he price from the ASCP (212/268-4260) is $600.This is a 702-page, spiral-bound curriculum dated February, 1997, that is organized into the following sections:
Organization of a Psychopharmacology Program (2 pages):
This review will focus on what this very expensive curriculum is and what it is not, and on suggestions for increasing its usefulness to psychiatric residency training directors and psychopharmacology teachers.
There are two major components to this volume. One is the set of chapters on developing psychopharmacology training in a residency training program. The other is the various appendices that serve as source material. The first is relatively short, whereas the latter is very substantial. However, the value of the sections may be more inversely than directly related to their length.
The chapters on developing an effective, comprehensive psychopharmacology training program are quite good, with 1) useful suggestions, such as appointing a Director of Psychopharmacology Training; 2) appropriate educational goals and skills for guiding the training (see below); 3) detailed outlines for the suggested units of the training such as the "crash course," and 4) templates listing the type of information residents should have for each class of drug (e.g., predictors of response, age-related issues, drug discontinuation effects, etc). There is also coverage of a usually ignored topic: patient and family education about medications. In these chapters, there is an emphasis also on promoting residents' record-keeping and charting skills and the useful inclusion in Appendix B of various rating scales that clinicians can use in routine practice, as well as a suggested format for the systematic recording of progress notes documenting the pharmacological treatment.
The biggest section of this curriculum, however, is Appendix A, 540 pages of hard-copies of slides, three to a page. These comprise the two Lecture Series, a Basic Course for second-year residents of 12 lectures, and an Advanced Course for third- or fourth-year residents of 18 lectures. For a few lectures, there is a narrative, but for only very few. In other words, these are the slides of data and "cue cards" that experts in the field have used, as slides, for their own lectures, such as Grand Rounds presentations. The lectures are very detailed, giving results of specific studies with specific percentages and data. For example, the "Basics on Antidepressants" lecture, by Nicholas Ward, one of the suggested lectures in the Basic Course, has 105 slides, including specific rates of side effects for mirtazapine and the half-life of the three metabolites of bupropion. Overall, this presentation of slides allows for rapid review of a large amount of detailed information. If one knows the territory, it is quite easy to add to one's knowledge. This presentation could easily be used in preparing for Psychopharmacology Boards, if such were to be developed.
What this curriculum is not is 1) user-friendly; 2)neurobiology-based; nor 3) psychiatric-resident—focused. The format is unlike any book one has ever reviewed, and it has an unprocessed feel. A teacher who wished to reenter them into "PowerPoint" could possibly reconstruct the slides, but this would involve substantial work. The slide format also fails to convey to the user (presumably the teacher) what the major points are that need to be kept in a talk if one were to prune the suggested version. The slides are not numbered, nor is the specific lecture to which the slides belong listed on each page. Thus, for the few narratives that make reference to the slide and give slide numbers, it is not easy to link them as one turns back and forth. The lack of appropriate indexing and numbering is taken to an extreme by its not even having an index of the page numbers for the various lectures; one must leaf through the many pages to find the beginning page of hard-copy slides for that lecture. Second, very few of the slides are focused on the neurobiological aspects of the psychiatric disorders. Thus, the lectures on OCD or generalized anxiety disorder, for example, do not present and link an evolving understanding of the biology of these disorders to the available treatments. Finally, there is a relative lack of slides that focus on what psychiatric residents need to take away from such psychopharmacology lectures, namely algorithms for deciding on the choice of an initial or subsequent drug strategy for a certain disorder, or slides focusing on practical aspects of the use of these agents (e.g., how long to wait for a response before drug discontinuation, the usefulness of blood levels, etc.).
This criticism could be summarized by pointing out that the lectures provided do not match well with the proclaimed goals for the psychopharmacology program stressed in the beginning of the volume, which emphasize integrating knowledge of the biology of psychiatric disorders and teaching which agents are the treatments of choice.
The above criticism notwithstanding, this could be the beginning of a process and product that would help teachers of psychopharmacology develop their lectures. Of great benefit would be the production this material via electronic media that would allow for the easy selection and reproduction of slides that one would wish to use in a lecture. For example, the slides could be contained on a CD-ROM in PowerPoint format. Also, it would be most useful to provide narratives that would discuss the meaning of the slides with easy, preferably electronic, links between the reference to the slide in the narrative and the slide itself. Third, I would suggest that the lectures themselves need to be pruned by someone who is not the owner/author of these "slide shows."
A subcommittee of the ASCP, chaired by Ira Glick, prepared this curriculum. Good thought went into many chapters, and it would be useful as a reference, especially for advice on how to establish a premier psychopharmacological training program. However, its lack of organization, flexibility, and suitability for resident teaching make it unsuitable to accomplish its own aims. In the preface, the question is asked: "Why do we need a curriculum in psychopharmacology? What use will it have?" The field would benefit from a product not too dissimilar to this, but, as currently presented, the answer to the second question is "very little."