Quality of resident violence risk assessments in psychiatric emergency settings

Can J Psychiatry. 2012 Jun;57(6):375-80. doi: 10.1177/070674371205700607.


Objective: To identify how psychiatric residents perceive their ability to conduct violence risk assessments and the risk factors they considered relevant in an emergency department setting.

Method: We surveyed 55 of 159 psychiatric residents at the University of Toronto as to their experience and education in assessing suicide and violence risk. The residents, and a comparison group of 11 of 16 staff psychiatrists in the Law and Mental Health program at the Centre for Addiction and Mental Health, then participated in a mock interview with one of the authors. The subjects were directed to ask for all risk factors that would be relevant in determining the violence risk of a hypothetical patient with homicidal ideation. The risk factors they requested were compared with the risk factors found in the Historical, Clinical and Risk Management-20 (HCR-20) structured clinical judgment tool.

Results: Psychiatric residents, on average, inquired about 6 fewer HCR-20 risk factors than staff psychiatrists (8.5, compared with 14.7). The number of HCR-20 items identified by residents correlated with several items; more risk factors were elicited by residents in a higher year of training, those who had received more formal and informal education, the number of patients for whom they had discharged a duty to warn, and the number of suicidal and violent patients they had previously assessed. Confidence at assessing violence risk was not correlated with performance.

Conclusions: Psychiatric residents identify significantly fewer risk factors for violence than staff psychiatrists. Resident performance was correlated with increasing experience and education. It was not related to self-confidence in performing this task.

Publication types

  • Comparative Study

MeSH terms

  • Attitude of Health Personnel
  • Checklist
  • Clinical Competence
  • Commitment of Mentally Ill / statistics & numerical data
  • Dangerous Behavior*
  • Educational Status
  • Emergency Services, Psychiatric*
  • Homicide / prevention & control
  • Homicide / psychology
  • Hospitals, University
  • Humans
  • Internship and Residency*
  • Ontario
  • Psychiatry / education*
  • Quality Assurance, Health Care / standards*
  • Referral and Consultation / statistics & numerical data
  • Risk Assessment / standards
  • Statistics as Topic
  • Suicide / prevention & control
  • Suicide / psychology
  • Violence / prevention & control
  • Violence / psychology*