Abstract
Reading this book confirmed to the reviewer he meet all the diagnostic criteria for a grumpy-old-man selfindulgently reflecting on the barrenness of modern western thought.
On to specifics. The US has characteristically delegated a private organization called the Accreditation Council for Graduate Medical Education (ACGME) to accredit residency education programs and this book was written for directors of psychiatric residency programs to detail the policies and procedures that a residency program has to meet for accreditation. The guiding principals of this organization are ‘whatever we measure we improve, programs need more flexibility to be creative and public accountability must be served’.
Part of this philosophy is of course ‘devising and implementing evaluation instruments that accurately assess attained competencies’.
On the positives, the book succinctly describes the natural history of the acquisition of clinical skills and how laborious conscious rule learning progresses to skilled, unconscious pattern recognition.
This is followed by a useful discussion on how a supervisor can attempt to negotiate the sensitive area of providing accurate feedback to residents minimizing the possibility of hurt and resentment and keeping the resident–supervisor relationship on a sound footing. I liked the way the apprenticeship model was emphasized and the statement ‘the best way to collect data of trainees' work comes from observations of repeated patient interactions’.
The final part of the book is described as a toolbox (now why did not we think of that phrase?) of assessment methods and the nationalistic reader will be glad to hear the College now possesses a considerably bigger toolbox than the Yanks.
Comments about OSCEs (Objective Structure Clinical Examination) being difficult to create and administer and only cost-effective when many candidates are examined at one site will resonate with many readers.
Happily, we so far seem to have avoided the current fashion of 360-degree evaluation instruments that have been enthusiastically embraced by the Americans and Brits. These involve supervisors, fellow trainees, nursing and allied health professionals, patients and their families all rating a hapless resident's performance.
So, in summary, the book highlights all that's good and all that's bad about modern approaches to postgraduate psychiatry training where stultifyingly dull and mindlessly formulaic approaches are being applied to what is essentially a process of conveying something of the wonder and complexity of human behaviour to a younger generation.
Hopefully, despite the cluster C pile of forms, governance structures, consumer-focused outcomes and labrynthine bureaucracy our trainees will still be able to hear what John Ellard so eloquently described as the music of psychiatry.