Log books are increasingly being used in specialist training in the UK as an assessment tool and in 1998 the Royal College of Psychiatrists introduced a ‘personal training file’ for use in preparation for taking the MRCPsych examination (Royal College of Psychiatrists, 1997 a ). The log book is a trainee-owned document consisting of a record of formal training experiences, rather than a list of cases seen. During its development, concern was expressed by trainees that the log book should not be used as a means of summative assessment and so use of the log book has not been made compulsory (Reference Sullivan, Cornwall and CormacSullivan et al, 1997). A pilot study in four UK training centres undertaken prior to the introduction of the log book showed that trainers (80%) were more likely than trainees (68%) to consider the log book useful (Royal College of Psychiatrists, 1996). However, previous research has demonstrated that log books will not work unless they are easy to use and there is a two-way commitment by both trainee and trainer (Reference Cole and ScottCole & Scott, 1991; Reference Paice, Moss and WestPaice et al, 1997). We used a cross-sectional survey to determine whether there were differences between trainees and trainers in their opinions and use of the log book.
The study
We sent a confidential postal questionnaire to all psychiatric trainees in general professional training (n=79) and their consultant trainers (n=81) in the Northern region of England. This covered five feeder schemes for pre-MRCPsych Part I trainees and the regional unified scheme for post-Part I senior house officers. One hospital with up to six psychiatric trainees had to be excluded because of lack of necessary information. Repeat questionnaires were sent out after 6 weeks to non-responders. Those subjects who had received the log book were asked whether they were committed to using it and whether their trainee/trainer was committed (on a scale of 1, not at all, to 4, completely). We then asked if they thought that the log book was useful and usable (on a scale of 1, no good to 4, excellent), replicating the questions from the College pilot study (Royal College of Psychiatrists, 1996). Scores of 1-2 and 3-4 were combined to produce 2 × 2 tables (i.e. committed v. not committed; useful v. not useful). Yes/no questions were asked on the log book's actual use and subjects' views on the proposed use of the log book in the four areas outlined in guidance from the Royal College of Psychiatrists (1997 b ). The four areas are in: setting educational objectives; weekly supervision with the consultant; appraisal meetings with the local college tutor; and discussion about progress on the rotation with the scheme organiser. Proportions were compared with Chi-squared (χ2) and Fisher's exact test.
Findings
Responses were received from 64 (81%) trainees and 56 (69%) trainers (χ2=3.01, P=0.08). Forty-nine (77%) trainees and 37 (66%) trainers reported that the trainee had received the log book (χ2=1.62, P=0.20). There were no significant differences in the proportions of trainees receiving the log book according to their stage of training (see Table 1).
Table 1. Questionnaire responses of trainees
| Responders | Log book received | |
|---|---|---|
| n | n (%) | |
| Year of training | ||
| 1 | 21 | 15 (71) |
| 2 | 25 | 22 (88) |
| 3 | 8 | 7 (88) |
| 4 | 9 | 5 (57) |
| Exam status | ||
| none | 38 | 30 (79) |
| Part I | 22 | 18 (82) |
| Part II | 4 | 1 (25) |
Table 2 shows the differences in trainee and trainer responses to the questionnaire. Trainers believed they were more committed to using the log book than their trainees were (26/35 v. 16/33, χ2=4.78, P=0.03), but there was a major discrepancy between the views of trainees and trainers about trainer commitment. More trainers than trainees found the log book useful and usable, replicating the findings of the pilot study (Royal College of Psychiatrists, 1996). The results showed moderate use in objective setting, but little use elsewhere. However, there was strong agreement that the log book should be used in three of the four areas.
Table 2. Differences in trainee and trainer responses to the questionnaire
| Trainee response | Trainer response | ||||
|---|---|---|---|---|---|
| n (%) | n (%) | Difference (95% Cl) | χ2 | P | |
| Trainee committed | 25 (51) | 16 (48) | 4 (-25 to 20) | 0.05 | 0.82 |
| Trainer committed | 21 (43) | 26 (74) | 31 (11 to 51) | 8.18 | 0.004 |
| Log book useful | 31 (63) | 29 (88) | 25 (7 to 42) | 6.09 | 0.01 |
| Log book usable | 30 (63) | 26 (84) | 21 (3 to 40) | 4.17 | 0.04 |
| Actual use | |||||
| Objective setting | 29 (59) | 21 (62) | 3 (-19 to 24) | 0.06 | 0.81 |
| Supervision | 11 (22) | 7 (21) | -2 (-20 to 16) | 0.04 | 0.84 |
| Appraisal | 12 (24) | 15 (47) | 22 (1 to 43) | 4.37 | 0.04 |
| Progress | 6 (12) | 5 (16) | 3 (-12 to 19) | * | 0.75 |
| Proposed use | |||||
| Objective setting | 44 (92) | 34 (97) | 5 (-4 to 15) | * | 0.39 |
| Supervision | 31 (65) | 21 (66) | 1 (-20 to 22) | 0.01 | 0.92 |
| Appraisal | 44 (92) | 32 (91) | 0 (-12 to 12) | * | 1.00 |
| Progress | 43 (90) | 30 (94) | 4 (-8 to 16) | * | 0.70 |
Paired data were available in 44 cases where both the trainee and his or her own consultant trainer returned questionnaires. Curiously, more trainees (n=32) than trainers (n=30) reported that the trainee had received the log book. The paired data showed identical significant findings to those reported above and so are not reported in detail.
There were some differences in the responses of trainees and trainers according to their level of experience. Trainees who had passed at least MRCPsych Part I were significantly less likely to report their trainer to be committed to using the log book (4/19 v. 17/30, χ2=6.03, P=0.01). Conversely, experienced trainers (more than 5 years as a consultant) were significantly more likely to report their trainee to be committed to using the log book (14/26 v. 2/10, χ2=5.25, P=0.02).
Discussion
Log books have never been very popular among psychiatric trainees (Reference Sheldon and CornwallSheldon & Cornwall, 1998). However, they have been proposed as a method of recording the progress of specialist training in the UK and for psychiatric training throughout Europe (Department of Health, 1996; Union Européenne des Médecins Spécialistes, 1996). This is the first evaluation of the trainee's log book covering all psychiatric trainees and their trainers throughout a deanery. The high response rate from trainees and the replication of the results of the pilot study suggest that the findings can be generalised to the UK as a whole. The fact that nearly one-quarter of trainees had not received a log book, including many trainees who had recently commenced training, is of concern.
Trainees reported that fewer than 45% of their consultant trainers were committed to using the log book. Given the lack of two-way commitment it is unsurprising that the log book was not being used to any great extent. However, there was a high level of agreement that it should be used in setting educational objectives and in trainee appraisal. Concerns by trainees about the log book being used as a tool of assessment have not been borne out; indeed 90% of trainees agree that it should be used in discussion about progress through the training scheme. The uncertainty about using the log book in supervision reflects a lack of understanding of, training in and good practice of educational supervision (Reference CottrellCottrell, 1999; Reference Sembhi and LivingstonSembhi & Livingston, 2000).
Currently the responsibility for using the log book remains with the trainee, although it is acknowledged that trainees will not be motivated to use the document if neither consultants nor tutors ever ask to see it (Royal College of Psychiatrists, 1997 b ). For new trainees in particular, there needs to be more guidance on how the log book can promote a quality training experience. Two years after its introduction, there are still significant numbers of trainees and trainers who remain unfamiliar with its use, its purpose and even its existence. More work needs to be done by the College to promote the log book to both trainees and trainers if it is to serve the purpose that was intended.
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