TO THE EDITOR: We very much appreciate the efforts of the editors in preparing the special issue on "Development of Model Curricula" (1). They have done an extraordinary job of not only presenting the genetic issue of model curricula, but also outlining problems and solutions specific to psychiatry. Further, we are grateful that they featured our American Society of Clinical Psychopharmacology (ASCP) model psychopharmacology curriculum as a centerpiece of that issue, noting that of the many model curricula developed to date, ours was one of a very few that have been actually used (2).
We wish to comment on some of the remarks made by the various authors who critiqued our 1998 edition of the curriculum. First, it is important to discuss some of the criticisms made by a residency training director and teacher in a "small program." Fitz-Gerald and Kablinger (3) noted that the topic of anxiety disorders should have been included in the first year and that more detailed lectures and/or outlines should be made available. This criticism brings up a more fundamental point concerning the use of the curriculum. Our objective in developing the model curriculum was to provide a series of tools with which the teachers of psychopharmacology could more effectively teach. We assumed that the curriculum would serve as a rough guideline to be adapted for local use. It was not intended to serve as a standardized operations manual. This is how we have personally used it in our own teaching. We fully expected teachers of psychopharmacology to modify all aspects of the curriculum, taking elements from here and there, rearranging materials and tools, and modifying the enclosed teaching materials. The topic of anxiety disorders, for example, was not included in our recommended first-year curriculum because in our own programs this topic comes later; in the first year we tend to concentrate more on the severe and chronic disorders residents are likely to see during their inpatient rotations. We recognize that this is a relatively arbitrary choice and that other programs will choose differently. We offered the slides of the lectures volunteered by our contributors in the order in which they had been given, thus reflecting the idiosyncrasies of these individuals, but fully expected users to pick and choose, rearrange, and even modify the slides. We thus hoped to give our users a good start at drawing on their own knowledge and experience, which we suspect is far and away the greatest resource for teachers of any psychopharmacology topic. Jonathan Borus, Chair at Brigham and Women's Hospital, cogently and succinctly summarizes the issue: model curricula are "helpful, but never sufficient" (4).
Drs. Fitz-Gerald and Kablinger talk about their experience working with our material on psychotic disorders (2), material by the way that Dr. Dubovsky in his review found to be "excellent" (5). She notes she had to give the residents information that we provided plus her own handout. As Dr. Borus makes clear in his commentary, this is exactly what we had intended (4). We, in fact, suggested this on page 199 of the curriculum. Fitz-Gerald and Kablinger also note that we didn't provide individual references for each lecture. Again, as we explained in our response to Dr. Dubovsky (5), we are not providing a textbook of psychopharmacology. We assumed that the teachers would be able to provide their students with the latest references from journals or textbooks.
Fitz-Gerald and Kablinger (2) also criticize the $500 price. In spite of the enormous amount of professional time and effort, all given gratis by the curriculum committee and contributors, that went into creating the curriculum, we as authors were indeed divided on whether or not to charge. Some of us thought charging would make the curriculum more meaningful to those who bought it, and some thought more teachers would use it if it were free. Ultimately, we decided to charge for the practical reason that some of the ASCP costs for preparing, editing, publishing, marketing, and distributing would be defrayed. We did consider the idea of soliciting drug company support to underwrite the costs of development. Only in the end, after the lecture content and hard copy of the slides were completed, did we ask for pharmaceutical company support to convert the hard copy into PowerPoint, at a cost of close to $20,000. Therefore, the curriculum represents the efforts of clinical psychopharmacologists and educators presumably unencumbered by subtle biases toward one or another drug company. Of course, we recognize that individual training programs may wish to take advantage of local industry support to help defray the cost of educational materials, including this curriculum, at their own institutions.
Likewise, we wish to mention issues inherent in a "big program" having more than a half-dozen or so psychopharmacology researchers and teachers. Here program directors are often dismissive, believing if material is given for free, it can't be worth much, especially if they have many (most) of the bases already covered. If, on the other hand, they have to pay, they argue "Why pay for the lecture areas we do have covered when we only need some of them to fill in our curricula?" We can only note that often the trainees in such a program report very different perceptions of the presence or effectiveness of faculty teaching than do their busy basic and clinical-research teachers.
The second edition of our curriculum has now come out (6). In line with some of the criticisms of our 1998 edition, we have changed it by adding to and updating the lectures and adding lecture outlines; presenting the slide-lectures both on CD-ROM and as hard copy; updating our suggested readings, rating scales, and relevant web site lists; and adding algorithms and other teaching materials. We hope the changes have made the new version more useful, while fully recognizing that any such curriculum by its definition is a work in progress and perfection an almost certainly unattainable goal.