Guidelines, algorithms, and evidence-based psychopharmacology training for psychiatric residents

Harvard University, Cambridge, Massachusetts, United States
Academic Psychiatry (Impact Factor: 0.81). 05/2005; 29(2):180-6. DOI: 10.1176/appi.ap.29.2.180
Source: PubMed

ABSTRACT The authors describe a course of instruction for psychiatry residents that attempts to provide the cognitive and informational tools necessary to make scientifically grounded decision making a routine part of clinical practice.
In weekly meetings over two academic years, the course covers the psychopharmacology of various psychiatric disorders in 32 3-hour modules. The first half of each module is a case conference, and the second is a literature review of papers related to the case. The case conference focuses on the extent to which past treatment has been consistent with evidence-supported guidelines and algorithms, and the discussants make recommendations that take the relevant scientific evidence into consideration. The second half of each module focuses on two papers: 1) a published guideline, algorithm, or review article and 2) a research study.
Residents absorb a comprehensive overview of recommended clinical practices and acquire skills in assessing knowledge that affects decision making. Satisfaction with the course is rated highly.
The course appears useful by its face validity, but research comparing the attitudes and practice outcomes of graduates of this course compared with recipients of other training methods is needed.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Increasing attention has been directed in healthcare today to the importance of performance measurement, (i.e., the implementation of measurable methods to demonstrate that practitioners are engaged in high-quality, evidence-based medicine). Many medical specialties, as well as many state medical licensing boards, now require that candidates submit performance measurement data, to be eligible for maintenance of board certification or medical licensure. National organizations such as the National Quality Forum and the Physicians Consortium for Performance Improvement of the American Medical Association are active collaborators with federal, state, and medical specialty initiatives to improve healthcare. These developing efforts are summarized here, with a specific focus on the status of these efforts in the field of psychiatry.
    05/2008; 14 Suppl 2:8-17. DOI:10.1097/01.pra.0000320122.53681.67
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the characteristics of curricula for teaching the content of clinical practice guidelines (CPGs) in psychiatric residency and child and adolescent fellowship programs as well as to determine if and how the learning of CPG content is applied in clinical care settings. We conducted a national online survey of directors of general psychiatry residency and child and adolescent fellowship programs in the USA. The survey questionnaire included 13 brief questions about the characteristics used to teach CPGs in the programs, as well as two demographic questions about each program and director. Descriptive statistics were reported for each questionnaire item by program classification (i.e., child and adolescent vs. general psychiatry). The survey response rate was 49.8 % (146 out of 293). Just 23 % of programs reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect of CPGs was their content (72 % of programs). Didactic sessions were the most frequently employed teaching strategy (79 % of programs). Regarding the application of CPG learning in treatment care settings, just 16 % of programs applied algorithms in care settings, and 15 % performed evaluations to determine consistency between CPG recommendations and care delivery. Only 8 % of programs utilized audit and feedback to residents about their adherence to CPGs. Faculty time constraints and insufficient interest were the leading barriers (39 % and 33 % of programs, respectively) to CPG teaching, although 38 % reported no barriers. However, child and adolescent programs less commonly identified insufficient interest among faculty as a barrier to teaching CPGs compared to general programs (20 % vs. 43 %). Moreover, compared to general programs, child and adolescent fellowship programs taught more aspects of CPGs, used more educational activities to teach the content of specific CPGs, and used more methods to evaluate the teaching of CPGs. Although the majority of programs provided some teaching of CPGs, the rigorousness of the teaching approaches was limited, especially attempts to evaluate the extent and effectiveness of their use in clinical care. Child and adolescent fellowship programs provided more extensive teaching and evaluation related to CPGs.
    Academic Psychiatry 03/2014; 38(2). DOI:10.1007/s40596-014-0057-3 · 0.81 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Addictive disorders receive little attention in medical school and residency program curricula.Objective To evaluate an innovative learning approach encouraging and stimulating residents to focus on key competencies by testing before and after their addiction psychiatry rotation.Methods We developed a 50-item test on substance use disorders. Twenty-six general psychiatry residents, post-graduate year I (PGY-I) and II (PGY-II), participated in the pilot study and were divided into three groups. PGY-I residents were divided into Group 1, who were tested the last day of the rotation and again 2 months later, and Group 2, who were tested on the first and the last day of the rotation. Eight of 11 PGY-II residents agreed to participate as controls (Group 3), as they had previously completed their 2-month addiction psychiatry rotation as PGY-I's. All residents were informed that the testing would not affect their individual grade. After taking the first test, all three groups received related study materials.ResultsA statistically significant increase in re-test scores occurred in the combined groups (p < .001). The largest changes in scores were among Group 2 (the group taking the test on first and last day of their addiction psychiatry rotation).Conclusion The greatest learning seemed to occur when residents were tested at beginning and end of the rotation. However, all residents' test scores improved to some degree, regardless of their level of training or the timing of the test.Scientific SignificanceThis study offers support for testing as a learning guide and as a means of stimulating residents' learning. (Am J Addict 2014;XX:XX–XX)
    American Journal on Addictions 07/2014; 23(6). DOI:10.1111/j.1521-0391.2014.12141.x · 1.74 Impact Factor