This study examined sociodemographic and practice-related characteristics of psychiatrists working at Dalhousie DME sites in, as well as their perspectives regarding enablers and barriers influencing its expansion. Comparisons with existing literature reveal both similarities and unique findings, shedding light on important considerations for future developments in medical education.
Regarding sociodemographic characteristics, the study revealed that the majority of participants were male, which aligns with the data from the Health Workforce Database showing a predominance of male psychiatrists in Canada [14]. However, it is worth noting that there is a larger difference in the gender distribution of psychiatrists between the studied sample and the rest of Canada. While the national proportion of male and female psychiatrists is approximately 53% and 47% respectively [14], this specific group exhibits a more pronounced gender imbalance, with 69% being male and only 31% female.
Location of practice information suggests that the current geographical distribution of psychiatrists in the region reflects an imbalance of psychiatrists between the two provinces. The average number of psychiatrists is 14.5/100,000 habitants in Nova Scotia and 6.6/100,000 in New Brunswick [15]. AlthoughNova Scotia has a slightly higher number of psychiatrists per capita when compared to the national average of 13.2/100,000 [15], these practitioners tend to cluster into larger cities, leaving rural areas underserviced [16]. Limited availability of psychiatrists as mentors, supervisors, and educators hampers the opportunities for medical learners, including residents and students, to receive comprehensive and specialized training in these underserved areas. The lack of exposure to diverse clinical experiences and expert guidance may impede the development of future psychiatrists and their ability to meet the mental healthcare needs of the population [17]. Without a substantial influx of new psychiatrists to these locations, the current imbalance of psychiatrists between urban and rural areas across the Maritimes is expected to worsen in the future.
The substantial representation of international medical graduates (IMG) with Canadian specialist training highlights the contribution of international medical graduates to the psychiatric workforce. When it comes to all physicians, IMGs make up about one-quarter of Canada’s doctors, and for some provinces, this ratio is considerably higher—46% in Saskatchewan and 38% in Newfoundland and Labrador [18]. In Nova Scotia and New Brunswick, this number accounts for approximately 30% and 22%. Back to the results of this study, it is evident that male psychiatrists have a higher likelihood of receiving their training outside Canada. This observation suggests a specific trend: Canadian-trained female psychiatrists are less inclined to work in rural areas, and the overseas-recruited psychiatrists predominantly consist of males. It is worth noting that at Dalhousie, our program accommodates more female residents than male ones.
Notably, a significant proportion of participants held academic appointments with the Department of Psychiatry at Dalhousie University, suggesting a strong academic presence among the study participants. This finding emphasizes the importance of academic affiliations for psychiatrists involved in medical education and research. The participants' interest in applying for promotions and the desire for academic appointments further demonstrate their dedication to academic pursuits.
In terms of practice-related variables, general adult psychiatry emerged as the primary specialization for most participants, consistent with the broader trend in psychiatry practice in Canada [19]. The practice of psychotherapy, particularly Cognitive Behavioral Therapy (CBT), was reported by a notable proportion of participants, highlighting the integration of evidence-based psychotherapy in psychiatric practice [20].
Regarding medical education and training, a significant proportion of participants reported not receiving formal training in medical education. However, many participants possessed knowledge or skills in curriculum delivery, indicating the importance of incorporating educational training for psychiatrists to effectively engage in medical education activities. The majority of participants demonstrated experience in clinical training and supervision of medical learners, highlighting their role in shaping the future generation of psychiatrists.
Enablers for participation in scholarly activities were predominantly observed among the participants, with a high willingness to engage in clinical training, supervision, and skills-based examinations for psychiatry residents. However, barriers were also identified, including the lack of protected time for teaching/training and inadequate financial incentives. These findings resonate with existing literature highlighting the challenges faced by physicians in balancing clinical practice with academic responsibilities [21–25].
Factors associated with the willingness to engage in scholarly activities
Interestingly, familiarity with the RCPSC training was significantly associated on Chi Square analysis with participants' willingness to engage in specific scholarly activities. This finding underscores the potential correlation between the interest and involvement in education and the desire to know more about Competency-Based Medical Education.
The association between participants' selected characteristics and their willingness to engage in scholarly activities further supports the importance of factors such as availability for formal training, academic appointments, and practice of psychotherapy. These factors emerged as significant predictors of participants' willingness to participate in specific scholarly activities, suggesting the need to address these variables when designing strategies to enhance engagement in medical education. The association between availability for this training and the willingness to participate in clinical training, supervision, and skills-based teaching for psychiatry residents underscores the importance of incorporating structured training programs to enhance engagement in medical education.
The province in which the psychiatrists’ practice was another significant factor influencing psychiatrists' willingness to participate in the provision of lectures or skills-based teaching for psychiatry residents and skills-based examinations. Participants working in New Brunswick were more willing to engage in these activities compared to their counterparts in Nova Scotia. This finding suggests potential regional variations in the motivation and opportunities for psychiatrists to contribute to medical education. This finding supports the local needs of expanding the number of psychiatrists in New Brunswick region.
Having an academic appointment with the Department of Psychiatry at Dalhousie University was also significantly associated with the willingness to participate in the provision of lectures or skills-based teaching for psychiatry residents. This finding once more shed light on the association between academic affiliations on physicians' involvement in medical education. Psychiatrists with academic appointments often have access to resources, mentorship, and a supportive academic environment, which may foster their enthusiasm for teaching and supervision activities.
The practice of psychotherapy also emerged as a significant factor associated with psychiatrists' willingness to engage in the provision of lectures or skills-based teaching for psychiatry residents. This finding suggests that psychiatrists involved in psychotherapy practice may perceive teaching and mentoring as complementary activities that enhance their clinical expertise and professional growth. Psychiatrists specializing in psychotherapy often develop strong interpersonal and communication skills, which are highly transferable to teaching and mentoring roles. These skills include active listening, empathy, and creating a supportive and collaborative therapeutic environment. In this context, the willingness of these psychiatrists to engage in teaching and mentoring activities might be attributed to their specific skills.
Furthermore, psychiatrists who expressed they were available to participate in formal training in the RCPSC training were more willing to engage in the training and supervision of psychiatrists undertaking fellowships, both Canadian-trained and internationally trained. This finding underscores the potential cascading effect of participation in structured training programs, where psychiatrists who themselves receive specialized training are more motivated to contribute to the training and supervision of other psychiatrists. When controlling for all other variables in the regression models, availability to participate in formal training in the RCPSC training emerged as the only predictor of the psychiatrists willingness to engage in each of the scholarly activities of interest, except participation in the training and supervision of internationally trained psychiatrists seeking to undertake the Dalhousie University accredited Fellowships. This finding is significant as it provides a simple and yet most reliable way for identification of psychiatrists at DME sites to support scholarly work, including of training and supervision of medical students, residents and Canadian trained psychiatrists undertaking accredited Fellowships.
Implications for DME policy and practice
Based on the psychiatrists' perspectives on the expansion of DME within the Atlantic Canada context the following implications for DME policy and practice can be established:
1. Bridge the Gap in Rural Zones: Rural psychiatry shortages have an impact on medical education and community health. Attracting and retaining psychiatrists in underserved communities can improve mental health treatment and medical education. Examples include recruitment, incentives, and professional assistance. Rural residency roles and educational opportunities will help to develop a strong and long-lasting psychiatric workforce. Telemedicine and technology can also aid in the delivery of mental health care in remote locations.
2. Allocate protected time for teaching/training: Efforts should be made to provide psychiatrists with dedicated time for teaching and training activities. This can involve creating structured schedules or designated blocks of time specifically dedicated to educational responsibilities. By ensuring protected time, psychiatrists will be better equipped to contribute to the training and supervision of psychiatry residents and accommodate Canadian-trained and internationally trained psychiatric fellows on their teams.
3. Address workload and resource constraints: Efforts should be made to address workload and resource constraints that hinder psychiatrists and other professionals from participating in training initiatives. This can involve optimizing staffing levels, ensuring appropriate staffing ratios, and providing adequate resources and infrastructure to support teaching and supervision activities. By addressing these barriers, psychiatrists will have the necessary resources and support to actively contribute to the training and supervision of psychiatry residents and fellows.
4. Promote Academic Affiliations and Competency-Based Training: The study highlights the importance of academic affiliations and competency-based training frameworks in promoting psychiatrists' active involvement in medical education and scholarly activities. Building strong collaborations between academic institutions, medical schools, and psychiatric departments can enhance opportunities for psychiatrists to engage in teaching, supervision, and examination of psychiatry residents. Continual efforts should be made to align residency programs and training curricula with the RCPSC Competency by Design framework, ensuring that educational practices reflect the evolving needs of the field.
5. Enhance the Quality of Psychiatric Training: The findings emphasize the significance of factors such as psychotherapy practice and structured training programs in influencing psychiatrists' willingness to engage in teaching, supervision, and examination of psychiatry residents. Medical education initiatives should consider incorporating these factors into curriculum development and training opportunities. By providing comprehensive support and resources, medical educators can enhance the quality of psychiatric training programs and foster a culture of continuous professional development.
6. Foster collaboration and knowledge sharing: Encouraging collaboration and knowledge sharing among psychiatrists within the same zone can help overcome barriers related to the participation of trainees in their practice. Establishing platforms for regular communication, peer support, and sharing of best practices can create a supportive environment where psychiatrists can learn from each other's experiences and address common challenges together.
By addressing the reported barriers and implementing these recommendations, it is anticipated that the participation of psychiatrists in training and supervision activities will be enhanced, allowing for a more robust and effective DME system in psychiatry.
Strengths and Limitations
The study has several strengths that contribute to the consistency of its findings. Firstly, it adopts a comprehensive approach by employing a rigorous data collection process and ensuring the questionnaire's relevance and validity through development and revision by members of the Nova Scotia and New Brunswick Psychiatry Academic Council. Additionally, conducting data collection during psychiatrists' meetings provides an organized and conducive environment for survey completion, further enhancing the reliability of the data. The study's sample is also a strength, as it includes psychiatrists from seven administrative health zones in Nova Scotia and New Brunswick, representing a diverse range of rural and urban settings.
However, it is important to acknowledge certain limitations of the study. The reliance on voluntary participation introduces the possibility of selection bias. Psychiatrists with a stronger interest in medical education or more pronounced opinions on the topic may have been more likely to participate, potentially leading to the overrepresentation or underrepresentation of certain perspectives. Additionally, the study relies on self-reported data, which can be susceptible to biases such as social desirability bias or recall bias [25]. Participants' responses may not always accurately reflect their actual behaviors or opinions. While the study includes a diverse sample of psychiatrists from different settings, the findings may not be fully generalizable to all psychiatrists in the Maritimes Provinces or other regions, as regional variations in healthcare systems and educational resources can influence the willingness to engage in scholarly activities differently in different contexts. Lastly, although the study controls for various variables in the regression analyses, there may still be unmeasured factors that could confound the relationships between the predictors and outcome variables, potentially influencing the observed associations.