Psychopharmacology Training for Psychiatry Residents: A Pilot Iterative Quality Improvement Project

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Excerpt

To the Editors
The Royal College of Physicians and Surgeons of Canada (RCPSC) recognizes that training and competency in prescribing psychotropics safely and effectively is a core requirement for all postgraduate (PG) psychiatry trainees in Canada.1 However, recent studies report that psychiatry residents feel insufficiently prepared to prescribe psychotropic medications competently, and they experience significant anxiety and frustration to prescribe psychotropics safely.2–4
Experts in the field suggest that a psychopharmacology curriculum is best delivered through a combination of tools such as lectures, case conferences, journal clubs, case-based learning modules, specialty clinics, and other innovative modalities.5–8 The American College of Neuropsychopharmacology training committee had originally developed a psychopharmacology model curriculum in 1984, which over the years has been updated every 2 years by the American Society of Clinical Psychopharmacology (ASCP) Curriculum Committee.9 This is a unique, and widely disseminated, curriculum designed for teachers and trainers of clinical psychopharmacology, and different versions are available for 3 groups of learners: 1) psychiatric residents, 2) medical students, and 3) primary care physicians. The Psychiatry residency program committee at Western University, London, Canada, bought the ASCP psychopharmacology curriculum for residents, 7th edition, in 2013.10
Immediately after receiving the curriculum, one of us (K.V.) designed a quality improvement project. The aim was to improve the existing psychopharmacology curriculum by both using resident feedback and supplementing the existing curriculum by making the model curriculum available to the teachers in the program. To do this, an informal, anonymized secure survey was administered to all psychiatry residents in 2014 to gauge their level of satisfaction with the existing psychopharmacology teaching and their own perceived needs. The residents (7 of 30) responded with comments highlighting strengths and gaps in the curriculum. They specifically identified 1) a lack of a coherent curriculum, 2) lack of lectures specifically dedicated to psychopharmacology, 3) a need for case-based discussions and real-world scenarios, 4) a need to incorporate up-to-date information and evidence-based guidelines, and 5) to deliver psychopharmacology knowledge with gradually increasing complexity over their training years.
The 7th edition of the model ASCP curriculum for psychiatry residents was updated and published in 2012; it was anticipated that some of the lecture content when implemented at Western might need further updating by the local trainers for teaching in the academic year 2015–2016. It was also identified that the content of some of the lectures in the ASCP curriculum was more relevant to the US setting, eg, names of the drugs available only in the Unites States. Even so, the residency program committee agreed that the model ASCP curriculum and its lecture series could be used to standardize the local curriculum across the 5 years of training and for delivery of the psychopharmacology lecture format.
The existing psychopharmacology lecture curriculum was compared with the ASCP curriculum. This process helped identify pedagogical deficiencies in core psychopharmacology constructs in the lectures, duplicities, and redundancies in the curriculum (see Supplementary Appendix 1, Supplemental Digital Content 1, http://links.lww.com/JCP/A486) with respect to local psychopharmacology teaching on academic days. This process led to certain lectures being deleted, added, or rearranged according to the year of training.
Two of the authors, A.V. and K.V., also met the psychopharmacology education and content expert I.G. in June 2015 and attended a workshop on this topic to understand, appreciate, and learn about tackling barriers in implementing changes to a local psychopharmacology curriculum.
Recommendations on standardized lecture objectives, content, and method of teaching were developed using the ASCP curriculum and the residents' feedback (see Supplementary Appendix 2, Supplemental Digital Content 2, http://links.lww.com/JCP/A487).
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