Academic Psychiatry 27:174-181, September 2003
© 2003 Academic Psychiatry
How Competent Are We to Assess Psychotherapeutic Competence in Psychiatric Residents?
Joel Yager, M.D. and
David Bienenfeld, M.D.
Dr. Yager is Professor and Vice Chairman for Education and Academic Affairs at the University of New Mexico School of Medicine, Albuquerque, New Mexico and Professor Emeritus, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles School of Medicine, Los Angeles, CA. Dr. Yager is also with the Board of Trustees for the American Psychiatric Institute for Research and Education (APIRE). Dr. Bienenfeld is Professor, Vice Chairman, and Director of Residency Training in the Department of Psychiatry at Wright State University, Dayton, Ohio. Address correspondence to Dr. Yager, Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker NE, Albuquerque, NM 87131-5326, jyager{at}unm.edu (E-mail).
Background: The Residency Review Committee (RRC) for Psychiatry has mandated that training programs "must demonstrate that residents have achieved competency in at least the following forms of treatment: brief therapy, cognitive-behavioral therapy, combined psychotherapy and psychopharmacology, psychodynamic therapy, and supportive therapy." Aim: To analyze the extent to which programs can realistically demonstrate that residents have achieved summative competency in these modalities. Method: We briefly review methods from other fields for assuring procedural competence, review methods available to psychiatric educators for assuring competencies in psychotherapy, and assess these methods for their adequacy. Results: Available and foreseeable assessment methods are incapable of demonstrating that residents achieve summative competency in the five specified psychotherapies or of definitively distinguishing potentially dangerous practitioners from safe practitioners. At best, educators may be able to assure formative competencies, including mastery of core knowledge of the psychotherapies, actual undertaking of these psychotherapies, and adequate performance in selected elements of these psychotherapies. Conclusions: Since it is unrealistic to assume that training programs will ever be able to confirm summative competencies in these psychotherapies, we advise programs to define precisely the levels of formative competence they expect, and design curriculum and measures accordingly. Further, we urge the RRC to revise their requirements to address expectations more honestly, and to re-state the expected competencies more modestly. We believe that the RRC can expect programs to show that all residents can demonstrate knowledge about the evidence base, theories and rules of practice supporting at least the following forms of treatment: brief therapy, cognitive-behavioral therapy, combined psychotherapy and psychopharmacology, psychodynamic therapy, and supportive therapy. We also believe that programs might be asked to demonstrate by means of patient logs and other forms of documentation that all residents have at least conducted such types of psychotherapy under qualified supervision.
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