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Brief Communication

Canadian Psychiatry Residency Training Programs:A Glance at the Management Structure

Louis T van Zyl, MB, ChB, MMedPsych, FRCPC1, Paul R Davidson, PhD, CPsych

2

Key Words: physician executives, program development, professional staff committees,organization and administration, stress (psychological), internship and residency(organization and administration)

Each of the 16 Canadian medical schools has a psychiatry

RTP. These vary in size according to the number of resi-

dents in training. Every program is overseen by a PD and an

RPC. The Royal College of Physicians and Surgeons of

Canada sets standards and guidelines for residency programs

and outlines the responsibilities of a PD and a supportive

RPC (1).

We collected information about general administrative struc-

tures for RPCs at Canadian psychiatry training programs,

using a questionnaire that was circulated in person or by mail

in 2004 to all PDs. We had a response rate of 100%. To obtain

specific information about current and past PDs, we mailed a

second questionnaire several months later. The follow-up

survey had an 81% response rate.

We have elsewhere presented parts of this data in summary

format (2) but did not include data from the individual pro-

grams. The complete data are important to Canadian psychia-

try RTPs because they allow specific comparisons among

Can J Psychiatry, Vol 51, No 6, May 2006 W 377

Objectives: To describe the administrative functioning of all current Canadian psychiatry

residency training programs (RTPs) and to suggest available improvements to existing

systems.

Method: We obtained data about the 2004 RTPs by distributing 2 questionnaires to all

Canadian psychiatry RTPs.

Results: Residency program committees (RPCs) are mainly consultative and carry only asmall amount of the workload of managing a residency program. Program directors (PDs)

manage more than 80% of the work and report that the time allowance to perform their

duties is suboptimal. PDs remain in office for about 5 years, departing during or at the end

of a predetermined second term.

Conclusion: RPCs bear only a small amount of the workload generated by the RTP. We

piloted administrative changes that led to more equitable work distribution.

(Can J Psychiatry 2006;51:377381)

Information on funding and support and author affiliations appears at the end of the article.

Clinical Implications

Owing to its focus on issues of residency program administration, there are no clinicalimplications related to this paper.

Limitations

Reported workload measures are subjective.

Generalizing this data beyond Canadian jurisdictions is problematic.

Limited information regarding terms of office of past PDs is available.


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individual schools. Accordingly, in this study we present the

complete data and highlight several issues across programs.

Survey Results and Discussion

Program Size and Structure of the RPC

In Canada, there are 6 small programs (that is, fewer than 25

residents), 6 medium-sized programs (that is, 26 to 40 resi-dents), and4 large programs (that is,morethan 40 residents).

The size of the RPC does not appear to be related to the num-

ber of residents (Table 1); however, the size of the program is

related to the number of standing subcommittees. Of the 16

programs, 12 reported at least one standing subcommittee

(range = 1 to 10), with smaller programs reporting a mean of

1.5 committees, medium-sized programs a mean of 4.0 com-

mittees, and large programs reporting a mean of 6.3 commit-

tees. All programs reported specific work roles for some

members of the RPC, but these varied between programs.

RPCs of small programs had an average of 1.8 work roles,

medium-sizedprogramshad an average of 2.0 roles,and largeprograms had an average of 3.5 roles assigned for each RPC.

The overall average was 2.3. Roles included managing rota-

tionevaluation forms, psychotherapy, individual program and

site matters, curriculum development, developing training

objectives, funding resident activities, research, core program

management, safety and security, Canadian residency match-

ing service, PGY1 issues, and continuing professional

development.

The PD and the RPC: Sharing the Burden

Of the 16 directors, 14 reported that their RPC functioned

mainly as a consultant. On average, it was estimated that the

PDs performed 84% of the committees duties (range 67% to90%).

PDs carry the brunt of the work generated by RTPs. However,

the fact that most RPCs have standing committees suggests

the intent to divide the workload between the committees and

the PDs. Table 1 indicates that the PD carried 90% or more of

the work in programs with no subcommittees, whereas the

work of the PD was less in programs with many subcommit-

tees. Of PDs total work time, 38% or 0.38 FTE was allocated

to the RTP duties. This is well below Beresins recommenda-

tion of about 50% of full-time or 0.5 FTE (3). Only 3 of the

programs met this target. This was not well accepted and

one-half of the16 PDsstated that they required more time than

was available to perform their duties.

PDs Term of Office

PDsreported havingserved an average of 3.5years(range 1 to

10 years). In 2 cases,the appointmentsare indeterminate in.In

the remainder, the average term is 4.0 years (range 3 to 5

years). In two-thirds of the cases, the term appointment is

renewable, and at most schools, the renewals are limited to

one time. The data indicate that historically PDs have

remained in office about 5 years (range 1 to 10 years).

The role of the PD is difficult, and there is a high rate of turn-

over. At some US schools, high turnover in PDs is related to

administrative problems, lack of institution support for the

RTP, loss of job satisfaction, littlehope of promotion, a desire

to spend more time teaching or doing clinical work, and plans

to take a less demanding job (4).

These issues may account for the relatively short times that

Canadian PDs are in office (mean 4.8 years, Table 2). We did

not collect the data necessary to examine this possibility.

Addressing the Problem

Queens University has addressed the inequity of the work-

load between the PD and the RPC. We have recently

described a novelapproach to streamline the administrationof

our psychiatry RTP, leading to a PD:RPCworkload ratio shift

from 90:10 to 60:40.This resulted in a more efficientRPC andRTP (2).

According to our system, each member of the RPC has a port-

folioof responsibilities. This resulted in a substantial decrease

in the workload carried by the PD, which enabled the PD to

stay current with major areas of the RTP without bearing the

brunt of the administrative work.

Funding and Support

This study received no funding or support.

Acknowledgements

We thank the directors of postgraduate education of the variousdepartments of psychiatry across Canada who participated in thissurvey and we acknowledge their contributions.

We also acknowledge contributions to earlier work on this projectby Dr Susan Filch and Dr J Arboleda-Florez.

W Can J Psychiatry, Vol 51, No 6, May 2006378

The Canadian Journal of PsychiatryBrief Communication

Abbreviations used in this article

FTE full-time equivalent

PD program director

PGY1 postgraduate Year 1

RPC residency program committee

RTP residency training program


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Canadian Psychiatry Residency Training Programs: A Glance at the Management Structure


Table1

Individualprogram

responsestofirstquestionnaire

UniversityRTP

PDassistedbya

codirector?

N

N

N

N

N

N

Y

N

N

N

Y

N

N

N

N

N

Y2/16

Secretarialsupport

(percentageoffull

time)?

65

30

50

50

50

50

50

100

60

80

100

100

37

50

150

68

PercentageofPDs

timededicatedto

program?

40

25

45

30

35

25

45

30

35

40

40

50

55

20

25

50

37

Ifnotsufficient,what

percentageisideal?

50

25

45

30

50

50

50

40

35

40

40

50

75

35

40

50

44

Residentsinprogram

(n)?

13

15

18

22

23

27

29

30

30

30

32

32

39

48

56

134

36

MembersonRPC(n)?

14

12

13

8

14

10

12

12

10

12

14

10

28

12

10

40

14

ResidentsonRPC(n)?

3

3

3

4

5

4

4

3

3

3

6

4

6

5

3

8

4

Chiefresidenta

member?

Y

Y

Y

Y

Y

Y

Y

N

Y

Y

Y

Y

N

Y

Y

-

Y13/15

Meetingfrequency?

M

M

M

M

M

M

M

M

M

M

M

M

2W

M

M

M

M15/16

AnyRPCstanding

committees?

N

Y

Y

Y

N

N

Y

Y

Y

Y

Y

N

Y

Y

Y

Y

Y12/16

Howmanystanding

committees?

0

1

4

2

0

0

3

2

10

3

5

0

4

5

4

10

3

RPCrolemainly

consulting?

Y

Y

Y

Y

N

Y

Y

N

Y

Y

Y

Y

Y

Y

Y

Y

Y14/16

DoRPCmembers

carryasubstantial

portionofworkload?

N

Y

N

N

N

N

N

Y

Y

N

N

N

Y

Y

Y

Y

Y7/16

N=no;M=monthly;W

=weekly;Y=

yes

aTheresponsesforQueensUnivers

itywerecollectedpriortotheimplementationofthenewadministrativesystem.

Saskatchewan

Sherbrooke

Calgary

Western

Memorial

Alberta

McGill

Ottawa

McMaster

Manitoba

Dalhousie

British Columbia

Laval

Montreal

Toronto

Average

Queensa


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W Can J Psychiatry, Vol 51, No 6, May 2006380

The Canadian Journal of PsychiatryBrief Communication

Table2

Program

Directorstermsinoffice:responsestofollow-upquestionnaire

PsychiatryRTPs

PDinformationasofJanuary15,200

5

Yearassumed

office

2004

2002

2002

2002

2004

2004

1999

2001

2002

2000

2001

2002

1994

Yearsinoffice

1.0

3.0

NR

3.0

2.5

1.0

1.0

6.0

3.5

2.5

4.5

4.0

3.0

NR

N

R

10.0

3.5

Appointment

term(years)

3.0

3.0

NR

3.0

IN

IN

IN

5.0

4.0

5.0

3.0

IN

5.0

NR

N

R

5.0

4.0

Ifterm

appointment,isit

renewable?

N

N

NR

Y

NA

NA

NA

Y

Y

Y

Y

NA

Y

NR

NR

Y

Y6/12,

N3/12,

NA3/12

Ifrenewable,

howmanytimes?

NA

NA

NR

2.0

NA

NA

NA

1.0

1.0

1.0

IN

NA

1.0

NR

N

R

1.0

1.2

Terminoffice

1

1

NR

1

1

1

1

2

1

1

2

1

1

NR

N

R

2

1.2

PastPDs

Yearsinoffice

Immediate

predecessor

3.5

8.0

NR

5.0

1.0

6.0

4.0

7.0

5.0

5.0

2.5

3.0

6.0

NR

N

R

7.0

4.8

Numberofterms

inoffice

1.2

2.7

NR

1.7

1.0

1.0

1.0

1.4

1.3

1.0

0.8

1.0

1.2

NR

N

R

1.4

1.3

aQueensUniversitypriorto2001

IN=indeterminate;N=no;NA=notap

plicable;NR=noreplyreceived;Y=yes

Saskatchewan

Sherbrooke

Calgary

Western

Memorial

Alberta

McGill

Ottawa

McMaster

Manitoba

Dalhousie

British Columbia

Laval

Montreal

Toronto

Average

Queensa


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References

1. Royal College of Physicians and Surgeons of Canada. Accreditation of residency

programs: specific standards of accreditation for residency programs in

psychiatry. Royal College of Physicians and Surgeons of Canada. Available:

http://rcpsc.medical.org/information/index.php?specialty=165&submit=Select

Accessed 2005 June 28.

2. van Zyl LT, Finch SJ, Davidson PR, Arboleda-Florez J. Administrative

restructuring of a residency training program for improved efficiency and output.

Acad Psychiatry 2005;29:46470.

3. Beresin EV. The administration of residency training programs. Child Adolesc

Psychiatr Clin N Am 2002 Jan;11:6789.

4. Barton LL, Friedman AD. Stress and the residency program director. Arch

Pediatr Adolesc Med 1994;148:1013.

Manuscript received July 2005, revised, and accepted January 2006.1Past Director, Residency Training Program, Department of Psychiatry,

Queens University, Kingston, Ontario.2Codirector, Anxiety Disorders Program, Department of Psychiatry,

Queens University, Kingston, Ontario; Psychologist and ClinicalSupervisor, Department of Psychology, Queens University, Kingston,Ontario.

Address for correspondence: Dr LT van Zyl, Division of

Consultation-Liaison Psychiatry Connell-4, Suite 2-489, Kingston GeneralHospital, 76 Stuart Street, Kingston, ON, K7L 2V7;[email protected]

Canadian Psychiatry Residency Training Programs: A Glance at the Management Structure


Rsum : Les programmes canadiens de rsidence en psychiatrie :

un coup dil sur la structure de gestion

Objectif : Dcrire le fonctionnement administratif de tous les programmes canadiens actuels de

rsidence (PR) en psychiatrie et suggrer des amliorations disponibles aux systmes existants.

Mthode : Nous avons obtenu des donnes sur les PR de 2004 en distribuant 2 questionnaires

tous les PR canadiens en psychiatrie.

Rsultats : Les comits des programmes de rsidence (CPR) sont principalement consultatifs et

neffectuent quune petite partie de la charge de travail que comporte la gestion dun programme de

rsidence. Les directeurs de programmes (DP) grent plus de 80 % du travail et dclarent que le

temps allou lexcution de leurs fonctions est sous-optimal. Les DP demeurent en poste environ

5 ans, quittant pendant ou aprs un deuxime terme prdtermin.

Conclusion : Les CPR neffectuent quune petite partie de la charge de travail que comporte un PR.

Nous avons mis lessai des changements administratifs qui ont men une rpartition des tches

plus quitable

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