Academic Psychiatry 25:87-89, June 2001
© 2001 Academic Psychiatry
Model Curricula
An Introduction
Paul C. Mohl, M.D.
Dr. Mohl is Editor of Academic Psychiatry and Professor and Residency Training Director, University of Texas Southwestern Medical Center at Dallas. Address reprint requests to Dr. Mohl, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., MC-9070, Dallas, TX 65390-9070.
Key Words: Editorial • Model Curricula
This special issue of Academic Psychiatry, like two of its predecessors, created itself—a very different process from that of special issues that are formally proposed, developed by a special editor, and so forth. In the latter instance, there is much lead time, a call for papers, usually more papers submitted than can be accommodated, a rigorous internal review by the special editor before sending the manuscripts out for peer review, and, only after the submissions likely to be published are identified are needed additions, special invitations, and so on, supplied. The last issue of this journal, focusing on education in research, edited by Dr. Laura Roberts, is an excellent example of this kind of special issue.
In contrast, self-created special issues usually arise from the coincidental submission of several manuscripts on a particular topic or by the submission of an article that strikes the editors as highlighting an important topic in psychiatric education that deserves more discussion than a single paper. This issue, focused on model curricula, began with the submission of a single manuscript by Glick et al. (1) The article entered a stream of history leading the editors to conclude that it was time to do something to examine the entire issue of model curricula. In some ways, the history is a personal one of one of the editors (PCM).
My entry into the field of administration of residency education was via the vehicle of a model curriculum (2). We worked very hard on that paper, presented it in a number of forums, got a great deal of feedback, and felt very proud of our work. But, over the years, I had come to question the value of that paper for a variety of reasons. As a training director, I found myself feeling rage when I would see a new model curriculum proposed or a survey arrive where the agenda was clearly to demonstrate that residency programs were not doing a very good job of teaching some topic. I believe my rage was a combination of exasperation at the insensitivity of various zealous experts to the realities of residency education combined with guilt at the recognition that few programs (including mine) are able to achieve the excellence to which we aspire—the curricular excellence that is encouraged by model curricula. The interaction between practical training directors and "zealous experts" is a recurring theme among some of the commentaries in this special issue.
At the annual meetings of this journal's two sponsoring organizations, jokes abound about how much dust is gathered by model curricula on how many shelves in how many offices throughout the country. At the same time, the original Psychopharmacology Model Curriculum developed by the American College of Neuropharmacology (3) is often cited as an exemplar of what a model curriculum can be, even though it, too, is more "honored in the breach"—by being ignored—than by being used. Wulsin and Kramer have regularly presented their survey data on model curricula (published here for the first time [4]) at national meetings. There has been a palpable sense, over the years, of a great deal of energy expended on the way one would expect a model curriculum to be effective, with little tangible effect.
Enter the American Society for Clinical Psychopharmacology (ASCP). The field of psychopharmacology is now moving so rapidly that the idea of an updated curriculum was inevitable. In fact, training directors had openly expressed a wish for one. As described in Glick et al.'s article in this issue, the ASCP decided to make every effort to "do it right." The result was a very large, very expensive model curriculum that attempted to provide much more in the way of resources to training directors for actually implementing the curriculum as proposed. Academic Psychiatry had eliminated regular book reviews 3 years earlier (journal space was at a premium, and we were doubtful that we were providing anything to our readers that was not already available in other journals they regularly read), but the ASCP asked if we would make an exception in this instance for a publication of unique interest to our readers, unlikely to be reviewed in other venues. We agreed, and took the additional step of asking two individuals to review the model curriculum; one, a psychopharmacologist known for his commitment to education (Dr. Steven Dubovsky [5]), and one, a leading educator known for his expertise and interest in neuroscience and psychopharmacology (Dr. Ronald Rieder [6]). We further gave them no word limit, wanting to allow for more in-depth reviews than are typically presented.
Both reviews were very critical of the ASCP effort. Glick et al.'s response to Dubovsky's review is also included in this issue (7). It should also be noted that reviews of the ASCP Model Curriculum in other journals were more positive than those published in Academic Psychiatry. We have received permission from the publisher of Annals of Clinical Psychiatry to reprint Dr. Richard Balon's review (8) of the curriculum. In our opinion, his review was the most comprehensive and thorough, one of the more positive ones we have seen. Of note is his recognition of several of the points of criticism noted by Dubovsky and Rieder. He, however, saw these deficiencies as more readily correctable and less damaging overall.
When we saw the Glick et al. manuscript and realized the effort to which they had gone to "do it right," especially with smaller, resource-poor programs in mind, our reaction was, "What's wrong with this picture?" We decided to make this article the centerpiece of a special issue that would attempt to examine the entire concept and usefulness of model curricula.
We selected referees who would also make thoughtful, knowledgeable commentators on the model-curriculum enterprise. Some have produced model curricula of their own (Drs. Jonathan Borus and James Lomax); some have chaired the AADPRT Curriculum Committee or ad hoc committees on curricular issues (Drs. Lomax, Ed Silberman, and David Goldberg); some have been presidents of the AAP and AADPRT (Drs. Borus, Goldberg, and Lomax); and some have been in unique positions to collect and review model curricula over the years (Drs. Lawson Wulsin and Steve Kramer, and AADPRT's Executive Director, Dr. Goldberg). In discussing with Dr. Glick the use of the article as a jumping-off point to examine the entire role of model curricula in psychiatric education, he noted the importance of input from smaller programs that had actually used the ASCP product. Thus, Dr. Mary Jo Fitz-Gerald, current Chair of the AADPRT Small Program Caucus, was asked to be a commentator, as well. She is joined by her Assistant Training Director, Dr. Anita Kablinger.
We hope that our readers will find the discussion illuminating and that the collective wisdom will inform future developers of model curricula so that pitfalls can be avoided and the entire field can evolve and move forward.
Of interest is the fact that Drs. Fitz-Gerald and Kablinger's experience very much parallels the criticisms of Drs. Rieder and Dubovsky. Of additional interest is the fact that none of our commentators concludes that the model-curriculum enterprise should be abandoned, although each notes major problems with it. Both Drs. Lomax and Borus suggest that the major usefulness of model curricula lies in the creative adaptations that programs make of them and their stimulation of ideas and discussion. Dr. Silberman points out that model curricula often fall on a perceived absence of need, and, where need is acknowledged, specific resources for teaching may be more helpful than a detailed curriculum. The quality of ownership makes it psychologically difficult for teachers to embrace someone else's product enthusiastically. This phenomenon is what Zeb Taintor, M.D., editor of this journal's predecessor, The Journal of Psychiatric Education, dubbed, "the NIH (‘not invented here’) syndrome." Dr. Goldberg cites developments in the area of pedagogy, especially, new ideas on the educational needs of adult learners. He suggests that in these ideas may lie a way to make the ideal of a portable, widely shared curriculum more viable. All of our commentators note the problem of model curricula designed by experts, often zealous ones, for training directors who must serve many masters.
Thus, our commentators have produced common themes, yet a variety of different ideas, as well. Different solutions have been suggested, ranging from scaling back our expectations, to setting up a consistent template for proposing model curricula, to establishing structures for prior communication between the producers and consumers of model curricula, to a website that might create greater ease of accessibility.
We invite our readers to contemplate these thoughtful reactions and to communicate their own thoughts to us.
REFERENCES
- Glick ID, Janowsky DS, Zisook S, et al: How should we teach psychopharmacology to residents? results of the initial experience with the ASCP Model Curriculum. Acad Psychiatry 2001; 25:90-97[Abstract/Free Full Text]
- Mohl PC, Lomax J, Tasman A, et al: Psychotherapy training for the psychiatrist of the future. Am J Psychiatry 1990; 147:7-13[Abstract/Free Full Text]
- Glick ID, Janowsky DS, Salzman C, et al: A Model Psychopharmacology Curriculum for Psychiatry Residents. Nashville, TN, The American College of Neuropsychopharmacology, 1984
- Wulsin LR, Kramer SI: Commentary on "Teaching Psychopharmacology in the 1990s." Acad Psychiatry 2001; 25:102-106[Free Full Text]
- Dubovsky SL: A Model Psychopharmacology Curriculum for Psychiatric Residency Programs, Training Directors, and Teachers of Psychopharmacology (book review). Acad Psychiatry 1999; 23:185-186[Free Full Text]
- Rieder RO: A Model Psychopharmacology Curriculum for Psychiatric Residency Programs, Training Directors, and Teachers of Psychopharmacology (book review). Acad Psychiatry 2000; 24:2-3[Free Full Text]
- Glick ID, Janowsky DS, Zisook S: Reply to Dubovsky book review. Acad Psychiatry 2001; 25:120-122[Free Full Text]
- Balon R: The American Society of Clinical Psychopharmacology, Inc., Model Psychopharmacology Curriculum for Psychiatric Residency Programs, Training Directors, and Teachers of Psychopharmacology (book review). Ann Clin Psychiatry 1999; 11:92-94
This article has been cited by other articles:
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I. D. Glick and S. Zisook
The Challenge of Teaching Psychopharmacology in the New Millennium: The Role of Curricula
Acad Psychiatry,
June 1, 2005;
29(2):
134 - 140.
[Abstract]
[Full Text]
[PDF]
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