Psychogeriatric training in Australia and New Zealand: a survey of psychiatry trainees and training program co-ordinators

Trainee experiences in a specialist neuropsychiatry training position

OBJECTIVE

To explore trainee perceptions of a specialist training post in neuropsychiatry.

METHOD

Of 47 past trainees who had worked in the Neuropsychiatry Unit at the Royal Melbourne Hospital during the period 1993 to 2017, 32 (68%) completed an online questionnaire including 10 questions, 4 of which asked for open-ended responses.

RESULTS

Most trainees provided positive feedback about their past experiences working on the unit, including utilizing knowledge and experience in their current practice. To an open question about how working on the unit influenced career choices 21/31 (68%) responses were positive. The remaining 10 responses highlighted areas of improvement for the trainee positions.

CONCLUSIONS

The specialty training position within neuropsychiatry was very popular among past trainees, the majority of whom endorsed using the knowledge learnt in neuropsychiatry in their current practice and recommended work on the unit to future trainees.

Perceptions of psychiatry of old age amongst psychiatry registrars in Australia and New Zealand

OBJECTIVE

To assess the perceptions of psychiatry registrars of their training experience in Psychiatry of Old Age (POA), and whether factors such as clinical exposure and stage of training correlate with these perceptions.

METHOD

Royal Australian and New Zealand College of Psychiatrists (RANZCP) registrars were surveyed in September 2009. Demographic information, POA exposure and responses to 14 statements related to registrar experience were collected.

RESULTS

From 978 surveys sent, 226 responses were complete enough to be analysed. Themes that emerged included a high level of enjoyment of a POA rotation, favourable views of supervision, the challenging nature of managing medical co-morbidities and concerns regarding the teaching of cognitive assessment. In general, type or duration of POA exposure and demographic variables were not correlated with a significant difference in perceptions of the field.

CONCLUSION

These data may be useful in addressing a shortfall of trainees in POA, which has implications for the health of older Australasians. It may inform service providers and the RANZCP of factors that could be modified or optimised to encourage registrars to consider subspecialty training in the area.

Teaching and training in old age psychiatry: a general survey of the World Psychiatric Association member societies

OBJECTIVE

One of the main goals of the World Psychiatric Association (WPA) section on old age psychiatry is to promote its discipline and consequently to help member societies to promote and develop locally specific medical education programmes in old age psychiatry. In order to target its support to the needs expressed by the member societies, the section conducted a survey within the WPA during the year 2001.

METHOD

A questionnaire was sent to each of the 116 WPA member societies in 93 countries. It assessed the level of development of medical education in old age psychiatry in each country, as well as the perceived needs in educational material.

RESULTS

Answers were obtained from 50 WPA member societies (response rate 54%) from 48 countries (response rate 52%). The existence of specific old age psychiatry services was reported in 40 (83%) countries, but the discipline is recognized as a subspecialty in only 13 (27%). Formal teaching in old age psychiatry was reported at the undergraduate level in 44 (92%) countries. Specific learning objectives for postgraduate training were reported in 30 (86%) of the countries where the discipline is not yet recognized as a subspecialty. Specific Continuing Medical Education (CME) programs were however reported in only 50% of the countries. Support for the development of educational material was mostly thought to be useful at the postgraduate level. Depression, dementia, psychopharmacology and psychotherapy were among the most frequently cited areas in which educational material might be usefully provided.

CONCLUSION

Support for the development of postgraduate training is seen as the most pressing need by WPA member societies. Such support could help to increase the level of recognition of the discipline locally and hence provide more effective support to older people with mental disorders.

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study

OBJECTIVE

To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices.

METHOD

Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire.

RESULTS

Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential.

CONCLUSIONS

The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

Psychiatry of old age: from section to faculty

OBJECTIVE

To describe the processes that led to formation of the RANZCP Faculty of Psychiatry of Old Age (FPOA).

METHOD AND RESULTS

Two criteria needed to be fulfilled before Faculty status could be approved. One was to demonstrate a recognised body of knowledge concerning psychiatry of old age, and the other was to be able to offer a comprehensive training program in this subspecialty.

CONCLUSIONS

On 1 January 1999, FPOA came into existence.

The Senior Psychiatrist Survey III: attitudes towards personal ageing, life experiences and psychiatric practice

OBJECTIVE

The aim of this study is: to explore whether there is a relationship between the effects of gender, age and perceptions of personal health on psychiatrist's reactions to personal ageing; and to determine the effects of psychiatrist's reactions to personal ageing upon their approach to clinical practice, retirement planning and post-retirement activities.

METHOD

A postal survey was conducted. Respondents were Fellows of the Royal Australian and New Zealand College of Psychiatrists resident in Australia or New Zealand. Of 1086 eligible subjects, 529 participated. The main outcome measures were: Reactions to Ageing Questionnaire (RAQ); self-rated health; location and type of psychiatric practice; the perceived benefits and drawbacks of age on psychiatric practice and case selection; and retirement plans.

RESULTS

Positive attitudes towards personal ageing were significantly associated with old age, males and good or excellent self-rated health. Negative attitudes were associated with working in universities and anticipated retirement due to poor health. Field of practice, anticipated post-retirement activities and approach to clinical practice were not found to have a significant effect on attitudes towards personal ageing.

CONCLUSIONS

The effects of life experiences on psychiatrists' attitudes towards personal ageing are complex. Attitudes towards personal ageing have little impact on psychiatric practice.

A survey of psychiatric services for elderly people in Australia

In 1992 a postal questionnaire identified 107 psychiatrists in Australia who, for a significant proportion of their time, were providing psychiatric services to elderly people. Only 18% were female. There were 34 psychiatrists working full-time in psychiatry of old age in the public health system. Twenty-three multidisciplinary catchment area psychiatric services for elderly people were identified, but staff to population ratios varied considerably. The ratio of psychiatrists to elderly was 1:30,000--similar to the ratio in a large part of Britain seven years previously. Psychogeriatricians are involved in a broad range of teaching and research activities. The mean number of non-medical staff in a catchment area psychogeriatric service should be increased.