Residents Perceived Physician-Manager Educational Needs: A National Survey of Psychiatry Residents

Transcription

1 Residents Perceived Physician-Manager Educational Needs: A National Survey of Psychiatry Residents Sanjeev Sockalingam, MD, FRCPC 1 ; Vicky Stergiopoulos, MD, FRCPC 2,3,4 ; Julie Maggi, MD, FRCPC 2,3,5 Objective: To determine Canadian psychiatry residents perceived gaps in physician-manager competencies during their residency training. Methods: Residents at 16 Canadian psychiatry residency programs were mailed an 11-item questionnaire (a copy is available from the authors) assessing their perceived deficiencies in selected managerial knowledge (GS k ) and skill (GS s ) areas as determined by gap scores (GS). GSs are defined as the difference between residents perceived current and desired level of knowledge or skill in selected physician-manager domains. Residents educational preferences were also elicited in the questionnaire. Results: Among the 494 psychiatry residents who were sent the survey, 237 residents (48%) responded. Residents reported the greatest GS k in Program Planning and the greatest GS s in Personal and Professional Self-Care. Predictors of greater total GS k s included a lack of previous administrative education during medical school, higher training level, and female sex. Only sex was a significant predictor of total GS s s. More than 50% of residents preferred workshops, small groups, mentoring, and didactic learning methods for furthering their knowledge and skills. Conclusion: Residents report significant gaps in specific physician-manager training areas, specifically Program Planning, and Personal and Professional Self-Care. The results of this national survey can inform the development of formal physician-manager curricula. To appeal to residents, such curricula should incorporate more interactive pedagogical methods combined with mentoring opportunities. Can J Psychiatry 2008;53(11): Clinical Implications Canadian psychiatry residents identify gaps in physician-manager training. Physician-manager education should include contextual and interactive teaching methods. A formal physician-manager curriculum is required to address these educational deficiencies during residency training. Limitations Nearly one-half of Canadian psychiatry residents did not complete the survey. Several survey respondents had previous committee or administrative experience, which might have resulted in a response bias. Implementation of a physician-manager curriculum for psychiatry residents may be limited by individual program resources. Key Words: psychiatry, education, hospital administrators, leadership, CanMEDS roles The Canadian Journal of Psychiatry, Vol 53, No 11, November

2 In response to changes within the mental health care system, the concept of the physician-manager has surfaced within psychiatry over the past 2 decades. 1 Increasingly, physicians, including psychiatrists, are assigned leadership and management roles within interdisciplinary teams in acute and ambulatory care settings. As a result, the RCPSC has emphasized the need for training future physicians to be managers and included the physician-manager role as 1 of 7 essential CanMEDS roles for physicians. 2 The CanMEDS guidelines state that, as managers, physicians function as integral parts of healthcare organizations, organize sustainable practices, allocate resources and contribute to the overall effectiveness of the healthcare system, 2 p17 emphasizing the need for training in the area. In the United States, the Accreditation Council for Graduate Medical Education has also recognized the importance of physician-manager training and has incorporated this role into their medical education competencies, such as the systems-based practice competency. 3 Despite the emergence of the physician-manager role, physician training in administration and management has failed to progress as rapidly as training in other professions, such as nursing and social work. 4 Within psychiatry, surveyed practising psychiatrists and fellows report feeling deficient in their administrative and leadership training. 5,6 In a pilot study of Canadian psychiatry residents, Sinai and Hodges 7 reported the residents felt unprepared to fulfill 12 of the 23 defined CanMEDS competencies, particularly in the manager, scholar, and health advocate roles. As a result, the need for improved training generated a 2003 position paper by the Abbreviations used in this article CanMEDS COPE CPA MIT GS GS k GS s PGY RCPSC TGS TGS k TGS s Canadian Medical Education Directions for Specialists Committee on Postgraduate Education in Psychiatry Canadian Psychiatric Association Members-in-Training gap score gap score managerial knowledge gap score managerial skill postgraduate year Royal College of Physicians and Surgeons in Canada total gap score total gap score managerial knowledge total gap score managerial skill CPA emphasizing the need for residency training in the following administrative areas: organizational structures and change in mental health; models of mental health delivery; quality assurance; program development; conflict management; skills for teambuilding; leadership; and lifestyle management. 8 Despite these recognized deficiencies, few programs have developed formal curricula to address physician-manager training needs. In British Columbia, a series of didactic lectures starting in PGY1, followed by mentorship and elective training, were implemented to provide residents with early exposure to administrative and leadership issues. 8 A formal organizational theories curriculum for residents at the Cabrini Medical Center in New York City, providing didactic and experiential learning for PGY3 and PGY4 residents, was also described in the literature. 9 There has been a limited emergence of fellowship programs in North America as well, such as Columbia University s 1-year fellowship in Public Psychiatry, which is offered to physicians who have completed their postgraduate training in psychiatry. 10 The need for earlier exposure to managerial and administrative education requires consideration of residents needs. A recent pilot study surveying psychiatry residents, from PGY2 to PGY5, at the University of Toronto highlighted residents perceived needs and preferences regarding a physicianmanager curriculum. 11 In this pilot study, residents reported significant gaps between their perceived current level of knowledge and skill in certain areas, and their perceptions about how important it is to further their knowledge or skills. Residents perceived the greatest gaps in the knowledge areas of Physician Compensation and Program Planning, and the skill areas of Leading Change, and Personal and Professional Self-Care. The needs assessment results were used to develop a formal physician-manager curriculum for psychiatry residents at the University of Toronto, which was well received Although these preliminary results are useful indicators of psychiatry residents perceived deficiencies in physicianmanager training, they reflect a single institution and may not be generalizable to other psychiatry residency training programs. A more representative sample is required to inform the development of a formal physician-manager curriculum that can be more widely implemented, and to inform faculty development efforts. Therefore, a national needs assessment was undertaken to determine the perceived importance of selected administrative knowledge and skill areas for psychiatry residents across Canada. 746 La Revue canadienne de psychiatrie, vol 53, no 11, novembre 2008

3 Residents Perceived Physician-Manager Educational Needs: A National Survey of Psychiatry Residents Methods Sampling and Recruitment The survey sample consisted of all psychiatry residents, from PGY2 to PGY5, in Canada. PGY1 psychiatry residents were excluded, owing to the limited and varied psychiatric training exposure during their first year of training in each of the 16 Canadian programs. During the 2006/2007 academic year, a total of 392 Canadian psychiatry residents were training in 15 out of 16 Canadian psychiatry residency programs, excluding the University of Toronto. The total number of residents in each residency training program was verified by psychiatry residency programs postgraduate office and the CPA-MIT Contact Network. The CPA-MIT Contact Network was established by the MIT section and consists of one resident representative from all 16 psychiatry residency training programs in Canada. The survey accompanied with a study consent form was mailed in 2 phases: a general web-based mailing (sent in July 2006); and, a program-specific mailing (from November 2006 to June 2007). During phase 1, the web-based survey was distributed through 2 processes: Canadian psychiatry residents who were members of the CPA were sent a general through the CPA-MIT membership directory; and, the individual CPA-MIT Contact Network representative for each Canadian psychiatry residency training program distributed the same with the survey link and consent form to all psychiatry residents in their respective program. Two reminder s were sent to all residents at weekly intervals. In phase 2, the COPE and the psychiatry postgraduate offices assisted in the second mailing of either a paper or a web-based version of the questionnaire (which is available from the authors) to all Canadian psychiatry residents in 15 out of the 16 psychiatry residency programs (excluding the University of Toronto). Residents were asked not to answer the questionnaire twice and respondents remained anonymous. University of Toronto psychiatry residents (n = 102) were surveyed in a previously published pilot study and were excluded from this national survey mailing. 11 To provide a nationally representative sample, we included this pilot study data in our final data analysis. Although there was a 12-month delay between our administration of the University of Toronto and national surveys, we did not discover any information that would prohibit our inclusion of our pilot study sample in the final national sample. Through our consultation with the COPE and educational experts in the Faculty of Medicine at the University of Toronto, we verified that no new administrative or physicianmanager curricula had been developed and offered to psychiatry residents nationally during the 12-month period between the 2 data collection points. In addition, no literature on manager training curricula for psychiatry residents was published during this time. Therefore, a final study sample consisting of 494 psychiatry residents (102 residents from the University of Toronto and 392 residents from the remaining 15 Canadian psychiatry residency programs) were surveyed for this study. Ethics approval was obtained from the University of Toronto Research Ethics Board. Questionnaire Design The survey instrument, including the paper and web-based formats, was adapted from our pilot study and was designed to address psychiatry residents gaps in physician-manager knowledge and skill areas and their educational preferences. 11 The questionnaire consisted of 2 questions assessing residents perceived importance and current level of knowledge or skill in specified physician-manager domains (Table 1) using a Likert scale (coded 0, 1, and 2). Each knowledge or skill area was selected based on the existing literature, previous surveys of psychiatry fellows and psychiatrists, and subject areas identified in the CPA position paper. Moreover, each topic area was followed by specific examples to assist in residents understanding of each knowledge or skill domain (for example, Models of Health Care Delivery was followed by the terms shared care and assertive case management). The questionnaire also assessed residents educational preferences and demographic data. Respondents were asked for their preferred method of learning, teaching location, previous administrative education, age, sex, PGY training level, academic degrees held, desired future practice, and previous committee experience. Lastly, we conducted a focus group with psychiatry residents, from PGY2 to PGY5, at one University of Toronto affiliated teaching hospital to elicit feedback regarding the questionnaire, which was incorporated into the final version of the survey. Data Analysis All data were analyzed using SPSS version 14.0 software (SSPS Inc, Chicago, IL). We determined residents gaps in specific knowledge (GS k ) and skill areas (GS s ) by subtracting the perceived current knowledge or skill level from the perceived importance of furthering knowledge or skill area. Therefore, higher gap scores equate to a greater difference between residents perceived importance of furthering their knowledge or skill in a designated area and their perceived current knowledge or skill level in this area. Mean GSs in each knowledge or skill area were compared using a one-way, repeated, within-subjects measures ANOVA. Paired Student t tests were employed to determine significance between all mean GSs approaching 1. The Canadian Journal of Psychiatry, Vol 53, No 11, November

4 Table 1 Psychiatry residents perception regarding physician-manager knowledge and skill areas Perceived level Perceived importance GS (GS k or GS S ) Areas Mean (SD) Mean (SD Mean (SD) Knowledge Canada s Health Care System 1.06 (0.51) 1.27 (0.59) 0.20 (0.79) Health care reform 0.82 (0.58) 1.37 (0.64) 0.55 (0.84) Function of regulatory bodies 0.83 (0.56) 1.33 (0.57) 0.50 (0.79) Role of stakeholders in mental health 0.82 (0.58) 1.30 (0.63) 0.47 (0.71) Hospital and medical staff organizational structures, roles, and relationships 1.19 (0.65) 1.14 (0.60) 0.54 (0.80) Models of mental health care delivery 1.64 (0.53) 0.74 (0.68) 0.50 (0.77) Program planning 0.74 (0.68) 1.61 (0.53) 0.87 a (0.78) Program evaluation 0.88 (0.65) 1.32 (0.61) 0.44 (0.82) Principles of quality improvement 0.71 (0.65) 1.45 (0.60) 0.73 (0.79) Reading and understanding a financial statement and budgeting 0.77 (0.73) 1.35 (0.66) 0.58 (0.91) Physician compensation 0.89 (0.61) 1.59 (0.56) 0.70 (0.87) The Mental Health Act 1.43 (0.61) 1.79 (0.47) 0.37 (0.79) Skill Innovation and leading change 0.77 (0.57) 1.58 (0.52) 0.81 (0.72) Working in teams 1.58 (0.52) 1.51 (0.71) 0.08 (0.79) Negotiating and resolving conflict 1.26 (0.64) 1.66 (0.56) 0.40 (0.84) Personal and professional self-care 0.86 (0.74) 1.89 (0.33) 1.03 a (0.80) a P < 0.05 TGSs were created for all TGS k and TGS s areas by summing respondents individual knowledge or skill GSs and were used to determine predictor variables on multiple regression analyses. We selected the following 5 respondent characteristic variables in our multiple regression analysis: sex, advanced degree, past administrative experience, prior medical school education in administration, and level of training. Studies support the influence of sex on self-assessment scores, with women demonstrating more accurate scores on self-assessment measures. 14,15 The remaining variables were included based upon their hypothesized influence of administrative training and exposure on GSs. Covariates demonstrating a univariate association with TGS k and TGS s at P < 0.25 were selected for the multiple regression analysis. 16 We employed 2 independent multiple regression analyses with the 5 respondent characteristic variables as independent variables, and TGS k and TGS s as the dependent variables. Statistical significance was determined at P < 0.05 for all data analyses. Results The overall questionnaire response rate was 48% (n = 237), ranging from 17% to 82%. The mean age of respondents was 30.8 years (SD 4.07), and 54% were women. Distribution of respondents PGY training level was as follows: 28% PGY2, 27% PGY3, 19% PGY4, and 26% PGY5. A minority of respondents had advanced degrees: doctor of philosophy (4%), a master s in public health (1%), a master s in health science (1%), and a master s in business administration (1%). In total, 80% of respondents had previous committee experience, with a majority serving on their local psychiatry resident association (56%), educational committees (46%), and as chief residents (28%). Fewer respondents had participated in their provincial psychiatric association (14%), the COPE (4%), and the CPA (3%). A large proportion of questionnaire respondents envisioned working in an academic hospital (64%), either exclusively or in addition to other practice settings, compared with nonacademic (34%), office-based (29%), and rural-based settings (14%). 748 La Revue canadienne de psychiatrie, vol 53, no 11, novembre 2008

5 Residents Perceived Physician-Manager Educational Needs: A National Survey of Psychiatry Residents Table 2 Multiple linear regression analysis Predictor variables TGS k P TGS S P Constant Sex a Previous administrative education Level of training Advanced degree Prior committee experience F (df) 9.11 (4,203) (2,221) Adjusted R a Sex-coded: male = 1, female = 0 Values for predicator variables expressed as standardized. Perceived Knowledge and Skill Levels Respondents perceptions of perceived knowledge and skill levels in individual domains and their perceived importance of furthering their knowledge in each domain are summarized in Table 1. Survey respondents reported the highest perceived knowledge levels for Models of Mental Health Delivery and the Mental Health Act. Among the perceived skill domains, residents reported the highest perceived skill level in the areas of Working in Teams, and Negotiating and Resolving Conflict. Among knowledge areas, residents identified Program Planning and the Mental Health Act as the most important areas to further their knowledge. Respondents placed the greatest importance on furthering their skill level in the domains of Negotiating and Resolving Conflict, and Personal and Professional Self-Care. Knowledge and Skill GSs GS k s and GS s s are also summarized in Table 1. Examination of mean GS k s using ANOVA revealed a significant difference in mean GS k among knowledge areas (F = 17.32, df = 11,215, P < 0.001). Mean GS k was significantly higher for program planning (t = 2.39, df = 234, P = 0.02). ANOVA revealed a significant difference in mean GS s for the skill areas (F = , df = 3,233, P < 0.001). Mean GS s for Personal and Professional Self-Care (t = 3.73, df = 235, P < 0.001) was significantly greater than other skill domains. The following predictor variables met the significance level of P < 0.25 and were entered in the multiple linear regression analysis: sex, committee experience, level of training, and previous administrative education for TGS k ; and, sex and committee experience for TGS s. Multiple regression analysis revealed a significant association between TGS k and sex, prior administrative education in medical school, and PGY training level (Table 2). Sex was coded as follows: females = 0, males = 1. Therefore, the association between sex and TGS k indicates that female sex predicted greater TGS k scores. The model accounted for 13.5% of the variance of TGS k. No significant association was found with committee experience and TGS k. In contrast, only sex significantly predicted greater TGS s on multiple regression analysis, with the model accounting for 3.5% of the variance. No significant association was found between TGS s and committee experience. Therefore, female sex was associated with both TGS k and TGS s, whereas previous administrative education in medical school and higher training level were only associated with lower TGS k values. Educational Preferences of Residents Respondents were instructed to select all preferred methods of learning and indicated a strong preference for workshops (76%), small groups (56%), mentorship (56%), and lectures (52%). Least preferred learning methods included web-based formats (39%) and online discussion boards (5%). Fifty-seven percent of resident respondents favoured site-specific teaching, compared with 39% and 17% favouring a centralized location and the web, respectively. Discussion Our data confirms that psychiatry residents across Canada identify gaps in physician-manager training during residency. Greatest gaps were found in the physician-manager knowledge area of Program Planning and skill area of Personal and Professional Self-Care. Moreover, greater TGS k was associated with female sex, a lack of administrative education in medical school, and lower training level. Female sex The Canadian Journal of Psychiatry, Vol 53, No 11, November

6 was the only predictor of greater TGS s. Residents preferred pedagogical methods included workshops, small groups, mentorship, and lectures at their local hospital site. The GS findings are similar to those in our pilot study 11 at the University of Toronto. Both Program Planning, and Personal and Professional Self-Care were identified as priority areas for training in our previous study. The present findings of significant gaps in physician-manager training areas could reflect failures of existing curricula to address these areas or residents perceptions of the importance of these areas in future successful and rewarding careers. Knowledge about program development may be viewed as essential in securing an academic or hospital-based appointment preferred by most respondents. Moreover, residents encounter mental health programs throughout their residency training and could contribute to their perceived need to further their training in this recognizable area. Similarly, Personal and Professional Self-Care may be viewed as a much needed skill to succeed in a competitive and challenging health care environment. Resident and physician well-being are growing areas of concern, given the high rates of stress-related morbidity noted in physicians and residents Our findings may reflect residents continued need for skills to preserve resident wellness, both personally and professionally. However, our earlier finding of the high importance residents give to furthering knowledge in Physician Compensation and Leading Change was not replicated. On multiple regression analysis, we elicited an association between female sex and higher TGS k and TGS s. Evidence suggests that women have greater self-awareness, compared with men, and provide lower self-assessment ratings, which may account for the association we observed between female sex and higher GSs. 14,15 Smaller TGS k was associated with previous administrative education in medical school and higher training level. More senior residents might have had greater exposure to program and system level challenges as well as greater teaching in physician-manager knowledge domains, which could explain the association with lower perceived TGS k. Further, previous administrative training during medical school likely provided residents with some background administrative knowledge and could explain the trend for reduced TGS k with this educational experience. The finding that prior administrative education was not a predictor for TGS s may reflect the difficulty in transferring managerial skills from the classroom to an experiential setting. In contrast to residents exposure to administrative knowledge, residents at all levels may not encounter opportunities to practice administrative skills, thus reducing the overall association between the predictor variables and the TGS s. Lastly, committee experience was not a significant predictor of TGS k or TGS s. This finding may be supported by the notion that residents have limited mentoring and experience in key leadership roles during their participation on various committees and therefore have difficulty in learning managerial skills in this setting. Residents preferred pedagogical methods included workshops, small groups, and lectures at their local hospital sites. These preferences regarding pedagogy were similar to the results from our pilot study. Further, mentoring was popular amongst residents and the importance of mentoring relationships in preparing psychiatric administrators was previously reported in the literature. 21 Lastly, survey respondents preferred to receive physician-manager education at their local hospital, which lends itself to smaller groups and more interactive teaching methods. This highlights the urgent need for faculty development efforts to accommodate this preference. Despite the significant findings, there were several limitations in our study. Nearly one-half of Canadian psychiatry residents did not complete the survey, which could limit generalization of our results. Nonetheless, our survey response rate is comparable to reported mailed survey response rates in medical journals (mean 59%, SD 20%), with physician questionnaire response rates at about 50%. 6,22,23 Further, our sample is the largest published resident sample eliciting residents preferences regarding administrative or managerial education. The survey involved a wide geographic sampling of psychiatry residents across Canada, including at least one residency program in Quebec, the Atlantic provinces, and the Western provinces, with a greater than 55% response rate. Other limitations include a potential response bias, given that nearly 80% of respondents had served on committees and about 25% of respondents had some experience as a chief resident. Although we acknowledge the possibility of a response bias, committee experience did not significantly predict TGSs for either knowledge or skill areas on multiple regression analysis. Lastly, the extended duration of data collection could confound our results; however, our consultations with educational experts and organizations and review of the literature did not identify any new administrative curricula or programs for psychiatry residents that would greatly influence the results from our sample. Conclusions Given the RCPSC s recent focus on physician-manager training in the CanMEDS framework, our study findings should be considered in the development of physicianmanager curricula during psychiatric residency training. The results of our pilot study have informed our development and implementation of a physician-manager curriculum for psychiatry residents, from PGY2 to PGY5, at the University of Toronto. The curriculum includes 4 workshops in each of PGY2 and PGY4, using both didactic and small group 750 La Revue canadienne de psychiatrie, vol 53, no 11, novembre 2008

7 Residents Perceived Physician-Manager Educational Needs: A National Survey of Psychiatry Residents formats, and is supplemented with supervised, longitudinal quality improvement projects during the PGY3. It is hoped that the results of our national survey will inform other Canadian psychiatry residency programs efforts in expanding physician- manager training and faculty development opportunities. Further research is required to guide the evaluation of residents in these desired competencies and to develop effective strategies for longitudinal reinforcement of learning. Funding and Support This work was supported by the Department of Psychiatry at St Michael s Hospital, Toronto, Ontario. Acknowledgements We thank Dr Susan Lieff, Dr Ivan Silver, and Ms Tina Smith for their feedback in developing the survey. We also thank the MIT section of the CPA and the Committee on Postgraduate Education in Psychiatry for their effort in disseminating the questionnaire. We thank Dr Robin Ouellet for his French translation of the questionnaire and consent forms, and Rosane Nisenbaum for her assistance with the statistical analysis of the data. References 1. Feldman S. Leadership in mental health: changing the guard for the 1980s. Am J Psychiatry. 1981;138: The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. In: Frank JR, editor. Ottawa (ON): The Royal College of Physicians and Surgeons of Canada; Accrediatation Council for Graduate Medical Education. ACGME Outcome Project [Internet]. Chicago (IL): ACGME; 2007 [cited 2007 Aug 22]. Available from: 4. Garman AN, Corrigan PW. Management coursework in graduate behavioral health programs. J Health Adm Educ. 1999;17: Stubbe DE. Preparation for practice: child and adolescent psychiatry graduates assessment of training experiences. J Am Acad Child Adolesc Psychiatry. 2002;41: Tobin M, Edwards JL. Are psychiatrists equipped for management roles in mental health services? A N Z J Psychiatry. 2002;36: Sinai J, Hodges B. An evaluation of the CanMEDS roles with psychiatry residents: a pilot study. Ann RCPSC. 1999;32: Somers JL, Goldner EM, Leseage AD, et al. Filling gaps in psychiatric education: skills in administrative psychiatry and knowledge of mental health systems, services and policy. Can J Psychiatry. 2004;49:1 6. Insert. 9. Yu-Chin R. Teaching administration and management within psychiatric residency training. Acad Psychiatry. 2002;26: Columbia University. Public psychiatry fellowship program. Public psychiatry fellowship academic curriculum [Internet]. New York (NY): New York State Psychiatric Institute; 2001 [cited 2007 Aug 23]. Available from: Sockalingam S, Stergiopoulos V, Maggi J. The physician as a manager: psychiatry residents perceived gaps in knowledge and skills in administrative psychiatry. Acad Psychiatry. 2007;31: Maggi JD, Stergiopoulos V, Sockalingam S. Barriers and facilitators to implementing a new physician-manager curriculum into a postgraduate psychiatry training program. Psychiatr Q. 2008;79: Stergiopoulos V, Maggi J, Sockalingam S. Teaching the physician manager role during psychiatric residency: development and implementation of a pilot curriculum. Paper presented at the 57th Annual Conference of the Canadian Psychiatric Association, Montreal, Quebec, Bakken LL, Sheridan J, Carnes M. Gender differences among physician-scientists in self-assessed abilities to perform clinical research. Acad Med. 2003;78: Lind DS, Rekkas S, Bui V, et al. Competency-based student self-assessment on a surgery rotation. J Surg Res. 2002;105: Hosmer DW, Lemeshow S. Applied logistic regression. New York (NY): John Wiley; Ramirez AJ, Graham J, Richards MA, et al. Mental health of hospital consultants: the effect of stress and satisfaction at work. Lancet. 1996;34: Reuben DB. Depressive symptoms in medical house officers: effects of level of training and work rotation. Arch Intern Med. 1985;145: Valko RJ, Clayton PF. Depression in internship. Dis Nerv Syst. 1975;36: Collier VU. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002;136: Greenblatt M, Rose SO. Illustrious psychiatric administrators. Am J Psychiatry. 1977;134: Asch DA, Jedrziewski MK, Christakis NA. Response rates to mails survey in published medical journals. J Clin Epidemiol. 1997;50: Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35: Manuscript received November 2007, revised, and accepted February This paper was presented as a Poster Presentation at the Academy of Psychosomatic Medicine, 54th Annual Meeting, Amelia Island, Florida, This paper was also presented as part of a workshop at the Canadian Psychiatric Association, 57th Annual Conference, Montreal, Quebec, Psychiatrist, Medical and Surgical Psychiatry Program, University Health Network, Toronto General Hospital, Toronto, Ontario; Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario. 2 Staff Psychiatrist, St Michael s Hospital, Toronto, Ontario. 3 Assistant Professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario. 4 Associate Scientist, Centre for Research on Inner City Health, Toronto, Ontario. 5 Staff Psychiatrist, Women s College Hospital, Toronto, Ontario. Address for correspondence: Dr S Sockalingam, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 8 Eaton North-225, Toronto, ON M5G 2C4; Sanjeev.Sockalingam@uhn.on.ca The Canadian Journal of Psychiatry, Vol 53, No 11, November

8 Résumé : Les besoins perçus des résidents en matière de formation du médecin-gestionnaire : un sondage national des résidents en psychiatrie Objectif : Déterminer les lacunes des compétences de médecin-gestionnaire que perçoivent les résidents en psychiatrie canadiens durant leur formation de résidence. Méthodes : Les résidents de 16 programmes canadiens de résidence en psychiatrie ont reçu par la poste un questionnaire de 11 items (les auteurs peuvent en fournir une copie) servant à évaluer les déficiences perçues des connaissances choisies en gestion (CELc) et des domaines de compétences (CELd), telles que déterminées par les cotes d évaluation des lacunes (CEL). Les CEL sont définies comme étant la différence, dans la perception des résidents, entre le niveau actuel et le niveau souhaité des connaissances ou compétences dans des domaines choisis de la gestion médicale. Les préférences éducationnelles des résidents ont aussi été sollicitées dans le questionnaire. Résultats : Sur les 494 résidents en psychiatrie à qui le sondage a été envoyé, 237 résidents (48 %) ont répondu. Les résidents ont déclaré la CELc la plus élevée dans la planification de programme et la CELd la plus élevée dans l autonomie personnelle et professionnelle. Les prédicteurs des CELd totales les plus élevées incluaient le manque de formation administrative précédente à la faculté de médecine, un niveau de formation plus élevé, et le sexe féminin. Seul le sexe était un prédicteur significatif des CELd totales. Plus de 50 % des résidents préféraient les ateliers, les petits groupes, le mentorat, et les méthodes d apprentissage didactique pour perfectionner leurs connaissances et leurs compétences. Conclusion : Les résidents ont déclaré des lacunes significatives dans des domaines spécifiques de la formation des médecins-gestionnaires, en particulier la planification de programme, et l autonomie personnelle et professionnelle. Les résultats de ce sondage national peuvent éclairer l élaboration des programmes d études officiels en gestion médicale. Pour plaire aux résidents, ces programmes d études devraient incorporer des méthodes pédagogiques plus interactives jumelées à des possibilités de mentorat. 752 La Revue canadienne de psychiatrie, vol 53, no 11, novembre 2008