Impact of Psychiatric Pharmacist-Led Psychopharmacology Didactics for Psychiatry Residents.

OBJECTIVE: The purpose of this study is to explore the impact of board-certified psychiatric pharmacist (BCPP)-led psychopharmacology lectures to psychiatry residents and fellows. METHODS: Surveys were administered to psychiatry residents and geriatric psychiatry fellows at two teaching institutions between Fall 2021 and Spring 2023, including two distinct residency programs and one fellowship program. The survey consisted of three quantitative questions and one qualitative question soliciting open-ended constructive feedback. RESULTS: Of 39 participants (response rate: 80%), 100% strongly agreed that learning from a BCPP enhanced their learning of psychopharmacology concepts. Additionally, 100% strongly agreed they would recommend psychopharmacology lectures from a BCPP to other psychiatry residents and that concepts taught by the BCPP were applicable to their clinical practice. Qualitative feedback indicated valuing pharmacist input and stated preference to learn from medication-experts on psychopharmacology topics. CONCLUSIONS: Integrating BCPPs into psychiatry resident/fellow didactic training is well received by psychiatry residents and may simultaneously enhance education of psychopharmacologic concepts in addition to enrichment of interprofessional experiences by increased routine exposure to working directly with a clinical pharmacist. Program directors are encouraged to meet with BCPPs at their respective institutions to discuss opportunities for collaboration.

Implementation and Evaluation of Educational Workshops to Increase Primary Care Provider and Medical Student Comfort in Psychiatric Care.

OBJECTIVE: Mental health treatment is often initiated in primary care settings, but many primary care providers (PCPs), residents, and medical students report discomfort in managing psychiatric conditions. This study evaluated the effect of an educational workshop that featured an evidence-based psychopharmacology clinical decision support tool (CDST) on trainee confidence and willingness to treat psychiatric conditions. METHODS: Participants completed pre- and post-workshop surveys. Nine months after the workshop, a subset of trainees participated in a focus group. RESULTS: Of the participants, 62.5% of the obstetrics-gynecology (OB-GYN) resident physicians (10/16) and 100% of the medical students (18/18) completed both pre- and post-surveys. Following the workshop, OB-GYN resident physicians reported significantly improved confidence in treating psychiatric disorders (p < 0.001), sense of having psychiatric support tools (p < 0.001), and knowledge of treating psychiatric disorders (p = 0.021). Medical students reported significantly improved confidence in treating psychiatric disorders (p < 0.001), willingness to devise treatment plans for psychiatric disorders (p = 0.024), sense of having psychiatric support tools (p < 0.001), knowledge of treating psychiatric disorders (p < 0.001), and comfort in presenting a psychiatric treatment plan to an attending (p = 0.003). Most focus group participants (93.75%; 15/16) reported that they continued to use the CDST, and it increased their confidence in formulating psychiatric treatment plans. CONCLUSIONS: These findings suggest that educational workshops that introduce high-quality psychopharmacology CDSTs may be an effective method for improving provider comfort in treating psychiatric disorders.

Challenges Faced by New Psychiatric-Mental Health Nurse Practitioner Prescribers.

One of the main challenges that psychiatric-mental health nurse practitioner (PMNHP) students experience is preparing to prescribe medications by demonstrating psychopharmacological competency. To examine the challenges as they relate to this issue, self-reflective journaling narratives were evaluated from two cohorts of Post-Master's PMHNP program graduates, across each of two semesters of pediatric and adult clinical experience. The most prominent challenges reported by students were in regard to medication treatment adherence, decision making, and monitoring symptom-related outcomes. The narratives also demonstrate that reflection, combined with faculty- and preceptor-supported clinical education, assists PMHNP students in developing psychopharmacological competency. All PMHNP students described in this article were nurse practitioners before they began the program. By seeking to augment their competencies and through continued self-reflective learning and practice, they will improve access to mental health care for the populations they serve. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 7-11.].

High-Fidelity Simulation: An Application to Psychopharmacological Training for the Psychiatric Nurse Practitioner Student.

As the demand for Psychiatric Mental Health Nurse Practitioners (PMHNPs) continues to grow, innovative teaching strategies that can enhance competency learning with skill transfer into the clinical setting is essential. Educational programs must adequately prepare the student for the complexity of the clinical environment. Simulation is an educational approach that replicates aspects of the real world in a safe environment so that learners can engage in an interactive manner. High-fidelity simulation (HFS) has been identified as an effective teaching strategy and mechanism to transfer knowledge and skills learned in the classroom to the clinical setting. HFS uses a human patient simulator to immerse the learner in a contextual learning environment by engaging in a realistic clinical scenario to develop cognitive, affective and psychomotor skills through deliberate practice. This article describes the theoretical foundation, development process, case scenarios, and implementation of HFS, an innovative teaching pedagogy, in a Psychopharmacology didactic course for PMHNP.

Videoconferencing Technology to Facilitate a Pilot Training Course in Advanced Psychopharmacology for Psychiatrists.

OBJECTIVE: Psychopharmacology requires practitioners to continually upgrade knowledge and skills, but attendance at live continuing medical education events presents many barriers. In addition, technology has generated new learning approaches. In response, a videoconference-based course on psychopharmacology was developed and evaluated for feasibility and acceptability. Specific goals included whether learners would engage and whether the technology would work well for both learners and instructors. Additional aims included providing guideline-concordant psychopharmacology training, enhancing patient safety, and fostering case discussion. METHODS: The course used BlueJeans® videoconferencing technology. Each of the six weekly sessions was taught by a facilitator and a speaker. Every class incorporated a 1-h interactive didactic presentation, followed by 1 h for case reviews. Topics included six major psychiatric disorders, managing key drug interactions, and pharmacogenomics. Three types of online self-report evaluations were conducted-individual session evaluation, overall evaluation, and faculty speaker evaluation. RESULTS: Nineteen participants enrolled, with 85% of respondents reporting course objectives were met as "very good" or "excellent." Moreover, 92% of respondents rated the course as "very good" or "excellent." Sixty percent of the faculty were "somewhat satisfied" and 40% were "extremely satisfied" with the videoconferencing tool. Qualitative responses from both participants and faculty were positive overall. CONCLUSIONS: This course provides preliminary evidence that an online, live longitudinal course in psychopharmacology is both acceptable and effective, both for CME learners and teachers. The authors plan to disseminate this model of CME to other institutions while extending the reach of the present course to more diverse practitioners.

Evidence for the Validity of the Psychopharmacotherapy-Structured Clinical Observation Tool: Results of a Factor and Time Series Analysis.

OBJECTIVE: The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) is a direct observation tool designed to assess resident performance of a medication visit. This study examines two dimensions of validity for the P-SCO: internal structure and how scores correlate with another variable associated with competence (experience). METHODS: The faculty completed 601 P-SCOs over 4 years. Multilevel exploratory factor analysis was performed with minimum thresholds for eigenvalue (≥ 1.0) and proportion of variance explained (≥ 5.0%). Internal reliability was assessed with Cronbach alpha. To examine how scores changed with experience, mean ratings (1-4 scale) were calculated for each factor by quarter of the academic year. Separate linear mixed models were also performed. RESULTS: The analysis yielded three factors that explained 50% of the variance and demonstrated high internal reliability: affective tasks (alpha = 0.90), cognitive tasks (alpha = 0.84), and hard tasks (alpha = 0.74). Items within "hard tasks" were assessment of substance use, violence risk, and adherence, and inquiry about interactions with other providers. Monitoring adverse effects did not load on the hard task factor but also had overall low mean ratings. Compared to the first quarter, fourth quarter scores for affective tasks (b = 0.54, p < 0.01) and hard tasks (b = 0.46, p = 0.02) were significantly improved while cognitive tasks had a non-significant increase. For the hard tasks, the proportion of residents with a low mean rating improved but was still over 30% during the fourth quarter. CONCLUSIONS: The results provide evidence for the validity of the P-SCO with respect to its internal structure and how scores correlate with experience. Curricular implications are explored, especially for the tasks that were hard to learn.

Performance Assessment of Pharmacotherapy: Results from a Content Validity Survey of the Psychopharmacotherapy-Structured Clinical Observation (P-SCO) Tool.

OBJECTIVE: The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) tool is designed to assess performance of a medication management visit and to enhance feedback. Prior research indicated that the P-SCO was feasible to implement in a resident clinic and generated behaviorally specific, high-quality feedback. This research also highlighted problems with some of the instrument's items. This study seeks to improve the items. METHODS: The authors initially revised the P-SCO items based on the problems identified by a prior study. Next, these items were iteratively modified by experts in clinical pharmacotherapy and educational assessment. Forty-five items emerged. Finally, faculty attending an annual department education retreat rated each item on its relevance (4-point scale) and provided comments on how the item might be revised. For final inclusion, an item must have met a quantitative threshold (i.e., content validity index equal to or greater than 0.8 and the lower end of the asymmetric confidence interval equal to or greater than 3.0) and received comments that were supportive. RESULTS: Forty-one of the 45 items had strong quantitative support. However, the comments endorsed lumping a number of items in order to decrease overlap between items and to shorten the instrument. This process resulted in the further elimination of 15 items. CONCLUSIONS: The revised 26-item P-SCO builds upon prior evidence of feasibility and utility and now possesses additional evidence of content validity. The use of the tool should enhance feedback and improve the capacity of educational programs to assess performance.

Psychopharmacology Prescribing Workshops: A Novel Method for Teaching Psychiatry Residents How to Talk to Patients About Medications.

OBJECTIVE: Traditional, lecture-based methods of teaching pharmacology may not translate into the skills needed to communicate effectively with patients about medications. In response, the authors developed an interactive course for third-year psychiatry residents to reinforce prescribing skills. METHODS: Residents participate in a facilitated group discussion combined with a role-play exercise where they mock-prescribe medication to their peers. Each session is focused on one medication or class of medications with an emphasis on various aspects of informed consent (such as describing the indication, dosing, expected benefits, potential side effects, and necessary work-up and follow up). In the process of implementing the course at a second site, the original format was modified to include self-assessment measures and video examples of experienced faculty members prescribing to a simulated patient. RESULTS: The course was initially developed at one site and has since been disseminated to a number of other institutions. Between 2010 and 2016, 144 residents participated in the course at the authors' two institutions. Based upon pre/post surveys conducted with a subset of residents, the course significantly improved comfort with various aspects of prescribing. Although residents may also gain comfort in prescribing with experience (as the course coincides with the major outpatient clinical training year), improvement in comfort-level was also noted for medications that residents had relatively little experience initiating. At the end of the year, half of the residents indicated the course was one of their top three preferred methods for learning psychopharmacology in addition to direct clinical experience and supervision (with none listing didactics). CONCLUSION: An interactive prescribing workshop can improve resident comfort with prescribing and may be preferred over a traditional, lecture-based approach. The course may be particularly helpful for those medications that are less commonly used. Based upon our experience, this approach can be easily implemented across institutions..

Evaluation of Branched-Narrative Virtual Patients for Interprofessional Education of Psychiatry Residents.

OBJECTIVE: This pilot study evaluated the utility of branched-narrative virtual patients in an interprofessional education series for psychiatry residents. METHODS: Third-year psychiatry residents attended four interprofessional education advanced psychopharmacology sessions that involved completion of a branched-narrative virtual patient and a debriefing session with a psychiatric pharmacist. Pre- and post-assessments analyzed resident learning and were administered around each virtual patient. Simulation 4 served as a comprehensive review. The primary outcome was differences in pre- and post-assessment scores. Secondary outcomes included resident satisfaction with the virtual patient format and psychiatric pharmacist involvement. RESULTS: Post-test scores for simulations 1, 2, and 3 demonstrated significant improvement (p < 0.05) from pre-test scores. Scores for simulation 4 did not retain significance. Resident satisfaction with the branched-narrative virtual patient format and psychiatric pharmacist involvement was high throughout the series (100 %; n = 18). CONCLUSIONS: Although there are important methodological limitations to this study including a small sample size and absence of a comparator group, this pilot study supports the use of branched-narrative virtual patients in an interprofessional education series for advanced learners.

Assessing Residents' Confidence in the Context of Pharmacotherapy Competence.

OBJECTIVE: We aimed to determine whether residents' confidence initiating medications increased with the number of times they prescribed individual medications and to quantify the relationship between prescription frequency and gains in confidence. METHODS: From July 2011 to June 2014, PGY-3 residents completed a survey of confidence levels at their psychopharmacology clinic orientation and then again 12 months later. The Emory Healthcare electronic medical record was used to identify all medications prescribed by each resident during their 12-month rotation and the frequency of these prescriptions. RESULTS: Confidence in initiating treatment with all medicines/medication classes increased over the 12-month period. For three of the medication classes for which residents indicated they were least confident at orientation, the number of prescriptions written during the year was significantly associated with an increase in confidence. CONCLUSIONS: Measuring resident confidence is a relevant and achievable outcome and provides data for educators regarding the amount of experience needed to increase confidence.

Teaching the Teachers of Clinical Psychopharmacology.

This commentary focuses on psychopharmacology teachers and their teaching. The authors offer broadly based pedagogic suggestions on how to deliver evidence-based and neurobiologically informed prescribing information to clinicians at all levels of experience. They argue that teaching essential psychopharmacology knowledge and practice must be up-to-date, accurate, and consistent with the reality of an individual patient's life experience and beliefs. They stress that educators must teach that nonpsychopharmacological factors in a patient's life may be as relevant to the treatment setting as the actual pharmacological basis of psychotropic drug therapeutics.

Psychopharmacologic Management in Integrated Care: Challenges for Residency Education.

The integration of psychiatric care in primary care is becoming a reality. Psychiatric training programs are facing multiple challenges to accommodate this transition. We here present the perspectives of Group for the Advancement of Psychiatry Committee on Psychopharmacology. The members of the group respond to the concerns raised by a resident currently confronting this changing landscape. By discussing the training, clinical, and communicating challenges of integrated care, they shed light on many of the questions being tackled by residency training programs. This commentary on the timely discussion about integrated care seeks to provide insight on the future of training in psychiatry by outlining the core questions of this change.

Ahead of the game: the use of gaming to enhance knowledge of psychopharmacology.

Experiential teaching strategies have the potential to more effectively help students with critical thinking than traditional lecture formats. Gaming is an experiential teaching-learning strategy that reinforces teamwork, interaction, and enjoyment and introduces the element of play. Two Bachelor of Science in Nursing students and a clinical instructor created a Jeopardy!(®)-style game to enhance understanding of psychopharmacology, foster student engagement in the learning process, and promote student enjoyment during clinical postconference. The current article evaluates the utility, relevance, and effectiveness of gaming using a Jeopardy!(®)-style format for the psychiatric clinical setting. Students identified the strengths of this learning activity as increased awareness of knowledge deficits, as well as the reinforcement of existing knowledge and the value of teamwork.

A psychopharmacology course for psychiatry residents utilizing active-learning and residents-as-teachers to develop life-long learning skills.

OBJECTIVE: The authors describe the implementation and evaluation of a 1-year psychopharmacology course using residents-as-teachers and active-learning exercises intended to improve understanding of current psychopharmacology and its evidence base, and skills for life-long learning. METHOD: Weekly classes were devoted to psychotropic medications, treating specific disorders, and use of psychotropics in special patient populations. Each class was divided into three sections: a pharmacology review, a literature review and a faculty-led discussion of clinical questions. Each class included residents as teachers, an audience response system and questions for self-assessment. Resident and faculty presenters evaluated the course weekly and all residents were given a year-end evaluation RESULTS: Resident and faculty evaluations indicated an overall positive response. The residents reported improved perception of knowledge and engagement with this interactive format. CONCLUSION: The course was well received, demonstrating the viability and value of residents taking a more active role in their own learning.

Knowledge of psychotropics and prescribing preferences of family physicians: a preliminary study.

OBJECTIVE: Family doctors often provide care for their patients' mental health needs. This study was designed to survey their opinions and actual practice of providing mental health care, specifically, prescribing psychotropic medication to outpatients with mild/moderate mental health disorders. METHOD: A group of 241 family medicine faculty and residents completed a self-administered survey designed to evaluate their comfort level with providing brief office counseling and psychotropic medication to their patients with mental health disorders. RESULTS: The majority of the sample reported that they prescribe psychotropic medication to their patients, despite often assessing their knowledge of psychotropics as absent or marginal. Most of the sample expressed strong interest in learning more about prescribing psychiatric medications. CONCLUSION: Results of the study suggest the need for improved training of family physicians who often prescribe psychiatric medications for outpatients with mental health disorders.