Psychiatry peer review groups in Australia: a mixed-methods exploration of structure and function

ObjectivesThe purpose of this study was to examine Australian psychiatrists’ experience of participation in a small group learning format of continuing professional development, known as peer review groups (PRGs), with a particular emphasis on group structure and functions.MethodAn exploratory mixed-methods study comprising a survey (n=77) and semistructured interviews (n=6) with Australian psychiatrists participating in a PRG in the previous 12 months.ResultsQualitative findings indicate that PRGs address experiential learning through a focus on both breadth and specificity of work, as well as participants’ experiences. Participants described using PRGs as a forum to manage difficult and complex work (through critiquing work, learning from one another, considering theory and guidelines, benchmarking, validating, reflecting and generalising learning) and to manage stress and well-being associated with crises, everyday stress and professional isolation. Particular structural aspects of PRGs considered essential to achieve these functions were self-selection of members, self-direction of meeting content and provision of a safe environment. These findings were convergent with the quantitative findings from scale survey data. Difficulties experienced during PRG participation are also described.ConclusionQualitative and quantitative findings from psychiatry PRGs demonstrate how practice-based professional experience functions as both a source of learning and of collegial connection that contributes to well-being and reduction in professional stress. Study limitations and future research directions are discussed.

Where do Peer Review Groups fit in the international Continuing Professional Development literature?

Objectives: To describe what is reported in the Continuing Professional Development (CPD) literature on small group learning formats in medicine, including the Royal Australian and New Zealand College of Psychiatrists (RANZCP) CPD Peer Review Groups (PRGs). Method: A literature review of international peer-reviewed publications in relation to the use of small group learning formats for CPD in medicine. Results: Small groups are commonly used as a learning format in medical CPD, primarily in general practice, but are little researched. Such groups take differing forms and they are valued by participants for a range of purposes, having effects on professionalism, clinical performance and doctors’ wellbeing. Conclusion: We believe that the contribution of these groups to medical CPD should be further explored. To this end, this review forms the first part of a research project focussing on the RANZCP PRG model used by Australian and New Zealand psychiatrists.

Peer Review Groups: Problems and Solutions

Objective: To elucidate and delineate principles for dealing with problems encountered in peer review groups. Method: A workshop format was utilised in which a number of interested psychiatrists were invited to rote-play specific problems which occurred in established peer review groups, and reported in recent research studies. Process notes or videotapes were used to record proceedings. Principles were delineated for the management of five specific problems via role-play and discussion. Results: Principles have been delineated for the management of the following problems reported by peer review groups: dominating group member; member with disturbing behaviour; member providing inadequate treatment; member transgressing treatment boundaries; and group members strongly disagreeing about the management of a case. Conclusion: Problems encountered within peer review groups were adequately replicated during role-played enactments. The workshop format offered a means of engaging with these, allowing exploration and subsequent resolution of problems which had not proved resolvable in the real group peer review situation.

Group Peer Review in Psychiatry: The Relationship to Quality Improvement and Quality Care

Objective: This study sought to elucidate the contribution of peer review groups involving psychiatrists to quality improvement and quality care. Method: Audio-taped interviews of groups engaged in peer review were analysed using a qualitative methodology. Participants' views of the ways in which they experienced and conceptualised peer review were explored. Results: The views of participants in peer review groups were analysed, and categories evolved which identified differences in how they perceived the structure and function of group peer review. Conclusions: Participants in the groups studied perceived peer review as a professional growth forum within a quality improvement framework providing critical review of treatment, continuing education, and a sense of collegiality. Boundaries of acceptable practice were tested and defined. At its best, participation in peer review groups enhanced reflective practice which achieved new understandings of clinical work. In this regard, peer review is seen as a highly desirable method for the maintenance of professional standards.