Academic Psychiatry 29:116-119, June 2005
© 2005 Academic Psychiatry
Teaching Psychopharmacology Introduction
Richard Balon, M.D., Guest Editor
Dr. Balon is with the Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan. Address correspondence to Dr. Balon, M.D., UPC-Jefferson, 2751 E. Jefferson #200, Detroit, MI 48207; rbalon{at}wayne.edu (E-mail). Copyright © 2005 Academic Psychiatry.
Psychiatry has changed profoundly over the last few decades. Whether we like it or not, psychopharmacology has become a major part of what we do as psychiatrists. It has also become a major focus of political battles with other mental health professionals, namely the psychologists. Psychopharmacology, again, whether we like it or not, has become a major defining feature of current psychiatric practice. Frequently, we distinguish ourselves from other mental health professionals as the ones who can prescribe medications, know how to prescribe medications, and do prescribe medications. However, I am not advocating that psychiatrists are defined simply as "those who prescribe psychotropic medications." On the contrary, I would like to continue to see psychiatrists as leaders in the mental health field, as those who are able to provide all available treatment modalities and their combinations, and as those who are best qualified to do so. Thus, I have been pleased by the recent developments in teaching psychotherapy and the establishment of psychotherapy competencies as a mandate to the field by the Residency Review Committee for Psychiatry (hopefully, the beginning of a lengthy process), in spite of the problems associated with competencies implementation (1). Teaching psychotherapy has always been a major part of what many psychiatrists connected to academic centers do. There are many texts available addressing teaching psychotherapy.
However, being an educator and clinical psychopharmacologist, I have been much less pleased with whatever I know and hear about teaching psychopharmacology. Psychopharmacology has undergone a major development over the last five or six decades, becoming a full-fledged discipline. We have witnessed extraordinary changes in the treatment of mental disorders during these decades. We expanded our horizons and broadened our armamentarium enormously. The repertoire of psychopharmacology is still expanding. For instance, we use medications to treat disorders that used to be considered amenable to psychological or behavioral treatments only, such as premature ejaculation (2, 3), or disorders that were considered nontreatable, such as paraphilias (4). We have been much more successful in assisting other medical disciplines in the treatment of psychosomatic illnesses, or we treat them ourselves. We have been able to provide our patients with more comprehensive care.
We even have a certifying examination in clinical psychopharmacology (offered by the American Society of Clinical Psychopharmacology), though neither part of nor approved by the American Board of Medical Specialties. Psychiatric journals are filled with a plethora of psychopharmacology articles. Many textbooks of psychopharmacology have been published, some in several editions. Almost all psychiatrists prescribe, and even psychoanalysts do (5, 6). But what about teaching psychopharmacology? The teaching of psychopharmacology has been vaguely mandated as part of the residency training curriculum. In the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements for Residency Training in Psychiatry, psychopharmacology is mentioned in several places; e.g.:
[a] clinical training should provide sufficient experiences in ...the major types of therapy,...and pharmacological regimens, including concurrent use of medication and psychotherapy; [b] didactic components: ..."The curriculum must include adequate and systematic instruction in neurobiology, psychopharmacology, and other clinical sciences relevant to psychiatry,..."
Interestingly, while the programs are required to demonstrate resident competency in several forms of treatment (including combined psychotherapy and psychopharmacology), no demonstration of competency in clinical psychopharmacology is required, here and anywhere. Nevertheless, residency training programs dutifully teach psychopharmacology. It is mostly taught using a mixture of didactics and apprenticeship. However, teaching psychopharmacology has lagged behind teaching other psychiatric (either diagnostic or therapeutic) skills. Interestingly and surprisingly, no major text on teaching psychopharmacology exists. Recent major psychopharmacology textbooks on both adult (7) and pediatric pharmacology (8) do not discuss teaching psychopharmacology. A number of articles regarding teaching psychopharmacology have been written (9–26). These articles deal with various issues, some of them only marginally related to teaching psychopharmacology to psychiatric residents and psychiatrists in general, for example, teaching psychopharmacology to psychology interns (19) or nursing students (23), the impact of psychopharmacology education on prescribing practices (15), or the role of consultation psychiatry in teaching psychopharmacology to other disciplines (12). Some of these articles might be useful for psychiatry residents in teaching psychopharmacology to other disciplines (15, 19, 23). Other articles address certain specific aspects of psychopharmacology teaching, such as teaching pediatric psychopharmacology (16) or teaching psychopharmacology on inpatient units (18). Other articles discuss the issues related to model psychopharmacology curriculum (25, 26). However, only one relatively recent article (21), published in Academic Psychiatry, eloquently questions the training structure in psychiatry and suggests the introduction of at least one psychopharmacology supervisor per year per resident, giving us the top 10 reasons for psychopharmacology supervision. Nevertheless, no major unifying text or a compilation of texts on teaching psychopharmacology currently exists.
This special issue of Academic Psychiatry is an attempt to provide the field and, especially, its educators with such a unifying and guiding compilation of articles on teaching psychopharmacology. No educational article, series of articles, or textbook, particularly the first one in an area, is perfect. Thus, we hope that the reader will forgive us if we have omitted areas that may be considered important. The selection of topic for this issue arose from several serious debates between the Editor-in-Chief, Laura Roberts, and myself. Our approach to this special issue was quite systematic. We carefully considered the content, methods, practical application of the knowledge, and special areas. We went through the outline of the issue several times, carefully considering the rationale for selecting each topic and possible authors and carefully considering the pros and cons of our choices. We questioned ourselves about the components of teaching psychopharmacology and the skills needed to teach psychopharmacology.
We also decided that all articles in this special issue (including this editorial) needed peer review. Thus, though the authors were invited to write the articles, all manuscripts went through a two-step review process: first, feedback from the guest editor, and second, peer-review by two reviewers. We believe that this process allowed us to receive the highest quality manuscripts.
Some issues required our special attention because of their prominence and their impact on the field. For instance, we are aware that the issue of pharmaceutical industry involvement in psychiatric education stimulates a lot of feelings, emotions, and debates. After a long and serious deliberation, we decided to devote two articles to this topic. One article proposes that there might be a middle ground, and the other suggests that there is no middle ground. I believe that the debate in this issue is great, stimulating, and educational. I have to admit that I am becoming more and more worried about the role of the pharmaceutical industry in my own education and that of others, and I have to admit that I have been participating, as have many (not an excuse, though, just an observation), in various, more or less useful pharmaceutical industry-sponsored activities. Some questions that come to my mind may be as provocative as the questions some purists may have regarding this issue. Questions such as, Are we abdicating education to the pharmaceutical industry? Is there a medicine-pharmaceutical industry complex? Are we even aware of all the subliminal messages with which the industry bombards us (27)? Can we only blame the industry, and should not we consider our role in this troubling issue? Are we willing to pay a one to two thousand dollar registration fee for the annual meeting of American Psychiatric Association (APA) and give up all the free dinner, lunch and breakfast symposia and pharmaceutical industry exhibits? Are we providing our residents with a critical and unbiased view of the results of pharmaceutical trials? I hope that the two articles on the role of pharmaceutical industry in education could push the debate a bit further and to another level.
Unfortunately, we were not totally successful in addressing another important emerging issue: computer-based teaching of psychopharmacology. We asked an experienced and distinguished psychopharmacologist with some expertise in this area to address this issue. However, he felt that there was not much to write about computer-based teaching of psychopharmacology. As the "computerization" of medicine continues, someone will certainly tackle this topic, and we will hopefully see articles on computer-based teaching of psychopharmacology in the near future. Fortunately, the role of computers and other modern technology in teaching psychopharmacology is addressed in this issue, albeit only as part of another article and not as the focus of a special article.
Nevertheless, we have been able to put together an excellent team of authors, who address many different facets of teaching psychopharmacology, such as the role of curricula in teaching psychopharmacology, venues of teaching psychopharmacology, the role of guidelines, teaching collaboration between psychopharmacologists and psychotherapits, who should be teaching psychopharmacology, evidence-based teaching of psychopharmacology, teaching medication compliance, the psychodynamics of psychopharmacology, testing the knowledge of psychopharmacology, and other important issues. Hopefully, everyone interested in psychopharmacology and its teaching will appreciate the authors’ thoughtful work. We are also pleased to have received the trainees’ perspective on teaching psychopharmacology, another important and useful part of evaluating psychopharmacology teaching.
As this issue is, above all, about education and professional development, we hope that the readers will learn from it and that it will serve the field of psychiatry in advancing the teaching of one of its core parts.
As one reads through the articles on teaching psychopharmacology, considers the development of the field, and deliberates about teaching other aspects of psychiatry, one important questions arises: Should there be a psychopharmacology competence required, similar to psychotherapy competencies? I believe that the majority of educators and psychopharmacologists, especially after reading this issue of Academic Psychiatry, will agree that there probably should be one.
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This article has been cited by other articles:
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I. D. Glick, C. Salzman, B. M. Cohen, D. F. Klein, C. Moutier, H. A. Nasrallah, D. Ongur, P. Wang, and S. Zisook
Improving the Pedagogy Associated With the Teaching of Psychopharmacology
Acad Psychiatry,
June 1, 2007;
31(3):
211 - 217.
[Abstract]
[Full Text]
[PDF]
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