GROWTH OF PSYCHIATRISTS DURING AND AFTER RESIDENCY TRAINING: AN OBJECTIVE EVALUATION

For the past 7 years the Educational Research Committee of the psychiatric training center in Topeka, Kansas, has attempted to evaluate objectively (a) the impact of psychiatric training on residents and (b) the post-residency development of psychiatrists. Our initial project was confined to a study of the development of psychiatric knowledge, factual, theoretical and clinical, in our test subjects. The first year's efforts were reported in 1955(2). This paper describes our 1956-57 project in which we devised 100-item multiple choice questions and administered them to 7 test groups: beginning residents in their first week of training; residents at the end of their first, second and third years; junior hospital staff psychiatrists; senior staff psychiatrists (Board certified); our Board certified alumni in private practice. The examination investigated knowledge only in basic subjects such as psychodynamics, psychotherapy and ward management, but not subspecialties such as psychosomatic medicine, research methodology and forensic psychiatry.

There is a discernible pattern of growth in psychiatric residents, year by year. The first year of training is the period for absorbing the psychiatric body of knowledge. Second and third year residents, and junior staff psychiatrists, perform slightly better than first year residents in most categories; on the whole, however, a remarkable lag in acquisition of basic psychiatric knowledge is evidenced by residents' scores, the one exception being the steady yearly improvement in knowledge of psychodynamics. Although advanced residents seem not to acquire much additional knowledge, the examination reveals a process of integration and facility in using it clinically which first year residents lack.

A second significant development in useable knowledge coincides with the period of concentrated preparation for passing the examinations of the American Board of Psychiatry and Neurology. The Board certified psychiatrists exceed our other test groups in factual, theoretical and clinical knowledge. Post-residency psychoanalytic training produces a measurably greater proficiency in theory.