Translation and adaptation of North American questionnaires for the assessment of skills and knowledge in the Brazilian psychiatric practice

Abstracts

INTRODUÇÃO: A bibliografia brasileira não faz referência a instrumentos e guias padronizados de investigação sobre a prática e o ensino de psiquiatria. Como contribuição ao tema, os autores traduziram e adaptaram instrumento norte-americano para avaliar habilidades e conhecimentos em psiquiatria. Os objetivos deste estudo foram: 1) descrever a metodologia para a elaboração de versões em português de questionários de avaliação de habilidades e de conhecimentos em psiquiatria; 2) expor os problemas de tradução e adaptação dos questionários; 3) disponibilizar os questionários na íntegra em língua portuguesa. MÉTODO: A metodologia compreendeu os seguintes estágios: primeira versão profissional; avaliação por psiquiatras bilíngües; avaliação por psiquiatras monolíngües; versão final em português; retrotradução independente por segundo tradutor profissional; revisão final pelo primeiro autor do trabalho original. Todos os estágios foram revisados sistematicamente pelos autores. RESULTADOS: Foram encontrados 11 problemas de tradução e de adaptação na busca da equivalência lingüística, com predomínio de cinco problemas de equivalência técnica. DISCUSSÃO: A pesquisa empírica em educação psiquiátrica é um campo novo e cada vez mais importante na formação de novos especialistas e na educação médica continuada frente aos desafios de uma especialidade em transição. CONCLUSÃO: O pequeno número de adaptações pode significar que a tradução e a adaptação das palavras da língua fonte alcançaram uma equivalência lingüística. O método comum de tradução e retrotradução foi insuficiente e precisou ser acompanhado pela avaliação de psiquiatras bilíngües e monolíngües e pela revisão de cada etapa pelos autores. O presente estudo disponibiliza em língua portuguesa instrumento único para avaliação de habilidades e conhecimentos na prática psiquiátrica brasileira.

Tradução; retrotradução; questionários; habilidades; conhecimentos; psiquiatria; prática profissional; psiquiatria em transição

ORIGINAL ARTICLE

Translation and adaptation of North American questionnaires for the assessment of skills and knowledge in the Brazilian psychiatric practice

Traducción y adaptación de cuestionarios estadounidenses para evaluar habilidades y conocimientos en la práctica psiquiátrica

Ibiracy de Barros Camargo^I; José Onildo B. Contel^II

^ICoordinator, Medical Residency in Psychiatry, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP, Brazil. Graduate Program in Mental Health, FMRP-USP, Brazil. Professor of Psychiatry, Universidade de Ribeirão (UNAERP), Brazil. Professor of Psychiatry, Centro Universitário Barão de Mauá, Brazil

^IIProfessor of Psychiatry, Department of Neurology, Psychiatry and Medical Psychology, FMRP-USP, Brazil. Professor, Graduate Program in Mental Health, FMRP-USP, Brazil. Coordinator, Hospital Dia Psiquiátrico, HC-FMRP-USP, Brazil

Correspondence

ABSTRACT

INTRODUCTION: The Brazilian literature does not make reference to standardized instruments and guidelines aimed at the assessing psychiatric teaching and practice. As a contribution to the theme, the authors of the present study translated and adapted a North American instrument designed to evaluate skills and knowledge in the psychiatric practice. The objectives of this study were: 1) to describe the methodology used to translate two questionnaires on skills and knowledge of psychiatry; 2) to summarize the difficulties faced in the process of translating and adapting the questionnaires; 3) to make the questionnaires available in Portuguese.

METHOD: The methodology comprised the following stages: first professional version; evaluation by bilingual psychiatrists; evaluation by monolingual psychiatrists; final version in Portuguese; independent back translation by a second professional translator; final review by the first author of the original paper. The authors systematically followed all stages.

RESULTS: Eleven of the translation and adaptation problems faced during the process referred to linguistic equivalence, whereas five problems were related to technical equivalence.

DISCUSSION: Empirical research in psychiatric education is a new and increasingly important field. It will improve the quality of education and training in both residency and continuing education programs in psychiatry — a specialty in transition.

CONCLUSION: The small number of adaptations may indicate that the translation and adaptation of the words in the source language reached linguistic equivalence. The use of translation and back translation proved to be insufficient, and the process had to be followed by bilingual and monolingual psychiatrists and also by the authors. This paper offers the scientific community the first instrument in the Portuguese language aimed at assessing skills and knowledge in the Brazilian psychiatric practice.

Keywords: Translation, back translation, questionnaires, skills, knowledge, psychiatry, professional practice, psychiatry in transition.

RESUMEN

INTRODUCCÍON: La bibliografía brasileña no menciona instrumentos y guías estándar de investigación sobre la práctica y la enseñaza de psiquiatría. Para complementar algún conocimiento al tema, fueran traducidos y adaptados instrumentos estadounidenses para evaluar las habilidades e conocimientos de psiquiatría.

OBJETIVOS: 1) describir la metodología para la elaboración de una versión en portugués de cuestionarios de evaluación de habilidades y conocimientos en psiquiatría; 2) exponer los problemas de traducción y adaptación de los cuestionarios; 3) disponer los cuestionarios, de forma íntegra en lengua portuguesa.

MÉTODO: La metodología comprende de las siguientes etapas: Primera versión profesional; evaluación por psiquiatras bilingües y por psiquiatras monolingües; versión final en portugués; una nueva traducción independiente por otro traductor profesional y una revisión final por quien hizo el trabajo original. Todas las etapas fueran sistemáticamente revisadas por los autores.

RESULTADOS: Se encontraron once problemas de traducción y de adaptación en la búsqueda de equivalencias lingüísticas, predominando cinco problemas de equivalencia técnica.

DISCUSIÓN: La pesquisa empírica en educación psiquiátrica es un campo nuevo y cada vez se hace más importante en la formación de nuevos especialistas y en la educación médica continua, confrontando así los desafíos de una especialidad en transición.

CONCLUSIÓN: El pequeño número de adaptaciones puede significar que la traducción y la adaptación de las palabras de la lengua fuente alcanzaron una equivalencia lingüística. El método común de traducción y retraducción fue insuficiente y necesitó ser acompañado por evaluaciones de psiquiatras bilingües y monolingües junto a una revisión de cada etapa por los autores. El presente estudio pone a disposición en lengua portuguesa un instrumento único para la evaluación de las habilidades y conocimientos en la práctica psiquiátrica brasileña.

Palabras clave: Traducción, retraducción, cuestionarios, habilidades, conocimientos, psiquiatría, práctica profesional, psiquiatría en transición.

INTRODUCTION

Up until the end of the Second World War, the teaching of psychiatry in Ibero-American countries was developed in large public or private psychiatric hospitals, did not follow structured programs, was centered on the personal relationship between master and disciple and emphasized programs from developed countries. In Brazil the situation was no different: programs of Residency in Psychiatry began to take form at the end of the 1950s and start of the 1960s.¹ Until then many future specialists sought training in developed countries, especially in the United States, England, France and Germany. This situation changed considerably to the extent that domestic programs were modified in such a way as to attract and train future specialists.²

Today, the number of Brazilian psychiatry programs accredited with the National Commission for Medical Residency (Comissão Nacional de Residência Médica — CNRM) has reached 56 and offer 203 places during the first year, with a compulsory component lasting 2 years, with 18 of the programs offering an elective third year in subspecialties.³

This growth in the demand for specialization in psychiatry by an ever-growing number of doctors is in line with what has been happening in the other specialties, demanding the establishment of protocols of intentions in order to promote equity regulation and standardization across the subspecialties.

The contents of the programs over the two compulsory years obey the minimum standards of the CNRM and periodic inspections are obligatory. The programs have gone to great lengths to establish either implicitly or explicitly the educational objectives of psychiatric training, meeting the demands of the CNRM and the needs of the students and local care providers.⁴

These organizational efforts made by the medical institutions include the search for permanent institutional mechanisms in order to maintain the quality of training and professionals' sustained competence. The Brazilian Association of Psychiatry (Associação Brasileira de Psiquiatria — ABP), by means of the Continuing Medical Education Program (Programa de Educação Médica Continuada — PEC), participates in this movement.⁵

The search for homogeneity in specialist training as a substitute for the two existing methods — specialization by medical residence, recognized by the CNRM and affiliated to the Ministry of Education and Culture (MEC), and specialization by evaluation by the Brazilian Medical Association (Associação Médica Brasileira - AMB) — is being discussed by the Federal Medical Council (Conselho Federal de Medicina).⁶

During the last 20 years psychiatry has been in transition with dramatic changes in the practical base and in psychiatric knowledge, in the increase in the number of non-psychiatrists involved in the treatment of those with mental illness and in the expansion and diversification of the locations where psychiatry can be practiced. In this scenario of accelerated changes it has been primitive to offer training programs that dictate which skills and what knowledge should predominate in the practice of the profession.^7,8

Despite all these efforts, surprisingly, little is known about the connection between training and subsequent professional practice. This being the case, to the extent that psychiatry progresses towards being a specialty that aims to occupy a position of the first order in the Brazilian and international medical scenario, empirical research that offers a secure scientific basis to the search for these skills and this knowledge becomes ever more necessary.⁹

Nevertheless, there is no existing instrument in Brazil with the specific objective of assessing the skills and the knowledge necessary to psychiatric practice. The importance of this issue has been testified to by the World Psychiatric Association (Associação Mundial de Psiquiátrica) and by the World Health Organization, who united in a cooperative project with the aim of preparing an atlas of post-graduation in psychiatry.¹⁰ The volume of indexed Brazilian publications has been insufficient and scattered;^11-15 furthermore, empirical research in Brazil is scarce and does not include investigations of this theme.^16-20

Since the 1970s, with the objective of promoting the usage of international instruments that are applicable to our country, both in psychiatry^21,22 and in other areas of medicine,²³ already existing instruments, the majority originating from English-speaking countries, have been translated and adapted transculturally.

This path has been considered preferable to the construction of new instruments,²⁴ as being practical, operational and as making comparison between countries possible,²⁵ allowing for the organization of international documentation on common instruments, thus opening the possibility of revealing problems relating to the diversity of different countries in terms of culture and language.^26,27

In the United States and Canada, the competencies necessary to psychiatric education and practice, required for evaluative ends from medical residency through continued medical education, have merited prominence. Certain categories in the evaluation process, such as patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professional and systems-based practice are considered essential.^28-30

The need for wide-ranging domestic studies of the competencies essential to psychiatric practice³¹ is the driving force of the efforts put into the present study to translate and adapt North-American questionnaires³² aimed at evaluating the skills and knowledge necessary to psychiatric practice.

The choice of instrument was defined by the coherence and importance of the questionnaires analyzed, as attested to by their publication in a high-impact, specialist international journal, according to ISI Web of Science criteria. Also involved in this choice was the fact that there were 27 article citations that referred to the questionnaires in the international literature up until 2001, of which, three were published in the American Journal of Psychiatry, one in the British Journal of Psychiatry and one in the Bulletin of the Menninger Clinic. The relevance of the theme itself was attested to by the publication of 59 articles related to the subject in the international literature during the last five years. The identification of the non-existence of a similar study in Brazil and the authors experience both in practice and teaching also played a part.³³

The selected instrument is self-administrated and was developed by Lagsley & Yager in 1989, in empirical research with 485 heads of psychiatry departments and residency program coordinators and 499 psychiatrists in clinical practice, members of the American Psychiatric Association, aiming to identify and describe the practice standards and educational ideas on the skills and knowledge that a psychiatrist must possess in the United States.³²

The present study is placed within the context of increasing searches for standardized instruments that allow for more formal assessment structures.²¹ This is the case, for example, of the search for a common international language in psychiatry, being a work of unification and equivalence of diagnostic language or globalization of technical terminology, offered by the two dominant classification systems^34,35 that have directed psychiatric teaching, research and clinical practice throughout the world and in Brazil. It is believed that a common language, established via standardized instruments, would allow clinicians and researchers from the four corners of the world speak to each other³⁶ in a more objective manner.

OBJECTIVES

The objectives of this study were: 1) to describe the methodology of translation and adaptation of the Portuguese versions of two questionnaires for evaluating skills and knowledge in psychiatry; 2) to expose the problems associated with the translation and adaptation of questionnaires into Portuguese; 3) to make available the complete questionnaires as translated into and adapted for Portuguese.

METHODS

The translation into Portuguese was performed using the methodology presented in Figure 1, with the objective of obtaining two versions with the greatest possible equivalence, one directly from the source and the other with adaptations for the target language for Brazilian psychiatrists.

Subjects. The authors followed the whole process of translation and adaptation step by step, and were responsible for the first version, together with the first professional translator. This version was continually modified, as it was evaluated by three bilingual Brazilian psychiatrists, 12 monolingual psychiatrists (four heads of psychiatry departments, four coordinators of psychiatry residency programs accredited by the CNRM and four specialists in psychiatry qualified by the ABP), before achieving the final version. Backtranslation was the responsibility of a second professional translator, and the final revision was made by one of the authors of the original work.

Instrument. The instrument is made up of two questionnaires. Questionnaire ^Q1, has 48 thematic items and evaluates skills, and questionnaire ^Q2, with 51 items, evaluates knowledge. Both were translated into and adapted for Portuguese. The majority of the items are composed of short, simple sentences, with less than 16 words each and one keyword with the dominant idea.

Translation and backtranslation. Authorization for the translation into and adaptation for Portuguese was requested from the original author, who gave permission. The translation was performed based on the recommendations of the World Health Organization²⁴ and on models from national and international literature that were compatible with the procedure.^25-27

Questionnaire modification stages (^Q1 and ^Q2)

First version.^Q1 and ^Q2 were translated by a professional translator without experience in the field of psychiatry. Next, 99 items were interactively revised by the authors, and the resulting consensus on this first translation was the first version in Brazilian Portuguese.

First evaluation by three bilingual psychiatrists. This first version was then revised by three renowned Brazilian psychiatrists who were involved in American psychiatry for a long time and have experience of the culture of the country in which the questionnaires were originally developed and applied. These specialists were considered capable of recognizing the principles behind the items and able to identify the concept behind each of them in the translated instrument from the point of view of linguistic equivalence. A consensus was established between the three revisers and the authors, in an attempt to clear up minor doubts that were the result of modifications to the manner in which some of the questions were posed. Next, this version in Portuguese was submitted to a committee of evaluators.

Second evaluation by monolingual evaluation committee. For 1 month, 12 assessors, specialists in psychiatry, reviewed ^Q1 and ^Q2 in Portuguese, attempting to bring minor details of this preliminary version in the target language up to date.

The suggestions and comments of these evaluators were incorporated as adaptations to the questionnaires, with improved understanding of some items, without, however, changing their number. As part of this process, once more via consensus, the specialists and the authors found solutions for any remaining doubts, from which resulted the final version in Portuguese.

Final source-version and target-version of the questionnaires. In this stage the final Portuguese version was backtranslated independently by a second professional translator into the original source language. The resulting backtranslation was compared with the original version in English. The authors and the second translator evaluated the observed differences in order to decide, once again by consensus, whether they affected linguistic equivalence. The backtranslation resulting from this consensus was sent to the original author, for him to compare it with the original version in English. This procedure was aimed at assuring that there was semantic, technical and conceptual equivalence in addition to equivalent criteria, in order that the translation into Portuguese maintained the same objectives and construction as the original version.

RESULTS

The translated questionnaires exhibited a format that was simple and easy to read and understand when assessed by the bilingual and monolingual psychiatrists.

Table 1 lists 11 problems of translation and adaptation found in the search for linguistic equivalence in the target language. The problems of semantic equivalence, two in number, were with the words "compassion" and "disorder", which had been translated as "compaixão" and "desordem". In place of "compaixão", two assessors preferred "empatia", which gained prevalence in ^Q1, item 5. In place of "desordem", they preferred the word "distúrbio", while the authors, in accordance with the Classification of Mental and Behavioral Disorders in the ICD-10, opted for the word "transtorno". This last occurred in ^Q1, items 24 and 30, and in ^Q2, items 1, 2, 9 and 22.

Technical adaptations predominated, of which there were five. Three of these occurred in ^Q1, as follows: in item 4, the meaning of the word "hospitalization" was amplified to "hospitalização integral e hospitalização parcial (hospital dia)"; in item 12, "neuropsicológicos, exames de imagem de função cerebral" was added; and in item 16, "psicólogos e terapeutas ocupacionais" was inserted. The remaining two adaptations occurred in ^Q2, as follows: in item 8, "hospitalização parcial" was added; and in item 11, "da neurologia, neurobiologia, clínica médica, endocrinologia e imunologia, psiquiatricamente mais relevantes".

With respect of the equivalence of content, problems were identified with the word "commitment", which had been translated as "confinamento", which, when the first author of the original work was consulted, became "hospitalização involuntária". This expression was used in ^Q2, item 24.

With respect of conceptual equivalence, ^Q2, item 10 had the word "bioquímicas" substituted by "psicobiológicas", in response to a suggestion by one of the evaluators.

Two modifications were introduced to maintain the equivalence of criteria, both of them in ^Q2, as follows: in item 22, the expression "distúrbios psicossomáticos" was substituted by "transtornos dissociativos e somatoformes"; and in item 36, "ciências neurobiológicas básicas" was changed to "bases neurobiológicas do comportamento normal e patológico".

DISCUSSION

Empirical research into psychiatric education is a new and ever more important field to the training of new specialists and continuing medical education, in the face of the challenges of a specialty in transition. In this direction, the present study is following a tendency towards the translation and adaptation to Portuguese of instruments for measuring behavior and responses related to the practice of psychiatry.

In other areas of psychiatry examples of this tendency are the development of adapted instruments to evaluate the quality of life of chronic renal patients that are highly useful for psychiatric liaison consultations, and of specific scales for the assessment of mania, the objective of which is to study the prevalence of this disease in family medicine programs. Another example is the 36 evaluation scales for systematic measurement instruments in psychiatry and psychopharmacology, published in Brazil in 1998.³⁷

This interest in empirical research has received government support from the Higher Educational Personnel In-Service Training Council (Conselho de Aperfeiçoamento de Pessoal de Nível Superior - CAPES) in the form of the strengthening of post-graduate courses at the psychiatry and mental health departments of certain Brazilian public universities.

In parallel with the support for research, regulations have appeared,³⁸ originating from the Health Ministry, that promote the quality of psychiatric care, and also improvements in the teaching of psychiatry as a specialty via CNRM. Last, but not least, the AMB's Scientific Council is perfecting the regulations for the granting of the title of specialist while they begin to introduce the process of revalidation of the title.

The efforts of these institutions in search of professional recognition for their specialties is an expression of a growing concern with regulation of the professions from the inside out. When put into practice, these traditional forms of organization that centralize directives and propose assessment systems based on the opinions of their commissions present the risk of representing concepts that can be of greater interest to the proposing agencies than to the specialists being assessed. Such imprudence can come to submit the training of psychiatrists and the practice of psychiatry to directives that do not always correspond to the principles that are accepted by those who have a true interest in them.

In order to avoid this centralizing bias it is ever more necessary to define local and internal indicators that direct dialogue and debate in order to inform practice. It is therefore indispensable to obtain the opinion of psychiatrists on their current practices, in order to establish criteria that define the skills and knowledge needed to meet the demands of their day-to-day work. Such an empirical investigative approach would make it possible to direct the efforts towards the construction of a minimum curriculum for training professionals, in tune with the constant transformations of psychiatry.

Psychiatry, as is the case in medicine in general, has a dimension that is predominantly practical, aiming to offer relief to the patient requiring help. This practice is fed by two basic scientific fields: the biological sciences, with emphasis on the neurosciences, and the psychosocial sciences, with anthropology, sociology, social psychology and epidemiology predominating. At the same time that it is enriching the specialty, this multidisciplinarity brings with it certain complicating factors, as it diffuses the roles that are necessary to the exercise of the demands of the profession.

Within this context, the psychiatrist is the mental health professional who can best integrate biological and psychosocial findings. However, in caring for people with mental disorders, it is necessary to apply immediate measures, which demand a repertoire of resources and therapeutic techniques the mechanisms of which are not yet sufficiently explained. The training of future specialists and programs of continuing medical education can reduce the degree of uncertainty in daily practice and help to protect against the illusion of scientific exactitude, which only reflects ignorance of these limitations.

Taking this panorama of uncertainties and transformations that constitute the area into account,³⁹ the authors of the original work attempted to investigate the directors of residency programs and psychiatrists in clinical practice in the United States in order to discover their opinions about how they defined themselves as opinion formers and specialists in psychiatry. The items within the instrument were therefore developed to highlight the relevance of skills and knowledge considered necessary to professionals in education and clinical practice. This was also the objective of the authors of the present paper, when translating and adapting said instrument.

The questionnaires presented here allow the opinions of psychiatrists from different geographical regions of the country, from residency programs, psychiatric units at general hospitals, traditional psychiatric hospitals, outpatients hospitals and centers and nuclei of psychosocial care, among others, to be compared. Qualitative and statistical treatments of the results may allow for useful generalizations as a form of contributing to the design of teaching programs within residencies and continuing medical education.

The instrument thus developed could still be improved further by the inclusion, for each item, of three possible responses: "Esse item é definitivamente necessário, provavelmente necessário, ou provavelmente não necessário para a prática profissional?". ("This item is definitely necessary, probably necessary or probably not necessary to professional practice?") This would make it possible to create a scale of the responses given from one to three. After completion it would then be possible to determine that, the more a given item had been classified by those responding as predominantly necessary, then, the more opinion formers at residency programs and on continuing medical education courses value, in pragmatic terms, the teaching and practice of that item.

Having characterized the importance of the application of the instrument in Brazil, it is now appropriate to highlight the potential and the problems of the method used for translation and adaptation. The 12 monolingual specialists were indispensable since they identified and adapted to the target language 11 problems that had passed unnoticed by the bilingual specialists. The follow-up through every stage by the authors was essential to integrate and define the methodological rigor of the final translation.

The small number of adaptations indicates a surprising level of symmetry. Thus the wide ranging process of translation and adaptation described made it possible to achieve a corresponding linguistic equivalence for the words in the source language in the target language. This symmetry suggests that an adequate transcultural equivalence was achieved for the questionnaires. Evidently certain problems had to be faced, such as those with the words "disorder", "psychosomatic" and "psychosomatically", as shown in Table 1.

From a semantic point of view, the word "disorder", whose literal translation is "distúrbio", constitutes a good example of how a difference between source and target languages can completely distort meaning from the transcultural point of view. The word "disorder" was translated as "distúrbio" in Brazil until 1994. From then onwards it was substituted for "transtorno". The change was made because, in the popular imagination, there was an association between "distúrbio" with social disorganization, public disorder, riot, fighting and blind violence, to the extent that people that caused these problems were described as, "desordeiros". The word does also mean madness, but with connotations of large-scale disorder, social upheaval and random violence.

From the technical point of view, the authors preferred the literal translation of the term "psychosomatically" ("psicossomaticamante") for item 14 of ^Q1. This decision was made because psychosomatic medicine is nowadays known in the United States as psychiatric consultation/liaison and general hospital applied psychiatry for more difficult and complex physically ill patients. When the author of the original work was consulted on the subject, he believed that "psychosomatic medicine" and "consultation-liaison" are synonymous, which is also stated in specialized literature.⁴⁰ On the other hand, in ^Q2, item 22, the assessors preferred "dissociativos e somatoformes" for "psychosomatic", probably under the influence of the DSM-IV and ICD-10 diagnostic classifications. The authors agreed and preserved this apparent contradiction as an expression of a historic dilemma in psychiatry, raised by the term psychosomatic, which remains current and cannot be banished from psychiatric practice.

The large degree of symmetry encountered may be related to the fact that the questionnaires define technical operational items that are clear and of interest to a given population of psychiatrists in both languages. Thus, it would be no exaggeration to claim that there is a surprising similarity in the thematic equivalence of the questionnaires from the United States and Brazil. This symmetry appears to demonstrate that the version that is now being made available to the Brazilian Portuguese speaking scientific community is the closest possible to the original instruments.

Certain limitations that weigh on translation and adaptation are related to the uncritical and mechanical adoption of imported models, one example of which is the translation of the word "disorder" described above. These limitations can be overcome as the adapted translation of the instrument undergoes field tests involving a significant sample of Brazilian psychiatrists, in an attempt to investigate how professionals react to the application of the questionnaires. One limitation of this translation and adaptation of the instrument that we must mention is the use of a small number (just 12) of monolingual psychiatrists for evaluation.

Therefore, the appearance of the translation as a finished product may be misleading. The process of translation and adaptation of an instrument is complex and does not end with finding linguistic equivalence. To a certain extent the process is similar to the construction of the original instrument, even demanding that the reliability and validation tests be redone in new contexts, based on reliability, internal coherence and factor analysis, among other statistical procedures.

Future modifications, or even the construction of a new instrument should be contemplated in the face of the transitory nature of significant fields of practice and of psychiatric knowledge. The evaluators, for example, did not include items that today touch on practice, such as medical computation, HIV/AIDS, the political and economic reality of mental health care and evidence based practice.

Taking into account the transitory nature of the specialty,³⁹ it can be assumed that the application, from time to time, of the instrument to a sufficient number of respondents would offer results that, when compared using the appropriate statistical methods, could reveal changes in the demands of teaching and practice that have not yet reached the text books.

Notwithstanding, the quality and applicability of the adapted instrument for assessing the skills and knowledge of Brazilian psychiatrists at a number of different levels can only be confirmed through research on a national level, which will be the objective of a second study.

CONCLUSIONS

The present study aimed to reduce the barriers that exist to the performance of experimental research into psychiatric education, by offering an instrument with an international scope for this purpose. Differences in the origin and structure of the English and Portuguese language demanded an in-depth study in order that the quality of the instrument be maintained throughout the process of translation and adaptation. The standard method of translation and backtranslation was shown to be insufficient and had to be coupled with revisions at every stage by the authors and followed-up by bilingual and monolingual evaluating psychiatrists. Current advances in psychiatry make it impossible to accept any single paradigm to explain or direct either current or future research and practice. This being the case any investigative instrument, in the best of hypotheses, would be a portrait of the present moment. Taking into account the dynamics of the transformations that may become necessary. A study with the type of scope that occurs with large-scale applications in the United States could allow for an empirical definition of which skills should be acquired and what knowledge is necessary, and even top priority, for the ever more diversified and complex tasks of psychiatric practice in our country.

REFERENCES

10. WPA-WHO. Atlas project on postgraduate training in psychiatry. Available at: http//www.who.int/mental_health/en/. Accessed 2003.

• 1. Camargo IB, Vansan GA, Contel JOB. História do início do ensino de psiquiatria na residência médica do HC-FMRP-USP. J Bras Hist Med 2002;5(1):38.
• 2. Guimón J, editor. Formation dês psychiatres de demain. Paris: Masson; 1998.
• ³
  3. Brasil, MEC/CNRM/SESU. Relação de instituições e programas de residência médica por região. Brasília: MEC/CNRM/SESU; 2001.
• ⁴
  4. Brasil, MEC/CNRM/SESU. Resolução No 1. Critérios Básicos para Credenciamento de Programas de Residência Médica. Brasília: MEC/CNRM/SESU; 2002.
• 5. ABP. Programa de educação médica continuada. Psiquiatr Hoje 2003;2:14.
• 6. Normativa para emissão de títulos de especialista e certificados de áreas de atuação. JAMB 2004;1331:12.
• 7. Rifkin B. Changes and dilemmas in psychiatric practice. In: Silberman EK, editor. Successful psychiatric practice. Washington DC: American Psychiatry Press; 1995. p.1-13.
• 8. Lieberman JA, Rush J. Redefining the role of psychiatry in medicine. Am J Psychiatry 1996;153(11):1388-97.
• 9. Okasha A. The future of medical education and teaching: a psychiatric perspective. Am J Psychiatry 1997;154(Suppl.):6.
• 11. Kerr-Corrêa F. Residência em psiquiatria na Faculdade de Medicina de Botucatu: relato crítico de um programa. Rev Bras Educ Med 1986;10(3):148-51.
• 12. Calil LC, Contel JOB. Estudo dos programas de residência médica em psiquiatria no Estado de São Paulo em 1993. Rev Bras Psiquiatr 1999;21(3):139-44.
• 13. Elkis H. Residência médica: competências mínimas e psiquiatria moderna. Rev Bras Psiquiatr 1999;21(3):137-8.
• 14. Rodrigues CRC. A especialização em psiquiatria. Revista ABP-APAL 1989;11(4):155-9.
• 15. Camargo IB, Contel JOB. Research methodologies to asses teaching in psychiatric residency: a literature review. Rev Bras Psiquiatr 2003;25(3):160-5.
• 16. Eizirik CL, Fonseca AF, Gazal CH, Ferreira ED, Costa FM, Goldim JR, et al. O psiquiatra do Rio Grande do Sul e sua prática de consultório: perfil dos entrevistados (1). Rev Psiquiatr RS 1991;13(3):160-6.
• 17. Eizirik CL, Costa FM, Goldim JR, Santos TM, Gazal C, Zampel R, et al. Perfil e prática profissional de psiquiatras no Brasil. Revista ABP-APAL 1996;18(2):49-52.
• 18. Eizirik CL, Goldim JR, Fonseca AF, Gazal CH, Costa FM, Piltcher R, et al. Uma amostra de psiquiatras do Rio Grande do Sul e São Paulo: perfil demográfico e prática de consultório. Revista ABP-APAL 1993;15(3):82-6.
• 19. Bastos O, Martins MCCA. Esboço de um perfil atual do psiquiatra pernambucano. Rev ABP 1979;2(1):19-29.
• 20. Cabrera CC. O tratamento manicomial e a desinstitucionalização, segundo opiniões de psiquiatras de Ribeirão Preto [tese de doutoramento]. Ribeirão Preto: Faculdade de Medicina de Ribeirão Preto, USP; 2000.
• 21. Jorge MR. Adaptação transcultural de instrumentos de pesquisa em saúde mental. In: Gorestein C, Andrade LHSG, Zuardi AW, editores. Escalas de avaliação clínica em psiquiatria e em psicofarmacologia. São Paulo: Lemos; 2000, p.53-8.
• 22. Shansis F, Berlim MT, Mattevi B, Maldonado G, Izquierdo I, Fleck M. Desenvolvimento da versão em português da escala administrada pelo clínico para avaliação de mania (EACA-M): "Escala de Mania de Altman". Rev Psiquiatr RS 2003;25(3):412-24.
• 23. Duarte PS, Miyazaki MCOS, Ciconelli RM, Cesso R. Tradução e adaptação cultural do instrumento de avaliação de qualidade de vida para pacientes renais crônicos (KDQUOL-SF). Rev Assoc Med Bras 2003;49(4):375-81.
• 24. Cardoso CS, Bandeira M, Caiaffa WT, Fonseca JOP. Escala de qualidade de vida para pacientes com esquizofrenia (QLS-BR): adaptação transcultural para o Brasil. J Bras Psiquiatr 2002;51(1):31-8.
• 25. Vallerand R. Vers une methodologie de validadtion transculturelle de questionnaires psychologiques. Can Psychol 1989;30:662-80.
• 26. Hunt SM, Alonso J, Bucquet DN, McKenna WI. Cross-cultural adaptation of health measures. Health Policy 1991;19(2):33-44.
• 27. Massoubre C, Lang F. La traduction des questionnaires et des tests: techniques et problèms. Can J Psychiatry 2002;47(1):61-7.
• 28. Persad E, Leverette J. Training issues in psychiatry in Canada. Can J Psychiatry 2003;48(4):213-4.
• 29. Scheiber SC, Kramer TAM, Adamowski SE. The implications of core competencies for psychiatric education and practice in the US. Can J Psychiatry 2003;48(4):215-21.
• 30. Miller SI, Scully JH, Winstead DK. The evolution of core competencies in psychiatry. Acad Psychiatry 2003;27(3):128-30.
• 31. Botega NJ. Residência de psiquiatria no hospital geral: uma enquête nacional. J Bras Psiquiatr 1991;40(8):419-22.
• 32. Langsley DG, Yager J. The definition of psychiatrist: eight years later. Am J Psychiatry 1988;145(4):469-75.
• 33. Contel JOB. A supervisão no processo de ensino de psiquiatria dinâmica e psicoterapia: retrospecto crítico de 30 anos da experiência pessoal. Medicina 1992;25(3):330-43.
• 34. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-4). 4th ed. Washington DC: American Psychiatric Press; 1995.
• 35. OMS. Classificação de transtornos mentais e de comportamento da CID-10. Porto Alegre: Artes Médicas; 1993.
• 36. Berganza CE. Broadening the international base for the development of an integrated diagnostic system in psychiatry. World Psychiatry 2003;2(1):38-40.
• 37. Gorestein C, Andrade LHSG, Zuardi AW. Escalas de avaliação em psiquiatria e psicofarmacologia. São Paulo: Lemos; 2000.
• 38. Brasil. Portaria GM/MS nş 2048. Regulamento técnico dos sistemas estaduais de urgência e emergência. Diário Oficial da União, Brasília, 5 nov. 2002.
• 39. Weissman SH, Nadelson. Psychiatry in transition. In: Dikstein L, Riba M, Oldham JM, editors. Review of psychiatry. Washington DC: American Psychiatry Press; 1996. vol. 15, p.503-5.
• 40. Gitlin DF, Levenson JL, Lyketsos CG. Psychosomatic medicine: a new psychiatric subspecialty. Acad Psychiatry 2004;28:4-11.

Publication Dates

• Publication in this collection
  14 Sept 2005
• Date of issue
  Dec 2004

History

• Accepted
  29 Nov 2004
• Reviewed
  28 Oct 2004
• Received
  22 Sept 2004