Group peer review: a questionnaire-based survey

Psychiatry peer review groups in Australia: a mixed-methods exploration of structure and function

OBJECTIVES

The purpose of this study was to examine Australian psychiatrists' experience of participation in a small group learning format of continuing professional development, known as peer review groups (PRGs), with a particular emphasis on group structure and functions.

METHOD

An exploratory mixed-methods study comprising a survey (n=77) and semistructured interviews (n=6) with Australian psychiatrists participating in a PRG in the previous 12 months.

RESULTS

Qualitative findings indicate that PRGs address experiential learning through a focus on both breadth and specificity of work, as well as participants' experiences. Participants described using PRGs as a forum to manage difficult and complex work (through critiquing work, learning from one another, considering theory and guidelines, benchmarking, validating, reflecting and generalising learning) and to manage stress and well-being associated with crises, everyday stress and professional isolation. Particular structural aspects of PRGs considered essential to achieve these functions were self-selection of members, self-direction of meeting content and provision of a safe environment. These findings were convergent with the quantitative findings from scale survey data. Difficulties experienced during PRG participation are also described.

CONCLUSION

Qualitative and quantitative findings from psychiatry PRGs demonstrate how practice-based professional experience functions as both a source of learning and of collegial connection that contributes to well-being and reduction in professional stress. Study limitations and future research directions are discussed.

Where do Peer Review Groups fit in the international Continuing Professional Development literature?

OBJECTIVES

To describe what is reported in the Continuing Professional Development (CPD) literature on small group learning formats in medicine, including the Royal Australian and New Zealand College of Psychiatrists (RANZCP) CPD Peer Review Groups (PRGs).

METHOD

A literature review of international peer-reviewed publications in relation to the use of small group learning formats for CPD in medicine.

RESULTS

Small groups are commonly used as a learning format in medical CPD, primarily in general practice, but are little researched. Such groups take differing forms and they are valued by participants for a range of purposes, having effects on professionalism, clinical performance and doctors' wellbeing.

CONCLUSION

We believe that the contribution of these groups to medical CPD should be further explored. To this end, this review forms the first part of a research project focussing on the RANZCP PRG model used by Australian and New Zealand psychiatrists.

Appreciative Inquiry in Psychiatry Peer Groups

OBJECTIVE

The purpose of the study was to explore the feasibility of using appreciative inquiry in a peer group of psychiatry residents.

METHODS

A peer coaching exercise using appreciative inquiry was modeled to a group of psychiatry residents who practised the approach. The topics discussed in separate sessions 1 month apart were values and identity as a psychiatrist, dealing with conflict and working within the psychiatric system. Following each session, the residents participated in focus group interviews. Transcripts were thematically analyzed and independently coded.

RESULTS

Four themes were identified: (i) connectedness, (ii) a structure for dialogue, (iii) reflection, and (iv) generative conversations.

CONCLUSION

Appreciative inquiry is a feasible method to facilitate focused and meaningful encounters and develop connection between members of a peer group.

Improving drug treatment in general practice

In the international Drug Education Project, an educational program involving auditing and feedback in peer groups to improve the treatment of asthma and urinary tract infections (UTI) was developed and tested in primary care. Individualized feedback was provided and discussed in 24 Dutch peer groups showing doctors their prescribing practices and underlying reasons for treatment. A parallel, randomized controlled design was used to test the effect on competence and actual prescribing; in one study arm doctors received feedback on asthma treatment and in the other on UTI treatment. Especially the messages to treat asthma exacerbations with oral corticosteroids (17% increase) and to prescribe short courses for UTI (decrease duration of 1.8 days) brought about large improvements. Both messages concerned acute situations, and were clear and relatively easy for GPs to implement. GPs will experience more barriers when changing maintenance treatment of an asthma patient, which could explain the more limited success of this part of the educational program: the proportion of patients treated with inhaled corticosteroids increased 5%. A ceiling effect was experienced regarding drug choice for UTI.

Peer review groups: problems and solutions

OBJECTIVE

To elucidate and delineate principles for dealing with problems encountered in peer review groups.

METHOD

A workshop format was utilised in which a number of interested psychiatrists were invited to role-play specific problems which occurred in established peer review groups, and reported in recent research studies. Process notes or videotapes were used to record proceedings. Principles were delineated for the management of five specific problems via role-play and discussion.

RESULTS

Principles have been delineated for the management of the following problems reported by peer review groups: dominating group member; member with disturbing behaviour; member providing inadequate treatment; member transgressing treatment boundaries; and group members strongly disagreeing about the management of a case.

CONCLUSION

Problems encountered within peer review groups were adequately replicated during role-played enactments. The workshop format offered a means of engaging with these, allowing exploration and subsequent resolution of problems which had not proved resolvable in the real group peer review situation.