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Teaching Psychopharmacology in the 21st Century

Dr. Wulsin is at the Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio. Dr. Kramer is at the Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Address reprint requests to Dr. Wulsin, 231 Bethesda Ave., ML 559, Cincinnati, OH 45267. e-mail: lawson.wulsin{at}uc.edu

Key Words: Psychopharmacology • Teaching Pharmacotherapy • Model Curricula

The publication in this issue of the report by Glick and colleagues (1) on the revised version of the American College of Neuropsychopharmacology's 1993 curriculum on psychopharmacology (2) describes almost a decade of work on what may be the most comprehensive curriculum development process in academic psychiatry. This publication raises the question "What is the state of the art of developing model curricula in academic psychiatry?" In 1998 (3), we found 43 model curricula in psychiatry that had been published or disseminated through organizations since 1985, covering roughly two dozen topic areas. At that time, only one of these curricula (2), had been used in more than two settings. Many had been created, but few had been borrowed. The model-curriculum tree clearly has borne fruit, most of it in various stages of near-ripeness, but where are the pickers?

The Situation
Beginning in 1997–98, we led two separate task forces of the Association for Academic Psychiatry (AAP) and the American Association of Directors ofPsychiatric Residency Training (AADPRT) to describe the status of model curricula for the general-psychiatry residency (3). We reviewed all available model curricula and rated each on six distinguishing criteria: 1) topical relevance to Residency Requirement Committee (RRC) Essentials for General Psychiatry; 2) evidence of use in or transferability to other programs; 3) specification of required resources; 4) clarity of objectives; 5) methods for evaluating the curriculum; and 6) constraints limiting the implementation of the curriculum. We excluded curriculum reports designed for fellowships, medical students, or primary-care trainees, and those that provided only reading lists or lists of objectives for curricula.

Our topical classification of model curricula (Table 1) shows that, with the exception of the broad field of child psychiatry, no topic is addressed by more than four model curricula, and most topics, including psychopharmacology, are addressed by one or two models. However, most topics required by the RRC Essentials are represented by at least one model curriculum. References for the model curricula are listed in the reference section of this commentary (4–31). Other relevant references follow (32–42; various unpublished references).

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TABLE 1. References by topic

Our independent ratings of 39 curricula across the six distinguishing criteria are also shown in Table 1. The form we used to rate each curriculum independently of the other appears in Appendix 1. On no item did we disagree by more than 1 point on the 13 scale; disagreements are represented by averages; for example, 1.5 or 2.5 or ±. Although most model curricula rated well (2 or 3) on most criteria, the majority (n=22) rated poorly ("?" or 1) on evaluation methods. Two model curricula (1,26) have been published and distributed as monographs, but the other 44 have only been disseminated as single journal publications or "white papers" distributed through organizations. Our impression from reviewing the literature and conducting three workshops on this topic is that academic psychiatrists are curious about model curricula, but few have tried to use one.

The Problem
Why are model curricula so rarely used? We have identified four possible reasons:

Episodic or idiosyncratic need.
In the often-brief life of training directors (average tenure is approximately 4 years), most training directors do not confront the need to establish a new curriculum more than once. The task may appear simple to the first-timer. It may take a year or two to discover the deficiencies of the first homemade curriculum. Assumptions about idiosyncrasies within one's own department (resources, fiscal constraints, personalities, etc.) may limit the training director's interest in looking elsewhere for guidance in solving curriculum problems.

No central source.
The task of scouring the literature for all available model curricula is neither a simple nor a quickly rewarding process. Many of the curricula listed in Table 1 are not published in Index Medicus journals. We know of no review of the available model curricula; and we know of no one person or organization who is responsible for collecting or disseminating model curricula in psychiatry. That means that each curious training director or faculty member begins from scratch and works the "academic grapevine" until a lucky hit, or frustration, ends the search.

No standard format.
Because we have no established format or method for describing model curricula, the available reports vary widely in format, content, and quality. This variability makes it hard to compare two curricula on the same topic.

Limited access to materials.
For those faculty who do choose to apply a model curriculum, the next task is to obtain curriculum materials (outlines, slides, case reports, evaluation forms, etc.). Sometimes these can be obtained from the first author, if you can find him or her and if he or she can be persuaded to collect and forward the materials to you. Publicly available packages or monographs, such as that described by Glick and colleagues in their article (1), are rare.

Distinguishing Examples
One measure of a model curriculum's usefulness is its ability to be implemented in a variety of settings and levels of training. Drell's "Infant Psychiatry" provides outlines for courses lasting from 3 to 8 weeks, with rationales for each level of sophistication. Gitlin's "C–L Guidelines" ranks curriculum content in three categories: essential, valuable, and advanced. The National Institute for Healthcare Research (NIHR) curriculum on religion and spirituality (26) is organized in three core and eight accessory modules, each of which can stand alone. These features facilitate the training director's job of fitting model curricula into the constraints of time, setting, and personnel that vary from program to program.

All model curricula address a well-defined topic area. However, a few curricula (e.g., three family therapy (Guttman et al. [12]; Claman [unpublished], Josephson [unpublished]) and three child psychiatry curricula (Abramson and White [unpublished], Drell [unpublished], Slomowitz [unpublished]) fail to describe specific objectives even though they provide other essential components of a model curriculum.

The resources required for curricula are presented in detail in the Glick curriculum on psychopharmacology (1), which includes teaching slides; and the NIHR curriculum on religion and spirituality (26) describes the application of six learning formats specifically for this curriculum. However, most model curricula simply list the content areas and the appropriate references, leaving format, teaching tools, and resource issues to the imagination of the training director or the teacher. The recent developments resulting in easy sharing of slides and teaching resources through graphics programs (such as PowerPoint) and e-mail raise the future standard of resource description and access for authors of model curricula.

Only 6 of the 39 reviewed curricula include substantial methods for evaluation of the model curriculum. This omission may reflect the broad neglect of systematic program evaluation among residency educators in general.

The Solution
We propose that an organization (AADPRT or AAP, or both) take responsibility for managing a "model-curricula website" that makes available a topical list of all known model curriculum reports and provides reviews or ratings of their various components, curriculum materials, and up-to-date information on how to contact the authors and how to obtain curriculum materials that are not posted on the website. To promote the use of curricula across a variety of training programs, the model-curricula website would require a standard format that specifies the essential curriculum components, such as learning objectives, required resources, core references, and evaluation methods.

This pilot project could track website use and periodically survey site users over 4 or 5 years to study patterns of use and the usefulness of the website. On the basis of this information, the organization could then assess the usefulness of specific model curricula and decide whether the model curriculum project justifies the effort it takes to manage the website.

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Appendix

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