RESULTS & CONCLUSIONS

1. 200 180 Each Resident’s COSE Score 160 140 120 0 5 10 15 Each Resident’s Outpatient Clinic Volume Psychotherapy Self-efficacy and Resident Outpatient Clinic Volume M. S. Chisolm, M.D. Johns Hopkins University School of Medicine Department of Psychiatry and Behavioral Sciences Baltimore, Maryland The author reports no conflict of interest for this study INTRODUCTION RESULTS & CONCLUSIONS • Medical education confers knowledge, skills and confidence that transfer easily to psychiatric resident inpatient training. However, psychiatry residents soon begin to care for outpatients, many of whom seem more troubled than diseased. With these patients who need psychotherapy, instead of or in addition to medication, psychiatry residents can feel unprepared and ineffective1,2 • Confidence, or self-efficacy, as a psychotherapist is positively associated with outcome expectation,3,4 which, in turn, is related to successful treatment outcome.5,6 B ut building self-efficacy as psychotherapist takes practice,1,2 which requires spending some amount of time with some number of patients • The Accreditation Council of Graduate Medical Education (ACGME) requires that psychiatry residents receive training, experience, and supervision in psychotherapy. However, the residency curriculum is crowded, and psychotherapy must compete with other educational demands, thus limiting longitudinal outpatient clinic volumes. Given the time constraints of residency training programs, the question arises: is there a relationship between resident longitudinal outpatient clinic volume and psychotherapy self-efficacy? • The primary aim of this study is to investigate the relationship between psychiatry resident psychotherapy self-efficacy and resident longitudinal outpatient clinic volume • It was hypothesized that higher longitudinal outpatient clinic volume is positively associated with better psychiatry resident self-estimate of psychotherapy capabilities (self-efficacy) • There was no significant correlation between psychiatry resident total COSE score and resident outpatient clinic volume (R square<.0006) • These results suggest that resident self-estimate of psychotherapy capabilities is unrelated to outpatient clinic volume • This study provides a background for evaluating this hypothesis in additional cohorts of psychiatry residents • This project also lays the groundwork for testing other hypotheses regarding the relationship between resident psychotherapy self-efficacy and other resident and training program variables such as: • post-graduate year • total number of longitudinal clinic hours • type of psychotherapy supervision METHODS • Twenty Johns Hopkins University (JHU) psychiatry residents provided informed consent and completed an IRB-approved, anonymous 37-item survey [Counseling Self-Estimate Inventory (COSE)].4 Eleven of the participants were PGY-2 residents, seven were PGY-3s and two were PGY-4s. Thirteen had entered the JHU psychiatry residency as PGY-1s; seven had joined as PGY-2s.. • The COSE measures an individual’s self-estimate of future performance as a counselor7 and has been shown to relate moderately to counseling performance.4Internal consistency of .93 and three-week re-test reliability of 0.87 have been reported.4 Validity estimates indicate that the COSE is positively related to psychotherapy outcome expectations3,4. • Sample COSE items: • I am certain that my interpretation and confrontation response will be concise and to the point • I feel confident that I will appear competent and earn the respect of my client • I am afraid that I may not be able to effectively relate to someone of lower socioeconomic status than me • COSE item responses range from one to six, with 19 of the items reverse scored. Total COSE score is the sum of all 37 item responses and can range from 37 to 222, with higher scores indicating greater self-efficacy • The same cohort of JHU psychiatry residents also consented to release of longitudinal outpatient clinic logs from residency files, from which each resident’s outpatient clinic volume per every six months of training was determined • Psychiatry resident total COSE scores were analyzed as a function of resident longitudinal outpatient clinic volumes. REFERENCES • Slavney, PR, McHugh, PR. The life-story method in psychotherapy and psychiatric education: The development of confidence. American Journal of Psychotherapy. 1985 39:57-67 • Slavney, PR. Psychotherapy: An Introduction for Psychiatry Residents and Other Mental Health Trainees. The Johns Hopkins University Press. Baltimore. 2005. • Daniels, JA, Larson, LM. The influence of performance feedback and casual attributions upon ratings of counseling self-efficacy. Counselor Education and Supervision. 2001. 41:120-130 • Larson, LM, Suzuki, L, Gillespie, K, Potenza, MT, Toulouse, AL, Bechtel, MA. The development and validation of the Counseling Self-Estimate Inventory. Journal of Counseling Psychology. 1992. 39: 105-120 • Greben, SE. On being therapeutic. Canadian Psychiatric Association Journal. 1991. 22:371-38 • Frank, JD, Fran, JB. Persuasion and Healing. 3rd edition. The Johns Hopkins University Press. Baltimore. 1991. 44-45 • Larson, LM , Daniels, JA. Review of the counseling self-efficacy literature. The Counseling Psychologist. 1998. 26:179-218