Alex Mears

Questionnaires for 360-degree assessment of consultant psychiatrists: development and psychometric properties

BACKGROUND Expert clinical judgement combines technical proficiency with humanistic qualities. AIMS To test the psychometric properties of questionnaires to assess the humanistic qualities of working with colleagues and relating to patients using multisource feedback. METHOD Analysis of self-ratings by 347 consultant psychiatrists and ratings by 4422 colleagues and 6657 patients. RESULTS Mean effectiveness as rated by self, colleagues and patients, was 4.6, 5.0 and 5.2 respectively (where 1=very low and 6=excellent). The instruments are internally consistent (Cronbachs alpha >0.95). Principal components analysis of the colleague questionnaire yielded seven factors that explain 70.2% of the variance and accord with the domain structure. Colleague and patient ratings correlate with one another (r=0.39, P<0.001) but not with the self-rating. Ratings from 13 colleagues and 25 patients are required to achieve a generalisability coefficient (Erho(2)) of 0.75. CONCLUSIONS Reliable 360-degree assessment of humane judgement is feasible for psychiatrists who work in large multiprofessional teams and who have large case-loads.

Characteristics of the residents of in-patient child and adolescent mental health services in England and Wales

This study describes the characteristics of the young people who use the full range of child and adolescent psychiatric in-patient units in England and Wales. Consultant psychiatrists or key workers were asked to complete a structured schedule about every resident on a census day – 19 October 1999. Schedules were returned from 71 of the 80 units in England and Wales, concerning 663 residents. Residents aged 13 or under had a wide range of diagnoses and more were male (58%). In contrast, two-thirds of residents aged 14–18 were categorized into one of three diagnostic groups – eating disorder, schizophrenia, delusional or psychotic disorders or mood disorders – and about two-thirds were female. In-patients had more severe problems than a group of young people using community services, particularly with hallucinations and delusions, emotional and related problems and problems of self-care and independence. The range of disorders treated by these units demonstrates the need for a range of specialist in-patient services to be available to children and adolescents in all regions.

Consultant psychiatrists' working patterns

AIMS AND METHOD To explore relationships between different styles of working and measures of occupational pressure in consultant psychiatrists. A random sample of 500 consultant psychiatrists were sent a questionnaire about working patterns and lifestyle factors, with other sections using validated tools (such as the 12-item General Health Questionnaire; GHQ). RESULTS There were 185 useable questionnaires returned (an adjusted response rate of 39%). Significant relationships were identified between job content and GHQ and burnout scores, indicating that occupational pressures are rendering some consultant posts ‘problem posts’, leading to problematic levels of psychological distress among some consultants. CLINICAL IMPLICATIONS Although consultant psychiatrists are more satisfied than not with their jobs, steps need to be taken to address the causes of ‘problem posts’, to reduce attrition in the most pressured individuals.