Selection of New Psychiatry Residents Within a National Program: a Qualitative Study of Faculty Perspectives on Competencies and Attributes

Poremski, Daniel; Tan, Gregory Tee Hng; Lau, Boon Jia; Lee, Yu Wei; Sim, Kang

doi:10.1007/s40596-020-01282-1

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…This challenge highlights the importance of life experience and maturity, which is important in the selection of psychiatry residents in Singapore. 20 It is also relevant to note that the success of clinical reasoning processes was not evaluated by the authors, and therefore, we have assumed that proficiency accrues with experience. This also engenders the assumption that independent psychiatrists had superior, and therefore preferable, clinical reasoning practices.…”

Section: Discussionmentioning

confidence: 99%

“…This centralized postgraduate training program has followed the American Accreditation Council for Graduate Medical Education—International (ACGME-I) system since 2010. 20 Residents rotate across several training settings during their 5 years, covering different facets of psychiatry. To supplement its demand for mental health services, foreign staff are actively recruited, and so psychiatrists from multiple countries practice in Singapore.…”

Section: Methodsmentioning

confidence: 99%

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The development of clinical reasoning throughout the training and career of psychiatrists in Singapore

Poremski,

Kwang,

Lim

et al. 2023

Int J Med Educ

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Objectives The current study sought to explain how different professional experiences led Singaporean psychiatrists to alter their clinical reasoning processes as their careers evolved from psychiatry residents to senior consultant psychiatrists. Methods The current qualitative study interviewed 26 clinicians at various stages of their psychiatric career, spanning residents to senior psychiatrists. The authors used a constructivist grounded theory approach to structure the collection and analysis of data. Analyses produced a dense theoretical explanation rooted in the experiences of participants. Results Several differences emerged between the way psychiatry residents and senior psychiatrists explained their reasoning process and the experiences on which they based their preference. Residents preferred using deductive logic-driven frameworks that were diagnosis-centric, because of the pressures they experienced during their training and assessments. Senior psychiatrists emphasized a more holistic and problem-centric approach. Participants attributed the changes that occurred over time to practical experiences, such as their greater clinical responsibility and independence, and individual experiences, such as growing sensitivity to the clinical reasoning process or their growing propensity for professional reflectiveness. These changes manifest as an increase in repertoire and flexibility in deployment of different clinical reasoning strategies. Conclusions It is important for trainees to be aware of the deductive and inductive modes of clinical reasoning during supervision and to be comfortable with shifting clinical focus from diagnoses to specific individual problems. Training programs should provide and plan adequate longitudinal clinical exposure to develop clinical reasoning abilities in a way that allows consequences of decisions to be explored. Continued faculty development to ease the diversification of clinical reasoning skills should be encouraged, as should reflectivity in the learners during clinical supervision.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The development of clinical reasoning throughout the training and career of psychiatrists in Singapore

Poremski,

Kwang,

Lim

et al. 2023

Int J Med Educ

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“…Most of the psychiatrists practicing in Singapore were trained locally. The local training system follows the US model and is accredited by the Accreditation Council for Graduate Medical Education-International [18]. While discussions about diagnostic criteria often follow the DSM nomenclature [19], the medical records record diagnoses as SNOMED and ICD-10 codes.…”

Section: Settingmentioning

confidence: 99%

The longitudinal dispositions of people diagnosed with adjustment or severe stress disorders

Poremski,

Hariram,

Wong

et al. 2024

BMC Psychiatry

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Background Adjustment and stress-related disorders are prevalent among psychiatric service users. Despite their prevalence, little is known about their prognosis. To reduce that gap, the present article documents the service use and diagnostic outcomes of people with adjustment or stress-related disorders presenting at Singapore’s largest psychiatric emergency department. Methods Administrative data from 2014 to 2021 was retrieved to follow a group of 683 service users whose first-ever psychiatric presentation in 2014 warranted a diagnosis of adjustment or stress-related disorder. People were grouped a priori depending on whether different diagnoses were recorded within 7 days, 9 months, after 9 months or not at all. Survival curves characterized conversion to other diagnoses and engagement with healthcare services. Service use outcomes include the number of hospitalizations, outpatient appointments, emergency department visits, and prescriptions. Results Sixty-one percent (n = 417) never received another diagnosis over the 8-year period. This group used emergency services most and received the most pharmacotherapy shortly after their first visit. Of those who received another diagnosis, depression, personality disorders, and psychotic disorders were the most common. Those who received another diagnosis within 7 days (n = 70, 10%) received it on their first day of hospitalization (IQR 1–1), making the most use of inpatient services. The group who received another diagnosis within 9 months (n = 105, 15%) did so after 42 days (IQR 26–84) and had the highest relative number of deaths. Those who received another diagnosis after 9 months (n = 91, 13%) did so after 1,134 days (IQR 613–1,823) and had the longest period of engagement but made the least use of any psychiatric service, potentially suggesting a group whose early index diagnosis heralded vulnerability to future disorders. Conclusions A large group of service users with acute stress or adjustment disorders will likely never be given another psychiatric diagnosis and appear to disengage following an initial period of high-intensity service use. The group that received a different diagnosis after the 9-month mark had prolonged contact with services but low intensity of service use and may represent a target for preventative intervention to help them improve their stress-managing skills and avoid developing other disorders.

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“…Manuscripts in this category suggest that there is a combination of measures such as clerkship grades, test scores, and skills simulations that will predict performance on outcome measures such as Accreditation Council for Graduate Medical Education (ACGME) Milestones or a graduate rank order list (re-ranking at the time of graduation). [16][17][18][19][20][21][22] Manuscripts vary in whether they focus on predictions of success in the specialty overall [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] or specifically within training programs. 16,18,19,[36][37][38][39][40][41] Authors of manuscripts in this category describe priority being given to selecting those who will do well during postgraduate training and also focus on avoiding those who will need remediation or be disruptive to program leadership.…”

Section: Using Available Metrics To Predict Performance In Postgradua...mentioning

confidence: 99%

Postgraduate Selection in Medical Education: A Scoping Review of Current Priorities and Values

Caretta-Weyer,

Eva,

Schumacher

et al. 2023

Academic Medicine

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Purpose: The process of screening and selecting trainees for postgraduate training has evolved significantly in recent years, yet remains a daunting task. Postgraduate training directors seek ways to feasibly and defensibly select candidates, which has resulted in an explosion of literature seeking to identify root causes for the problems observed in postgraduate selection and generate viable solutions. The authors therefore conducted a scoping review to analyze the problems and priorities presented within the postgraduate selection literature in order to explore practical implications and present a research agenda. Method: Between May 2021 and February 2022, the authors searched PubMed, EMBASE, Web of Science, ERIC, and Google Scholar for English language literature published after 2000. Articles that described postgraduate selection were eligible for inclusion. 2,273 articles were ultimately eligible for inclusion. Thematic analysis was performed on a subset of 100 articles examining priorities and problems within postgraduate selection. Articles were sampled to ensure broad thematic and geographical variation across the breadth of articles that were eligible for inclusion. Results: Five distinct perspectives or value statements were identified in the thematic analysis: (1) Utilizing available metrics to predict performance in postgraduate training; (2) Identifying the best applicants via competitive comparison; (3) Seeking alignment between applicant and program in the selection process; (4) Ensuring diversity, mitigation of bias, and equity in the selection process; and (5) Optimizing the logistics or mechanics of the selection process. Conclusions: This review provides insight into the framing and value statements authors use to describe postgraduate selection within the literature. The identified value statements provide a window into the assumptions and subsequent implications of viewing postgraduate selection through each of these lenses. Future research must consider the outcomes and consequences of the value statement chosen and the impact on current and future approaches to postgraduate selection.

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Selection of New Psychiatry Residents Within a National Program: a Qualitative Study of Faculty Perspectives on Competencies and Attributes

Cited by 4 publications

References 23 publications

The development of clinical reasoning throughout the training and career of psychiatrists in Singapore

The development of clinical reasoning throughout the training and career of psychiatrists in Singapore

The longitudinal dispositions of people diagnosed with adjustment or severe stress disorders

Postgraduate Selection in Medical Education: A Scoping Review of Current Priorities and Values

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