An oral examination of the psychiatric knowledge of medical housestaff: assessment of needs and evaluation baseline.

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and "psychogenic" pain. The standardized simulations were punctuated by standardized "open" questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized ad "good," "adequate," "inadequate," or "poor," in terms of "what an internist needs to know." Blind raters of the exam achieved an interrater reliability of 0.08. The results indicate major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were "good," where as 42% were "inadequate" or "poor". For example, 88% of the doctors could not name three factors that help distinguish organic from "functional" psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.