Educational Tools to Improve the Therapeutic Relationship of Psychiatrists and Psychiatric Residents with Patients Suffering from Psychosis: A Systematic Review

Objectives This systematic review identifies the literature on educational tools specifically targeting 2 of the keys competencies that a psychiatrist must acquire according to the Royal College of Physicians and Surgeons of Canada: the therapeutic relationship and empathy, in the context of psychosis. Method This review was carried out in the Medline databases via Ovid, PsycInfo (EBSCO) and Scopus using combinations of terms associated with therapeutic tools, empathy, residents in psychiatry, psychiatrists and psychosis. Two independent reviewers reviewed 1169 titles and abstracts, and retained 5 articles. Results All of the articles analyzed explore communication skills, in particular communication skills training, and 3 of the articles focus on one of its adaptations in psychiatry: ComPsych. It focuses on the announcement of the diagnosis and prognosis of schizophrenia through 5 areas of expertise: the meeting agenda, identification, questionnaire, organization of information and empathetic communication. These studies use role plays, standardized simulated patients, videos and feedback. An improvement in confidence regarding the prognosis is noted although the improvement obtained is inconsistent depending on the modalities used. A fourth article used the TEMPO model (Training to enhance psychiatrist communication with patients with psychosis) which resembles the ComPsych model, but includes, among other things, the use of real patients. TEMPO is also based on the Self-Repair measurement, a tool that determines how well a person strives to speak in a way that is understandable and acceptable to the listener in a conversation in general and in a psychiatric encounter. In the study, an improvement in the therapeutic relationship (moderate effect) by both psychiatrists and patients was observed. The last article provides a randomized controlled trial protocol for Shared decision making Plus (SDM-Plus) training in physician-patient interaction with an emphasis on shared and explicit decision-making. One module is for doctors, the other for patients. Conclusion Although many educational manuals and the Royal College of Physicians and Surgeons of Canada stress the role and importance of establishing a positive therapeutic relationship, this systematic review of the literature shows that there are only a limited number of studies on this subject, and they have low statistical power. It is therefore necessary to continue research on this field and to develop new educational tools. Here we make some recommendations.