How to Improve Training in Descriptive Psychopathology for Psychiatry Residents: A Delphi Study

Abstract

<b><i>Purpose:</i></b> Descriptive psychopathology (DP) is the language of psychiatry and is dedicated to the description of mental symptoms. Despite its core importance, a systematic review identified a series of shortcomings in its training. This Delphi study seeks to provide guidance for better didactic and clinical training in DP. <b><i>Method:</i></b> The authors used the Delphi method in order to gather, pool, and optimize the knowledgeable opinion of a highly qualified panel of international experts on how to improve DP training. A preliminary phase with open-ended questions was the basis to elaborate a Delphi questionnaire consisting of 14 questions on didactic and clinical training, which was then used in two successive Delphi rounds. Twenty-nine international experts in DP participated throughout the study. <b><i>Results:</i></b> A series of hierarchical lists on how to improve DP training were elaborated. Regarding didactic training, the experts valued the contents and educational methods, as well as recommended authors and texts. Regarding clinical training, the experts valued educational methods, desirable characteristics in clinical supervisors, how to improve the supervisors’ expertise, useful aspects and facilitating questions for direct supervision, and the suitability of including other evaluators besides the supervisor. In the final survey, 94% of the experts considered that the Delphi method had been effective to obtain and improve their opinions. <b><i>Conclusions:</i></b> Insufficient direct supervision in live interviews was considered the most important problem. A series of general measures were proposed to improve DP training: (i) adapting DP training throughout residency, with introductory and advanced levels; (ii) making DP training compulsory in psychiatry curricula; (iii) assessing residents’ DP knowledge and clinical use; and (iv) training the trainers/supervisors in both content (DP) and form (how to train/supervise residents). Within didactic training, epistemology of DP and contemporary and classic authors/texts were the highest rated contents, while supervised discussions based on cases, videos, or readings were the highest rated methods. Within clinical training, 8 aspects of DP that could guide the supervisor were highly rated: mental state examination, dialogue, empathy and understanding, attitude/willingness, knowledge-practice bridge, mental symptom formation, implications for decision-making, and the written report of the encounter.

Quality indicators for Delphi studies

“…a. Results of a final short survey of the panel experts, included in the last round (Etxeandia-Pradera et al, 2022), or conducted subsequently Turnbull et al, 2018) of the study . This might include their assessment of the degree to which the intended objectives of The first two groups of external indicators are aimed, mainly, at assessing the extent to which the Delphi study has been able to respond to the user context, that is, to the conditions and needs of the participants, of the users of the results and of the agents that promoted it.…”

“…These indicators provided external information closely linked to the assessment of the application in terms of its capacity to adapt to the social and political context of its development and the usefulness as perceived by recipients and users of the study. Finally, Etxeandia‐Pradera et al (2022) use some of the indicators mentioned above: increasing the degree of consensus, degree of change of opinion from the first to the second round, expert participation (dropout rate of experts and average number of qualitative contributions per expert and question) and expert panel satisfaction (by means of a satisfaction survey included in the second round).…”

“…Indicators of this type might include: Results of a final short survey of the panel experts, included in the last round (Etxeandia‐Pradera et al, 2022), or conducted subsequently (Landeta et al, 2011; Turnbull et al, 2018), measuring, for example, the degree to which the method has been effective in obtaining input from the expert panel members, the degree to which the feedback received has helped them to improve their confidence in the answers given, their confidence in the technique or methodology used, the quality and clarity of the presentation of the questions, their satisfaction with participation in the study , and the usefulness of the results achieved . Another possibility would be to provide the output from a final focus group with the experts (Gisbert‐Trejo et al, 2023).…”