the real world (Vassilas & Brown, 2005). It is therefore important that all aspects of psychiatric training, including the research day, are reviewed.

Specialist registrars’ use of the research day and its outcome remains topical. The ability to critically appraise research publications is the cornerstone of evidence-based medicine (EBM). A significant part of senior house officer training and the subsequent part II examinations organised by the Royal College of Psychiatrists is devoted to critical appraisal of published research. It is important because it involves assessment of the validity of research, through the appreciation of statistical techniques used in studies and the generation of clinically useful information from published research (Lawrie et al, 2000). Since some of this skill is assumed to have been demonstrated by passing the membership examinations, some consultants and trainees have questioned the appropriateness of devoting a huge amount of specialist registrars’ time to research, irrespective of the individual trainee’s interests and career plan. The importance of EBM in clinical practice and the central role it plays in the current climate of appraisal and re-evaluation cannot be overemphasised. This skill, like most others in medicine, requires continuous development and nurturing in order to be of any long-term benefit to trainees.

Allsopp et al (2002) evaluated the utility of the research day for SpRs in child and adolescent psychiatry and learning disability in the UK and Ireland with a postal questionnaire. They concluded that ‘a high proportion of respondents were involved in research at the time’ and the ‘majority believed research to be important’. They also reported that it was an enjoyable part of their training experience despite some difficulties such as protecting the day for research and actually getting started. However, these conclusions were not supported by another study. Vassilas et al (2002) found that only about one-third of programme directors and trainees thought that the research day was being utilised effectively (38% and 30%, respectively). A more recent study of final year Scottish SpRs and first year consultants found that two-thirds had published a paper following their SpR training (Petrie et al, 2004). The current study has attempted to extend these findings by exploring the views of consultants (trainers and non-trainers) on the effectiveness of the research day. Some of these consultants have had the benefit and experience of the research day during their training as SpRs. We explored whether their experience was positive and useful and their views on the utilisation of this day by SpRs.

	Method

Top Abstract Introduction Method Results Discussion References

 
We obtained lists of the consultant general adult and old age psychiatrists who work in the West Midlands from a variety of sources: deanery list of SpR trainers; personnel departments of individual health trusts in the region; and senior house officer rotational training lists. We amalgamated these lists and sent questionnaires to a total of 122 psychiatrists. The questionnaires were sent out with a prepaid return envelope and a second wave of questionnaires were posted 4 weeks later to non-responders.

The questionnaire consisted of 16 main questions. The first 4 questions ascertained whether the consultant was an SpR trainer, how long they have been a consultant, whether they had trained before or after the 1993 Calman reforms and whether the research day was available to them as a SpR. The next 4 questions examined how respondents used this day and whether they found it useful. The reply options were provided on a standard Likert scale (the consultant being asked to tick as applicable from a choice of: strongly agree, agree, undecided, disagree and strongly disagree). The other questions evaluated their views of the effectiveness of the research day for SpRs and whether its availability should be restricted. Also, if the availability of the research day was to be restricted, we invited criteria from respondents for making the research day available to the trainees. Some of the suggested criteria included: future career plans, expressed interest, having developed a research protocol, a research idea or choice of an optional research year. Finally, we assessed how many SpRs had trained under each trainer and how many of their trainees had published a paper following a research day during training.

	Results

Top Abstract Introduction Method Results Discussion References

 
Of the 122 consultants who were surveyed, 88 responses were received, a response rate of 72%. Replies to the initial questions on the questionnaire revealed that 59% (52) of the respondents were SpR trainers. Of the trainers, 77% (40) had been able to experience a dedicated research day during their training and 83% (30) of non-trainers also had had this opportunity. Only 25% (22) of respondents had undergone training after the Calman reforms.

The majority of respondents who had the research day used it for purposes other than research. Over 50% of respondents had used the opportunity to study for a higher qualification. Other purposes were mainly private study (25%), project management (2%) and clinical audit (12.5%). A few of the trainers also used this opportunity for teaching (1%), reflective practice (1%) and additional clinics (2%). Others used the research day for British Medical Association (BMA) duties (1%), special interest sessions (1%), psychotherapy training (2%) and management (2.5%).

Most of the consultants surveyed (31 trainers (60%), 25 non-trainers (69%)) had a positive view of their experience of the research day. It is interesting that a higher number of consultants not training SpRs considered the research day to be effective compared with consultants who trained SpRs (66% and 48%, respectively). The results of the questionnaire regarding the effectiveness of the research day according to consultants’ own experience and their perceived usefulness of this day to SpRs are shown in Tables 1 and 2 respectively.

Although the trainers had found the research day to be useful, an analysis of consultants’ views using the ² test showed that significantly more trainers compared with non-trainers felt the research day should be more restricted in availability (²=6.48, d.f.=1, P<0.05). The majority of non-trainers were in favour of a developed research protocol only (58%), compared with 40% of trainers who favoured the availability of the research day based on each SpR’s planned future career and developed research protocol.

Both trainers and non-trainers had positive attitudes to questions regarding continuation of the research day for SpRs (85% and 97% respectively). Also, the majority of respondents (67% of trainers and 89% of non-trainers) did not feel that the research day should be utilised for more clinical work.

	Discussion

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The relatively high response rate of 72% suggests that our findings are fairly representative of the views of general adult and old age consultant psychiatrists who work in the West Midlands. In addition to the options given in the questionnaire, the strength of feeling and views were such that about one-third of respondents went further to include handwritten unsolicited comments, thus suggesting that this topic continues to provoke considerable interest from trainers and non-trainers.

The majority of the respondents felt that the availability of the research day should be restricted rather than it should be abolished. This is comparable to an earlier study (Vassilas et al, 2002) which found that 46% of programme directors surveyed felt the day should be terminated. This is even more interesting considering that none of the SpR representatives in the study by Vassilas et al (2002) felt the research day should be withdrawn.

The availability of the research day ideally should be linked to objectives and clear outcomes. It may be reasonable to use publication of papers as an outcome measure, but it is also quite possible to utilise the day effectively on other projects or areas that may not readily lead to publication. This is demonstrated by the wide range of other activities undertaken by the respondents in this study. Whether all or some of these other activities will count as research experience implicit in the provision of the research day, as defined by the HSTC, is a different issue. Publication as an outcome measure is not without problems and may be too stringent. Only about 78% of the trainers we surveyed were aware of any publication by their previous trainees, which compares well with the study by Petrie et al (2004) which reported that one-third of trainees near the end of their training did not have a publication.

This study illustrates the research day to be useful both from the experience of consultants and their observation of SpRs utilising this day. Our findings among trainers are comparable to those of programme directors in the study of Vassilas et al (2002). It could be that these groups (trainers and programme directors) are closer to the activities of SpRs, thus reflecting the comparable results found in our study and that of Vassilas et al (2002).

There are two limitations to our survey. First, we surveyed only one deanery and, although it is a relatively large one, our findings cannot necessarily be extrapolated to others. However, it is not unusual to limit surveys of this kind to only one deanery. Second, the majority of non-responders were not trainers and it is likely that had more trainers replied, the findings might be different. Nevertheless, the response rate achieved was acceptable for a study of this nature.

We are able to conclude that consultants who are SpR trainers as well as non-trainers have had different but positive experiences of the use of the research day and view it as beneficial. The use of the research day for a range of purposes by respondents also suggests that there are advantages in the flexible use of this day to ensure improved benefits for SpRs. This would also be in accordance with the view of the Collegiate Trainees’ Committee (CTC) that the trainees’ objectives should be clear, with flexibility in the methods by which these objectives are met (Ramchandani et al, 2001). Onthe other hand, in order to fulfil the objective of the research day set out by the HSTC of planning, conducting and communicating the outcome of research projects, some restrictions and clearer objectives for each individual trainee may be beneficial. The criteria for restriction have not been widely discussed in our survey. However, in our opinion the day should be available for all trainees in their first year to prepare and develop a research protocol. Then, only those trainees who gain the approval of their programme director based on successful progress should have a research day available in their second year of training to pursue the project. Also, only those trainees who are actively pursuing approved research in their second year should have a research day in their third year to prepare their research for publication. If the day is to be utilised for purposes other than research then appropriate approval from the programme director should be required. Each trainee’s career interests and plans are usually different and this should possibly be reflected in the availability and utilisation of the research day.

	References

Top Abstract Introduction Method Results Discussion References

 
ALLSOPP, L., ALLEN, R., FOWLER, L., et al (2002) Research in psychiatric higher specialist training: a survey of specialist registrars. Psychiatric Bulletin, 26, 272 –274.[Abstract/Free Full Text]

CALMAN, K. (1993) Hospital Doctors’ Training for the Future: The Report of the Working Group on Specialist Medical Training. London: TSO (The Stationery Office).

LAWRIE, S., McINTOSH, A. M. & RAO, S. (2000) Critical Appraisal for Psychiatry. London: Harcourt.

PETRIE, R., ANDERSON, K., HARE, E., et al (2004) Research activity of specialist registrars. Psychiatric Bulletin, 28, 180 –182.[Abstract/Free Full Text]

RAMCHANDANI, P., CORBY, C., GUEST, L., et al (2001) The place and purpose of research training for specialist registrars: a view from the Collegiate Trainees’Committee (CTC) of the Royal College of Psychiatrists. Irish Journal of Psychological Medicine, 18, 29 –31.

ROYAL COLLEGE OF PSYCHIATRISTS (1998) Higher Specialist Training Handbook (Occasional Paper OP43). London: Royal College of Psychiatrists. http://www.rcpsych.ac.uk/files/pdfversion/op43.pdf

ROYAL COLLEGE OF PSYCHIATRISTS (2006) A Competency Based Curriculum for Specialist Training in Psychiatry. http://www.rcpsych.ac.uk/pdf/prov_jan06.pdf

VASSILAS, C. A. & BROWN, N. (2005) Specialist registrar training: at the crossroads (again). Psychiatric Bulletin, 29, 47 –48.[Free Full Text]

VASSILAS, C., TADROS, G. & DAY, E. (2002) The research day: a suitable case for treatment? Psychiatric Bulletin, 26, 313 –314.[Abstract/Free Full Text]

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