Training Psychiatry Residents in Descriptive Psychopathology: A Systematic Review

Abstract

Purpose: Descriptive psychopathology (DP, sometimes called psychopathology or phenomenology) is the language of psychiatry and is dedicated to the description of mental symptoms. Due to its importance, there is an ongoing case to put it back at the heart of psychiatry and its training. This study seeks to examine the literature on how to train psychiatry residents in DP, including reported educational interventions and educational methods. Method: The authors conducted a systematic review following the PRISMA and BEME guidelines to identify literature on how to train psychiatry residents in DP. In May 2019, they searched in Embase, ERIC, PsycINFO, PubMed, Scopus, and Web of Science; of 7,199 initial results, 26 sources were finally included for analysis. The assessment tools were the CRAAP test, Kirkpatrick’s 4 levels, and (when applicable) the Medical Education Research Study Quality Instrument (MERSQI). Results: The mean CRAAP score was 38.885 of a possible 50 (SD 0.983; range: 36.859–40.910). Fourteen sources (53.8%) had some kind of training evaluation: Kirkpatrick’s level 1 was present in nearly all (13) and was the highest in half of them (7). Regarding the educational interventions, the mean MERSQI score was 10.592 of a possible 18 (SD 2.371; range 9.085–12.098). Lectures were the most widely reported educational method (5); among those in clinical settings, the live supervised interview with feedback was the most usual (4). Conclusions: Despite its core importance as the language of psychiatry, the literature about training psychiatry residents in DP is scarce and heterogeneous. General lack of training evaluation and ongoing overemphasis on Kirkpatrick’s levels 1–2 at the expense of levels 3–4 are causes for concern. During the review process, the authors identified a selection of educational interventions that could serve as the basis for the design of new training efforts in both clinical and nonclinical settings. Topics for future research are also suggested, such as the role of DP in competency-based training frameworks now in vogue and a series of neglected contents. Finally, the combined use of the CRAAP test and the MERSQI may be useful for future systematic reviews in medical education.

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

“…As pointed out by Jaspers and Parnas [7,8,13], training in DP should encompass both a knowledge framework and the clinical capacity to use it properly with a variety of patients and within increasingly complex healthcare systems. In this regard, a recent systematic review of the literature on how to train psychiatry residents in DP identified a series of shortcomings and challenges [14].…”

“…The current lack of clinical training and assessment in DP is a cause for major concern, as DP comes alive in the patient-psychiatrist dialogue [14]. Clinical practice within real work contexts with actual patients is essential, especially as DP is senseless without real patients and simulation has intrinsic limitations regarding essential aspects (e.g., empathy) in the patient-psychiatrist dialogue that leads to symptom formation [15].…”

“…Training the trainers/supervisors in both content (DP) and form (how to train/supervise residents) seems as important as challenging. As far as we are concerned, no such hybrid initiatives have been reported so far [14]. Psychiatry does have broad literature on educating psychiatrists in how to train/supervise residents [17,57,58]; these general sources, together with the more specific initiatives pointed out in this Delphi study, may be a useful starting point.…”

“…Teaching of social sciences within psychiatry curricula has long been discussed [14,[62][63][64]; Jaspers himself considered that despite not having a specific applicability, it did provide interesting insight to the future psychopathologist [13]. Here, the expert panel considered the social sciences interesting as background disciplines, but not essential to be given predominant role as part of DP training during psychiatry residency.…”

“…Despite some didactic initiatives in this regard, a series of neglected contents have been identified, such as epistemological themes and contributions from classic and contemporary authors; the latter have been absent in the DP training experiences reported so far. These issues are considered to require further reflection and development [14].…”