Self-assessment of clinical competence by general practitioner trainees before and after a six-month psychiatric placement.

Abstract

BACKGROUND: General practitioners (GPs) are responsible for managing the majority of mental health problems. There is evidence that the recognition and management of mental disorders could be improved. Vocational training schemes including a placement in psychiatry should be a prime opportunity to develop the requisite skills. AIM: To determine whether GP trainees thought that a six-month psychiatric placement had improved their clinical competence. METHOD: Questionnaires were sent to 18 junior doctors in the south-west region entering a senior house officer placement in psychiatry. Trainees rated their perceived competency in 20 skill areas at the beginning and at the end of six months. Comparisons between matched trainees were made using ranking techniques. RESULTS: There was a statistically significant improvement (P < 0.05) in perceived efficacy for matched trainees in 19 of the 20 areas of clinical competency appraised. The exception was in the confidence to identify different types of eating disorders. On completion of training, ability to diagnose depression, take a psychiatric history, and examine mental state were ranked most highly. However, skill levels in dealing with problems such as prescribing in acute psychosis and managing psychiatric emergencies were generally ranked above those dealing with neurotic and psychological problems. Most trainees indicated a favourable impression of their training experience. CONCLUSIONS: Clinical competency appeared to improve in all but one of the areas appraised. However, skills were ranked more highly in dealing with hospital-based problems than those likely to be encountered in primary care. This may have implications for the focus of psychiatric training currently received.