Resident Training in the Psychiatric Emergency Service: Duty Hours Tell Only Part of the Story

Abstract

Background Psychiatry residents in North America are generally required to work on-call on the psychiatric emergency service (PES) during training. Resident discontent with the long hours, onerous case loads, and lack of on-call teaching has been reported as a barrier to PES training. Given that the PES is a longitudinal and important experience, we sought to develop a better understanding of this service from the resident perspective and identify factors that affect residents as they work and train in this area. Methods In this grounded theory qualitative study, we collected data from focus groups with psychiatry residents. We analyzed data according to grounded theory methodology to develop an enhanced understanding of the resident experience on the PES. Results Three major themes emerged from data analysis: (1) challenges residents face in the PES are complex and attributable to more than simply long duty hours, (2) the PES offers unique learning opportunities for residents, and (3) resident satisfaction with the PES depends on a good relationship with the team. Conclusions This study highlights important topics for any residency programs that require residents to work on a PES team. Although much attention has been paid to addressing challenges inherent to the on-call experience, such as limiting the amount of on-call hours and call frequency, equal attention should be paid to team dynamics. Like prior work on physician contentment and multidisciplinary team functioning, our study found that physicians will tolerate stressful workplace factors, so long as there is a supportive and healthy team dynamic. It is important for program directors to identify problems with team dynamics in the PES in light of their potential impact on residents.

Teaching emergency situations during a psychiatry residency programme using a blended learning approach: a pilot study

“…There were some limitations to this study: (1) As this was a pilot study, it was conducted with a relatively small sample within a single residency programme. (2) There was no control group using standard teaching to compare the real efficacy of this programme.…”

“…Emergency training is essential for mental health care as it represents the gateway to the mental health care system for many patients [ 1 ]. A psychiatric emergency is defined by the American Psychiatric Association as “an acute disturbance in thought, behaviour, mood, or social relationship, which requires immediate intervention as defined by the patient, family, or social unit”.…”