Teaching Evidence-Based Psychiatry: Integrating and Aligning the Formal and Hidden Curricula

McMaster University, Psychiatry and Behavioural Neurosciences, Hamilton, Ontario, Canada.
Academic Psychiatry (Impact Factor: 0.81). 11/2008; 32(6):470-4. DOI: 10.1176/appi.ap.32.6.470
Source: PubMed


The authors argue that adopting evidence-based psychiatry will require a paradigm shift in the training of psychiatry residents, and offer some suggestions for how this transformation might be achieved.
The authors review the growing literature that addresses how best to teach evidence-based medicine and highlight several examples of innovative instructional and assessment methods.
Little is known about how best to instill among residents the attitudes, knowledge, skills, and behaviors that are necessary to practice evidence-based psychiatry. However, there are indications that the integration of evidence-based medicine instruction into routine clinical care and the alignment of the "hidden curriculum" with evidence-based practice are important.
A whole-program approach may be necessary to create the conditions required in postgraduate training to produce evidence-based psychiatrists.

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    • "Furthermore, this literature also discusses how gender stereotypes and racial inequality often are implicitly perpetuated through teachers' differential behavior toward performance expectations of students. In medical education, most authors use the term hidden curriculum, and a considerable literature has developed in a number of specialty areas, such as pediatrics (Balmer, Master, Richards, & Giardino, 2009); end-of-life care (Billings, Engelberg, Curtis, Block, & Sullivan, 2010); and psychiatry (Agrawal, Szatmari, & Hanson, 2008). This literature examines the impact of messages from teachers and role models about what is acceptable behavior for a physician (Gaiser, 2009). "
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    ABSTRACT: This article focuses on the culture of human interchange, which is included as a component of the implicit curriculum in the current EPAS. It presents the use of the implicit curriculum concept in teacher and medical education as a context for its application to social work education. The authors argue that professional behaviors taught in the explicit curriculum of the classroom need to be consciously reinforced in the many venues and through the ongoing interpersonal relations throughout the educational environment. The article identifies the challenges that movement in this direction would create but which the implicit curriculum standard mandates us to address.
    Preview · Article · Jan 2013 · Journal of Teaching in Social Work
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    • "Recent studies suggest that evidence-based clinical skills can be taught, but they are not necessarily continued into future practice[32,33]. Most educators advocate for a "whole-program approach" and clinically integrated teaching of EBP seeded throughout a curriculum is likely required for truly meaningful learning and application[34-37]. "
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    ABSTRACT: Positive attitude toward evidence-based practice (EBP) principles in healthcare education may be one of the first steps for motivating a healthcare professional student to later apply EBP principles in clinical decision-making. The objectives for this project were to pilot an international web-based survey of chiropractic students and to describe student attitudes, behaviors, and knowledge about EBP principles. We used SurveyMonkey™ to develop our survey based on an existing questionnaire used to measure basic knowledge, skills and beliefs about EBP among allied healthcare professionals and CAM practitioners. We invited 26 chiropractic educational institutions teaching in English and accredited by official organizations to participate. Academic officials and registrars at participating institutions forwarded an invitation email and two reminders to students between July and September 2010. The invitation contained a link to the 38-item web-based questionnaire. Descriptive statistics were performed for analysis. Fourteen institutions from Australia, Canada, US, Denmark and New Zealand participated. Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all. Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care. Respondents without previous training in research methods had lower confidence in assessing published papers. While more than 60% marked the correct answer for two knowledge items, the mean number of correct answers to the five knowledge questions was 1.3 (SD 0.9). Although it is feasible to conduct an international web survey of chiropractic students, significant stakeholder participation is important to improve response rates. Students had relatively positive attitudes toward EBP. However, participants felt they needed more training in EBP and based on the knowledge questions they may need further training about basic research concepts.
    Full-text · Article · Mar 2011 · Chiropractic and Manual Therapies
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    • "Additionally, the tension between the goals of evidencebased practice and those of the recovery movement has created some confusion and conflict about what is needed to improve behavioral health care at the personal , provider, and organizational levels (Cook, Toprac & Shore, 2004). As a result, experts have emphasized the need to improve pre-service training programs across a breadth of disciplines in order to prepare new generations of physicians and other clinicians to apply patient-driven care, shared decisionmaking , and other recovery strategies within a context of evidence-based practice (Agrawal, 2008; Hoge et al., 2005). This article describes one university's attempt to transform the academic curricula in the medical, social, and behavioral sciences, all of which are mandated to adhere to accreditation requirements for their respective disciplines (e.g., American Association for Medical Colleges [AAMC] for medical students ). "
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    ABSTRACT: This article describes a curricular transformation initiative, the Recovery Education in the Academy Program (REAP), spearheaded by the University of Illinois at Chicago's National Research and Training Center on Psychiatric Disability. REAP is designed to integrate principles of recovery, self-determination, and other evidence-based practices for people with psychiatric disabilities into medical, social, and behavioral sciences curricula. The principles on which the curricula transformation efforts are based, the instructional activities employed, early outcomes of the endeavor, and future plans for replication are delineated. As described in this paper, REAP builds on a theoretical framework derived from the evidence-based literature, multiple technical reports, and curricular initiatives, including the Institute of Medicine, the Annapolis Coalition for Behavioral Workforce Development, and the Final Report of President's New Freedom Commission on Mental Health. REAP has delivered state-of-the-science education to over 1,000 trainees, including medical students, psychiatry residents, psychology and social work interns, and rehabilitation counselors, pre/post-doctoral students and professionals within a variety of academic settings. REAP serves as a replicable structure to successfully integrate recovery education into existing, accredited academic programs and curricula using the parameters outlined by multiple experts and stakeholders. Barriers to curricular transformation and strategies to overcome these barriers are highlighted.
    Full-text · Article · Sep 2010 · Psychiatric Rehabilitation Journal
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