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Telepsychiatry Services and Oral Board Examination Preparation
To the Editor: Candidates preparing for part two of the American Board of Psychiatry and Neurology (ABPN) Certification in Psychiatry use mock examinations in training programs (
1) as well as independent mock examinations (
2) to achieve a passing grade. The subspecialty certification in child and adolescent psychiatry also requires an oral examination, and candidates for the ABPN Certification in Child and Adolescent Psychiatry seek out mock examinations for practice. Recently, a novel approach to examination preparation was undertaken with telepsychiatry services.
Optimal preparation for child and adolescent psychiatry board certification includes mock oral examinations with an experienced, board-certified child and adolescent psychiatrist. In a child and adolescent psychiatric residency program based at a university medical center, oral mock examinations are given to residents with departmental faculty typically serving as examiners. For young clinicians in practice after graduation from residency, arranging for a board-certified child and adolescent psychiatrist to serve as an examiner in a mock examination is more difficult. Barriers may include availability, travel requirements, and coordination of the child and adolescent psychiatrist to meet at a mock interview setting with the examinee and patient. The Department of Psychiatry at Michigan State University used telepsychiatry services to provide mock examination services to a young clinician seeking preparation for board certification.
Mott Children’s Health Center (MCHC) in Flint, Mich., is a multidisciplinary outpatient facility that serves children and adolescents and provides comprehensive health care through direct and indirect services, advocacy in the context of family and community, and by joining others to promote the well-being of all children in its county. The department of psychiatry is a jointly administered department of the College of Human Medicine and the College of Osteopathic Medicine at Michigan State University (MSU), based in East Lansing, Mich. Since 2004, an ABPN board-certified child and adolescent MSU psychiatrist has been under contract with the MCHC to provide telepsychiatry consultation to its behavioral pediatric service. This service had on staff a child and adolescent-trained psychiatrist who was seeking a board-certified child and adolescent psychiatrist to serve as a mock examiner in preparation for the child psychiatry oral board certification examination in 2007.
The MCHC psychiatrist (the examinee) requested that the MSU psychiatrist serve as a reviewer for a series of preparation examinations. The examinee would interview an adolescent patient for the initial evaluation, blind to any previous health information. The examinee and the patient were onsite at MCHC while the MSU psychiatrist observed in East Lansing, via videoconferencing. The MSU psychiatrist remained online during the 30-minute assessment. The Polycom® videoconferencing system allowed the MSU psychiatrist to be seen on the video monitor by the patient and examinee at MCHC and also allowed the MSU psychiatrist to remotely control the camera to view the examinee and patient. The MSU psychiatrist followed the board certification model instructions and time-keeping requirements. At the end of the 30-minute interview, the examinee’s patient was escorted from the room, and the MSU psychiatrist began the questioning. After the 30-minute presentation and discussion of the case by the examinee, the MSU psychiatrist gave a critique of the interview and case presentation.
This method for mock examination via telepsychiatry allowed for six preparation evaluations to be completed by the MCHC psychiatrist with the MSU psychiatrist serving as the mock examiner. The MCHC psychiatrist successfully passed the child psychiatry oral board examination.
The following caveats should be considered regarding this method of preparation for board certification. This approach requires the procedure to be fully explained and consent obtained from the parent and assent from the adolescent being evaluated. Patients and families at MCHC are informed of the use of telepsychiatry services at the clinic and may choose not to participate.
A clinic with established telepsychiatry services is an optimal site for the application of telepsychiatry mock oral board preparation. The videoconferencing systems such as those used at both of these sites must support a secure connection. The use of web cams with less security is not recommended for this application. The authors also caution against attempts to replicate this approach in a setting where a telepsychiatry service is not established.
This method of preparation for the board certification provides an opportunity to assess and critique an examinee without the limitation of travel and with minimal coordination of appointments. In summary, with appropriate planning, university-based psychiatry departments with telepsychiatry capabilities can provide services such as board preparation to their graduates and other psychiatrists in practice settings conveniently and in parallel to those done onsite. This can be a valuable service, especially for rural or remote practitioners.