Training in a clozapine clinic for psychiatry residents: a plea and suggestions for implementation.

OBJECTIVE: The authors sought to develop a model educational clinic and curriculum for psychiatric residents, to increase knowledge and comfort about clozapine prescribing. This matters because clozapine is an important evidence-based treatment for refractory schizophrenia that remains underutilized in clinical practice. METHOD: This is a description of how the Clozapine Clinic of the Massachusetts General Hospital (MGH) Schizophrenia Program was integrated into the curriculum of the MGH-McLean Adult Psychiatric Residency. RESULTS: PGY-II residents participated in a weekly clozapine clinic with direct patient contact and accompanying curriculum-based instruction for a 6-week period. The method of teaching by participating in a dedicated Clozapine Clinic received favorable feedback. Residents' knowledge about clozapine increased. CONCLUSION: Residency programs should determine whether their trainees receive sufficient training in the use of clozapine and consider setting up clozapine clinics where feasible.

Web-based simulation in psychiatry residency training: a pilot study.

BACKGROUND: Medical specialties, including surgery, obstetrics, anesthesia, critical care, and trauma, have adopted simulation technology for measuring clinical competency as a routine part of their residency training programs; yet, simulation technologies have rarely been adapted or used for psychiatry training. OBJECTIVE: The authors describe the development of a web-based computer simulation tool intended to assess physician competence in obtaining informed consent before prescribing antipsychotic medication to a simulated patient with symptoms of psychosis. METHOD: Eighteen residents participated in a pilot study of the Computer Simulation Assessment Tool (CSAT). Outcome measures included physician performance on required elements, pre- and post-test measures of physician confidence in obtaining informed consent, and levels of system usability. RESULTS: Data suggested that the CSAT increased physician confidence in obtaining informed consent and that it was easy to use. CONCLUSIONS: The CSAT was an effective educational tool in simulating patient-physician interactions, and it may serve as a model for use of other web-based simulations to augment traditional teaching methods in residency education.

Does psychiatry residency training reflect the "real world" of psychiatry practice? A survey of residency graduates.

OBJECTIVE: The authors determine whether Massachusetts General Hospital's residency graduates believed their training reflected their current practice activities. METHOD: The authors surveyed 134 graduates from MGH and MGH-McLean residency classes from 1983 to 2003. Subjects ranked their satisfaction with different components of training on a scale of 1 to 6 and listed areas they wanted emphasized during residency. RESULTS: Sixty-six subjects (49%) returned surveys. Twenty respondents graduated in the 1980s (Cohort 1), 27 in the 1990s (Cohort 2), and 16 in the 2000s (Cohort 3). The most common activities included psychopharmacology, teaching, supervision, research, administration, psychodynamic therapy, and supportive therapy. Least common activities included geriatrics, addiction, and psychoanalysis. Satisfaction with training was high, as was relevance of training. CONCLUSIONS: Our graduates from 1983 to 2003 considered residency good preparation for the world of practice and reported that psychopharmacology should be emphasized during training. Respondents expressed a strong desire for continued training in psychodynamic therapy, despite growing emphasis on short-term therapies and biological treatments.

Pilot study of secondary prevention of posttraumatic stress disorder with propranolol.

BACKGROUND: Preclinical considerations suggest that treatment with a beta-adrenergic blocker following an acute psychologically traumatic event may reduce subsequent posttraumatic stress disorder (PTSD) symptoms. This pilot study addressed this hypothesis. METHODS: Patients were randomized to begin, within 6 hours of the event, a 10-day course of double-blind propranolol (n = 18) versus placebo (n = 23) 40 mg four times daily. RESULTS: The mean (SD) 1-month Clinician-Administered PTSD Scale (CAPS) score of 11 propranolol completers was 27.6 (15.7), with one outlier 5.2 SDs above the others' mean, and of 20 placebo completers, 35.5 (21.5), t = 1.1, df = 29, p =.15. Two propranolol patients' scores fell above, and nine below, the placebo group's median, p =.03 (sign test). Zero of eight propranolol, but six of 14 placebo, patients were physiologic responders during script-driven imagery of the traumatic event when tested 3 months afterward, p =.04 (all p values one-tailed). CONCLUSIONS: These pilot results suggest that acute, posttrauma propranolol may have a preventive effect on subsequent PTSD.