Psychiatric residents' experience and career interest in geriatric psychiatry: implications for training programs

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study

OBJECTIVE

To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices.

METHOD

Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire.

RESULTS

Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential.

CONCLUSIONS

The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

Psychogeriatric training in Australia and New Zealand: a survey of psychiatry trainees and training program co-ordinators

Psychiatry trainees and training program co-ordinators in Australia and New Zealand were surveyed about psychogeriatric training. Responses were received from the co-ordinators of all training programs and 68% of trainees. Over 94% of responding trainees believe they require at least 3 months' psychogeriatric training. Currently about 70% of trainees obtain a psychogeriatric term by Year 4 of training, with 17 out of 21 training programs having positions available. Most trainees positively rate their psychogeriatric training experiences, with 89% enjoying it and 78% believing it adequate for their needs. It is recommended that psychogeriatric training be available to all trainees before sitting the RANZCP Section 1 examinations.

Geriatric psychiatry: training guidelines and their application. Section on Geriatric Psychiatry of the Canadian Psychiatric Association

Geriatric psychiatry is now a mandatory part of psychiatric residency education in Canada. Educational requirements in geriatric psychiatry were updated by the Royal College of Physicians and Surgeons of Canada in 1988, and guidelines were developed in more detail in 1989 by the Section on Geriatric Psychiatry of the Canadian Psychiatric Association (CPA). These guidelines are presented here together with a survey, conducted in the fall of 1991, of all 16 Canadian psychiatry residency programs. Thirteen of the training centres now require residents to have a formal rotation in geriatric psychiatry, generally three months in length. Residents are exposed to elderly patients in other services, such as consultation/liaison, but these services may not include formal teaching in geriatric psychiatry. Most programs have a seminar series in geriatric psychiatry and have training guidelines similar to those of the CPA. However, it is not clear how closely these are being followed, since it was felt in almost one-third of all programs that there was an insufficient number of teachers to fulfill the training requirements. In addition, a number of training directors felt that the objectives were too comprehensive to be met in the three month period. Earlier studies in the field are reviewed, implications of the current findings are discussed, and suggestions are made for further research.

Intensive early exposure to geriatric psychiatry in residency training: impact on career choice and practice

The authors examined the impact of intensive early exposure to geriatric psychiatry on the career choice of trainees. All psychiatrists who had completed a six month inpatient rotation on a general hospital psychogeriatric unit as part of their first year of residency were interviewed three to 12 years later with a questionnaire designed to elicit practice patterns, prior interest in geriatrics, and the major influences of the rotation. Nine of 16 trainees had spent more than 50% of their time since graduation treating elderly patients. Those surveyed who were not practicing geriatrics spontaneously reported positive influences of the rotation on psychiatry training in general. The nature of geriatric psychiatry and the clinical issues, as well as the supervisors and educational activities were rated as the most important influences of the rotation. Early experience in psychogeriatrics seems valuable for subspecialty recruitment as well as general psychiatry training.

A Psychiatric Clinic within a Geriatric Medical Day Hospital: Descriptive Study

A survey of the first two years of a psychiatric clinic within a geriatric medical day hospital was undertaken to determine the role of such a clinic. Forty per cent of all day hospital attenders were referred for psychiatric evaluation: at least 80 per cent of these had major psychiatric diagnoses and 20 per cent had other conditions needing psychosocial intervention. Depression and dementia accounted for 62 per cent of all psychiatric referrals. Those who were referred to the psychiatric clinic were quite comparable to the unreferred group in age, sex, marital status, pre-retirement employment and source of referral to the day hospital. The outcomes of intervention at three, six and 12 months were similar in both groups but referred patients stayed longer in the program. It is concluded that such a clinic provides a necessary mental health service where it is needed.

Geriatric psychiatry training in Canada: current teaching facilities and resources

A survey of Canadian psychiatry residency programs requested information on training activities in geriatric psychiatry. Fourteen out of sixteen programs responded. On average ten hours of didactic instruction were provided per year over the four years of the residency program. Only one program had no facility that provided a rotation in geriatric psychiatry. The majority of programs have policies that encourage exposure of trainees to the care of the elderly. There is a concentration of teachers of this sub-specialty in a minority of centres. These findings are discussed in the light of current and future needs in the care of the elderly. Recommendations for meeting these are proposed.