Residents had higher scores on all nine competency items at post-rotation. Additionally, large effect sizes were seen for many items. Residents appeared to improve their understanding and confidence in initial treatment through psychiatry rotation. Mandatory psychiatry rotation is reasonable and worthwhile, and may constitute an essential and effective part of the residency curriculum. However, it is unclear whether these post-rotation scores are suitable for the residents completing psychiatry rotation. It is also unclear what the one-point increasing of the scale means. The post-rotation score of confidence in initial treatment seemed to be low in most items. Postgraduate residents are expected to be ready to practice across the full breadth of their chosen field . They are often assessed their performance (i.e., “Shows how”) and action (i.e., “Does”)  in the workplace, so called entrustable professional activity [14,15,16]. Increasing the post-rotation score of confidence in initial treatment are needed by continuous improvement of educational program in the future. Basic psychiatric knowledge and treatment skills are useful in various fields, and even some specialty fields require a psychiatric training program [17,18,19]. The need for psychiatric knowledge and skills is expected to continue to grow in the future. The importance of psychiatry is also likely to increase in both undergraduate and postgraduate medical education. It is necessary to repeatedly update educational strategies to meet changing social needs.
A previous study reported that psychiatry rotation had no significant educational effects on knowledge about disorders of growth and development . However, in the current study, residents achieved sufficient learning on this item. This item reflects a broad concept that can be experienced in both psychiatry (neurodevelopmental disorders and truancy) and pediatrics (failure to thrive). It was previously assumed that residents may not clearly recognize this item as a psychiatric competency. Child and adolescent mental health have recently been recognized as leading problems among primary care physicians, and their importance is increasing [20, 21]. In the Japanese residency system, all residents are expected to commit to working in child and adolescent mental health during the 2 years curriculum. Currently, residents may devote more study to psychiatric concepts related to this area, such as neurodevelopmental disorders, compared with residents several years ago.
Although the current study focused on the competency items, the residency system also contains other various objectives (e.g., communication skills, ethics, and interprofessional collaboration). Some of these objectives may be expected to be learned deeply during psychiatry rotation. There is no detailed description regarding how and what must be learned during psychiatry rotation in the teaching guidelines of the Japanese residency system. Clinical teachers in psychiatry can provide model attitudes and relationships, as well as knowledge and skills . It would be useful to clarify what residents should achieve in a more multifaceted way through psychiatry rotation. Furthermore, psychiatrists are needed as educators in various areas of medical education not only in psychiatry rotation .
The present study involved several limitations. First, the study was conducted at a single institution. Various strategies are implemented in clinical training during psychiatry rotation. Thus, it would be preferable to conduct future studies at multiple institutions. Second, the questionnaire used in this study was self-designed by the authors, and its validity and reliability may therefore be insufficient. Because few previous studies evaluated residents’ subjective achievements in the field of psychiatry, a self-designed questionnaire was necessary in this study. Third, social desirability bias may have affected the current results, if residents answered in a manner that they felt would be viewed favorably by others.
Psychiatry is only a part of various specialty in medicine. However, many doctors other than psychiatrist are expected to deal with psychiatric contents. Despite ongoing discussions about what should be taught during the student and residency periods, widely accepted conclusions have not yet been reached. There are substantial differences in educational content related to psychiatry between medical schools and postgraduate training curricula in various countries [24,25,26]. Further research is needed to expand the current findings.