Outcome Measures of Triple Board Graduates: 19912003

1
Outcome Measures of Triple Board Graduates
1991-2003 Marla J. Warren, MD,MPH David W.
Dunn, MD Jerry L. Rushton, MD,MPH. Section of
Child Psychiatry and Pediatrics, Department of
Pediatrics, Indiana University School of
Medicine, Indianapolis IN.

• BACKGROUND
• In 1986, the Combined Training Program in
  Pediatrics, Psychiatry and Child and Adolescent
  Psychiatry (Triple Board Program, TBP), approved
  by the American Board of Pediatrics and the
  American Board of Psychiatry and Neurology,
  admitted its first class of residents.
• 140 residents have graduated during 1991-2003,
  but no formal outcome studies have been conducted
  since the initial program evaluation was
  completed.
• Information on this program and graduates status
  is important to address workforce issues, access
  to mental health services, and evaluate the
  program.

RESULTS

• DISCUSSION
• Opinions regarding TBP
• Those who completed the program were satisfied
  enough to re-enroll, except for 5. Several who
  would not reenroll were from the first graduating
  classes, while the program was still being
  developed.
• No one disagreed with the usefulness of any
  aspect of the program, even though some felt that
  the time spent in training was greater than what
  they would have preferred in a particular area.
• 60 felt that the General Psychiatry portion was
  the right length, with 1/3 thinking that it was
  too short. Satisfaction with the length of
  Pediatrics and Child and Adolescent Psychiatry
  was higher. Further data analysis, looking at
  the year of graduation or individual program
  sites, may clarify these differences.
• Board Certification
• Pass rates compared to those taking board exams
  in the traditional program are similar or higher,
  as shown in a previous study.
• Lower rate of attempting pediatric boards may be
  related to the earlier years of the TBP, before
  TBP residents were eligible to take pediatric
  boards during their 5th year of training. It may
  also be related to the structure of the program,
  with less integrated programs resulting in
  graduates feeling less prepared to take Pediatric
  Boards.

SURVEY RESPONSES
BOARDS PASS RATES

• Response rate was 80 (n112/140)
• 10 Programs were represented
• Demographics of the sample are shown in Table 1.

• Board pass rates were generally high, especially
  when considering TBP graduates at least 5 years
  in practice.
• Pass rates were highest for General Psychiatry
  Boards then Child Psychiatry and Pediatrics.
• Many respondents who had taken Boards planned to
  maintain certification/recertify in Child
  Psychiatry (98.2), General Psychiatry (92.4),
  and less in Pediatrics (78.7)

TABLE 1 DEMOGRAPHICS OF TBP GRADUATES

• Gender 60.4 Female
• Mean age 39.2 years
• Mean age (at graduation) 32.7 years
• Mean years in practice 6.6 years

FIGURE 1 BOARD PASS RATES FOR TBP GRADUATES
OBJECTIVES The goals of this study were (1) to
determine the opinions of graduates regarding
this unique program, (2) to describe outcomes of
the program regarding board certification in all
three areas, and (3) to describe career outcomes
and explore whether balanced training results in
a balance of career activities.
CURRICULUM

• Overall satisfaction was very high 95 stated
  they would re-enroll in the TBP if given the
  choice again.
• Satisfaction with the 3 components of training
  was high in terms of usefulness and appropriate
  length within the TBP. (See Table 2A, 2B)
• Almost one-third of graduates (32.4) also
  completed additional training following
  graduation.

CAREER OUTCOMES

• Career Outcomes
• One goal of the TBP is to increase teaching and
  research related to child and adolescent
  psychiatry. With 25 of graduates employed in
  academics full-time and about 50 at least 10 of
  the time, it would appear that this goal is being
  met. Overall, an average of 20 of time is being
  spent in a combination of research and teaching
  activities.
• Another goal of the Triple Board Program is that
  graduates would treat patients who would
  otherwise be underserved. With 11 of graduates
  spending at least half of their time in
  pediatrics and 59 spending at least some time in
  pediatrics, it would appear that the needs of
  patients with both medical and psychiatric needs
  is being addressed by many graduates. The areas
  of developmental disabilities and adolescent
  medicine/psychiatry also may have benefited from
  the addition of triple board graduates to the
  workforce.
• Over 1/3 of graduates have changed the mixture of
  the 3 areas during their careers. One third have
  completed additional post graduate fellowship
  training in a variety of fields. These factors
  add to the flexibility enjoyed by triple board
  graduates during their careers.

• TBP graduates worked in a variety of settings
  upon graduation.
• Most TBP graduates (75) spent at least half of
  their time in Child/Adolescent Psychiatry. A
  minority of respondents worked more than half of
  their time in General Psychiatry (1) or
  Pediatrics (6).
• Many TBP graduates (38.4) reported a significant
  shift in the distribution of their career efforts
  with respect to Child/Adolescent Psychiatry,
  General Psychiatry, or Pediatrics.
• The most common setting for TBP practice was
  outpatient practice, and many graduates
  maintained an academic component to their
  careers. (See Tables 3A, 3B.)

• METHODS
• Sample of all graduates who completed the TBP
  during 1991-2003.
• Names of graduates and contact information were
  collected from Program Directors and the American
  Board of Psychiatry and Neurology.
• Participants were surveyed using a structured
  interview consisting of 40? items developed and
  piloted by the 3 authors.
• The same survey was administered by e-mail,
  phone, fax and mail over a period of three months
  from February to April 2004.
• Deidentified, anonymous data were entered into a
  dataset
• Data were analyzed using STATA statistical
  software.
• This study was reviewed and approved by exemption
  from the Indiana University School of Medicine
  IRB.

TABLE 2A AGREEMENT WITH USEFULNESS OF TRAINING
IN EACH COMPONENT
STRONGLY AGREE AGREE / STRONGLY
AGREE CHILD PSYCHIATRY 93.7 100.0 GENERAL
PSYCHIATRY 61.3 99.1 PEDIATRICS 62.2
96.4

TABLE 2B OPINION ON LENGTH OF TRAINING FOR EACH
TBP COMPONENT
TABLE 3A MEAN CURRENT EFFORT IN EACH SETTING
Outpatient care 45.3 Inpatient care 12.1
Research 10.6 Teaching/supervising 9.2
Administration 7.9 Consult-Liaison 4.9 Day
treatment 3.5 Note Figures are
not mutually exclusive, and thus do not
sum to 100
TOO SHORT APPROPRIATE TOO
LONG CHILD PSYCHIATRY 24.3 75.7 0.0
GENERAL PSYCHIATRY 32.4 59.5 8.1
PEDIATRICS 8.1 77.5 14.4

• Implications
• Our study is one of the most comprehensive
  surveys of TBP graduates to date. These data are
  important to understand how this unique program
  addresses 3 areas and describe the outcomes of
  graduates.
• These data may help the ABP and ABPN consider the
  future of the combined program and the curriculum
  for all trainees.
• Future research should consider the impact of TBP
  graduates on workforce issues such as the impact
  on education, research, and provision of mental
  health services to underserved populations.

TABLE 3B MEAN CURRENT EFFORT IN EACH CAREER
POSITION
Academics 32.3 Community MH 13.3 Hospital
(non-academic) 12.7 Private practice (Solo) 12.1
Private practice (Group) 11.9 Industry
1.6 Note Figures are not mutually exclusive,
and thus do not sum to 100
ACKNOWLEDGEMENTS Dr. Juul, Dr. Anders, Dr. Enzer,
Dr. Schowalter, Dr. Bartell, All triple board
training directors
.