Clinical practice guidelines, psychotherapy and implications for psychiatry.

OBJECTIVE: The 2020 RANZCP clinical practice guidelines (CPG) for mood disorders, published in January 2021, raise important questions for practice and teaching. The objective of this review is to critically appraise the content of the CPG to examine if it reflects contemporary practice-based evidence. CONCLUSION: Our review identifies factual error and notes international criticism. Retraction and amendment of the CPG is needed, particularly in the current political climate.

Policy, professionalism and psychotherapy; the clinical practice guidelines' dilemma.

OBJECTIVE: To review a rebuttal to widely published concerns that the Clinical Practice Guidelines (CPG) devalues the role of long-term psychodynamic psychotherapy as a treatment in mood disorders. CONCLUSION: There is a wider context to this debate. The CPG presents the RANZCP with a dilemma about treatments, professionalism and policy; it requires amendment.

How peer review groups support learning and wellbeing in psychiatrists.

OBJECTIVE: To explore the self-reported value of Peer Review Groups (PRGs) by Australian psychiatrists, focussing on learning and wellbeing. METHODS: A cross-sectional mixed-methods online survey of psychiatrists registered with the NSW Branch Royal Australian and New Zealand College of Psychiatrists (RANZCP) who had attended a PRG in the previous 12 months. RESULTS: Respondents described PRG participation as supportive to their learning and to their professional wellbeing by sharing professional experiences, emotional support for the inherent stresses of practice, the provision of a space for debriefing and the amelioration of professional isolation. Difficulties or challenges in group functioning were reported rarely and included new group member selection and limitations to individual support provided by the group. CONCLUSIONS: The PRG form of Continuing Professional Development (CPD) is unique, popular and highly valued by psychiatrists. In addition to supporting learning, PRGs provide a collegial space for processing of emotional aspects of practice that in turn supports wellbeing. Other healthcare professionals might benefit from similar self-directed, self-selected small group peer contact for CPD.

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

OBJECTIVES: The 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. METHOD: An 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. RESULTS: Qualitative 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. CONCLUSION: Qualitative 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.

Informed consent and childhood gender dysphoria: emerging complexities in diagnosis and treatment.

OBJECTIVE: To explore some of the emerging complexities in the management of childhood gender dysphoria. CONCLUSION: The authors raise questions about the gender-affirmation approach and highlight concerns about informed consent and research ethics.

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.