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.

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.

Learning the "Science of the Art of Prescribing": From Evidence-based Algorithms to Individualized Medicine in Psychiatric Care.

The purpose of this review is to highlight the limitations of the traditional diagnosis/evidence-based symptom reduction paradigm and advocate for an individualized medicine approach that incorporates psychological and relational aspects of prescribing in addition to the objective patient presentation. Potential barriers, challenges, and proposed future directions for improving education in psychological and relational aspects of prescribing are discussed. Psychological aspects of prescribing, as recently spelled out in the field of psychodynamic psychopharmacology, are generally acknowledged as important, but they do not have a well-defined position in contemporary residency training throughout North America. While residents receive in-depth exposure to diverse aspects of what to prescribe in their psychopharmacological training, and they work with patients' subjective and relational meaning and the quality of the therapeutic alliance in their psychotherapy rotations, an integrated approach to how to prescribe is generally lacking. Despite many legitimate challenges, the authors suggest that teaching an integrated approach that incorporates objective, subjective, and relational factors in the provision of psychopharmacology and utilizing evidence-based principles of individualized care should be prioritized in both residency training and the provision of psychiatric treatment as a whole.

A pilot psychedelic psychopharmacology elective.

BACKGROUND AND PURPOSE: There is renewed research attention on the use of psychedelic drugs to treat psychiatric illnesses. If psychedelic drugs are approved for medical use in the United States, patients, professionals, and policy makers will look to pharmacists as medication experts for advice on the safe, effective, and ethical use of these substances. To help prepare a future generation of pharmacists in this therapeutic area, a psychedelic psychopharmacology elective was developed and piloted. EDUCATIONAL ACTIVITY AND SETTING: Broadly, the objectives of the course were to train students to (1) analyze scientific literature, (2) engage in ethical discussions, and (3) make evidence-based clinical recommendations about the use of psychedelics. The pilot elective course was delivered synchronously online to 12 second- and third-year pharmacy students during spring 2021. Activities included journal clubs, textbook reading assignments, reflective structured dialogues, a monograph, and a term paper. FINDINGS: The course was feasible for a single instructor and well-received by students. A mix of instructor-directed and self-directed learning approaches were utilized. SUMMARY: The pilot psychedelic psychopharmacology elective was a success, providing a framework for future courses.

Steven R. Tulkin (1943-2022).

Memorializes Steve R. Tulkin. (1943-2022). Steve was the first Director, in the nation, of the first Postdoctoral Master's of Science Program in Clinical Psychopharmacology, at Alliant International University (1999-2014). Many hundreds of psychologists, around the globe, have earned their Master's of Science in Clinical Psychopharmacology (MSCP) from Alliant. In 2007, Steve helped to create the American Psychological Association (APA) Division 18/Alliant partnership to fund Native psychologists in their training in Clinical Psychopharmacology, so as to facilitate their practice as prescribing psychologists on tribal lands. Steve left this world peacefully on January 17, 2022. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Combining Asian and American pedagogy to improve clinical psychopharmacology practice.

As the world becomes increasingly interconnected, psychiatrists across geographical regions and from various international organizations need to collaborate to promote global health and wellness. A necessary step is for nations of the world to develop combined teaching initiatives and curricula to ensure best practices are shared globally. In no field of medicine is this more pressing than in psychiatry - especially psychopharmacology given the recent advances in the field. This paper highlights the need to work collaboratively in developing teaching curricula in psychopharmacology in order to incorporate pedagogy and content from international partners-here from Asia and America.

Psychotropic Medication Prescribing in Primary Care: Pediatric Chief Resident Perspectives.

OBJECTIVE: Evidence-based treatments for mental health concerns include psychopharmacological and psychosocial approaches. Pediatrics organizations indicate psychopharmacology needs to be a component of training. This study investigated the status of training in psychotropic medication prescribing through a national survey of pediatric chief residents. METHOD: Pediatric chief residents (one per residency program) completed a survey (response rate = 60.2%, 127/211) about their attitudes, knowledge, comfort, practice, and training around prescribing psychotropic medication in primary care. Quantitative data included descriptive statistics and correlational analyses to explore relationships between variables; qualitative data were examined through classical content analysis. RESULTS: Almost half of respondents reported prescribing sometimes or often. Frequency of prescribing varied by mental health condition, with highest frequency for attention-deficit/hyperactivity disorder. About two-thirds of respondents reported having at least some/average knowledge. About half of respondents reported being uncomfortable with prescribing; respondents were most uncomfortable with prescribing antianxiety, mood stabilizing, and antipsychotic medications, and with discontinuing medication; about half indicated their competence in progress-monitoring needed improvement. Concurrent psychosocial treatment was perceived as very useful, although often inaccessible to patients. Prescribing frequency was related to knowledge, comfort, progress-monitoring competence, and training quality; training quality was related to knowledge and comfort. Over 60% rated their training as not at all or only somewhat adequate. CONCLUSIONS: Pediatric chief residents reported having knowledge of psychotropic medication issues, but experience a general discomfort, especially with discontinuing medication, and with medications other than stimulants. Most thought their training needed improvement in terms of comprehensiveness and clinical practice experiences.

The revised 2019 standards for psychopharmacological training: Model education and training program in psychopharmacology for prescriptive authority.

The American Psychological Association (APA), under the oversight of the Board of Educational Affairs, and the Board of Professional Affairs, is responsible for the education and training of psychologists in prescriptive authority. All APA standards and guidelines are required by Association Rule 30-8.3 to be revised at least every 10 years. The standards for training psychologists in the safe and responsible practice of prescribing psychotropic medication have been recently updated (Model Education and Training Program in Psychopharmacology for Prescriptive Authority, APA, 2019). A departure from the 1996 and 2009 versions of that document is that training may now be conducted at the doctoral level; however, a postdoctoral supervised clinical fellowship can only occur after the attainment of licensure as a practicing psychologist. Two novel features of the 2019 revision are the use of a competency-based model of learning and assessment, and increased emphasis on supervised clinical experiences in physical assessment and medication management. By the time of completion of their fellowships, practicing psychologists are expected to have clinical competence in the measurement and interpretation of vital signs; neurological examination; therapeutic drug monitoring; systems of care; pharmacology; clinical pharmacology; psychopharmacological research; and finally, professional, ethical, and legal issues. The updated standards were approved as APA policy in February 2019. This article briefly reviews the revision process and highlights the updates made in the most recent version of the standards. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.].

Faculty and Resident Engagement With a Workplace-Based Assessment Tool: Use of Implementation Science to Explore Enablers and Barriers.

PURPOSE: Implementation of workplace-based assessment programs has encountered significant challenges. Faculty and residents alike often have a negative view of these programs as "tick-box" or "jump through the hoops" exercises. A number of recommendations have been made to address these challenges. To understand the experience with a workplace-based assessment tool that follows many of these recommendations, the authors conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify enablers and barriers to engagement with the tool. METHOD: The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) is a direct observation tool designed to assess resident performance during a psychiatric medication management visit. From August 2017 to February 2018, the P-SCO was implemented in the outpatient continuity clinics for second- and third-year residents at Zucker Hillside Hospital/Northwell Health. In February and March 2019, the authors conducted semistructured interviews of participating faculty and residents. Interview guides based on the CFIR were used to capture the enablers and barriers to engagement. Interview transcripts were independently coded. Codes were then organized into themes relevant to the domains of the CFIR. RESULTS: Ten faculty and 10 residents were interviewed. Overall, participants had a positive experience with the P-SCO. Enabling factors for faculty and residents included the ongoing training, design features of the P-SCO, predisposing beliefs, dedicated faculty time, and the perception that the P-SCO improved verbal feedback quality. Barriers for faculty included checklist length and discomfort with feedback that threatens identity, and barriers for residents included faculty variability in timeliness and quality of feedback and minimal review of the feedback after initial receipt. CONCLUSIONS: This study demonstrates that the negative experience of faculty and residents with workplace-based assessment tools shown in prior studies can be overcome, at least in part, when specific implementation strategies are pursued. The findings provide guidance for future research and implementation efforts.

Diseño formativo interprofesional: una estrategia para desarrollar el pensamiento complejo en estudiantes de ciencias de la salud / Interprofessional formative design: a strategy to develop complex thought in health science students

Introducción: La práctica clínica exige un conocimiento sistémico y un actuar interprofesional, de ahí que los profesionales de la salud deban estar formados en el ejercicio del pensamiento complejo. Objetivo: Presentar un diseño formativo interprofesional cuyo propósito es contribuir al desarrollo del pensamiento complejo en el desempeño clínico de los estudiantes de ciencias de la salud. Sujetos y métodos: Se incluyeron estudiantes de medicina, enfermería y psicología, quienes cumplieron con dos sesiones teóricas a fin de estudiar, a través de un caso escrito, la neurobiología y la farmacología de los medicamentos antidepresivos, además del tratamiento combinado con la psicoterapia; un seminario interdisciplinario, en el cual definieron sus roles profesionales, un tratamiento integral y una colaboración interprofesional; y una estación de simulación con una paciente estandarizada para evaluar, mediante lista de cotejo, su desempeño en cuatro categorías de aplicación del pensamiento complejo: valoración diagnóstica, instauración terapéutica, comunicación con la paciente y comunicación interprofesional, con 47 tareas en total. Resultados: Se encontró que las calificaciones medias en las categorías de pensamiento complejo estuvieron entre 8,1 ± 1,8 y 9,3 ± 0,9. Los estudiantes que cumplieron con las distintas tareas fueron el 80-94%. No hubo diferencias estadísticas entre los grupos. Conclusión: La implementación de un diseño formativo interprofesional se convierte en una estrategia de aprendizaje y evaluación que contribuye al desarrollo del pensamiento complejo en el desempeño clínico de estudiantes de ciencias de la salud

Introduction: Clinical practice requires systemic knowledge and an interprofessional act, hence, health professionals must be trained in the exercise of complex thinking. Aim: An interprofessional formative design is presented, whose purpose is to contribute to the development of complex thinking in the clinical performance of health science students. Subjects and methods: Medical, nursing and psychology students were included, who completed two theoretical sessions to study the neurobiology and pharmacology of antidepressant medications through a written case, and the psychotherapy; an interdisciplinary seminar, in which, they defined their professional roles, an integral treatment and an interprofessional collaboration; and a simulation station with a standardized patient to evaluate, by checklist, in four categories of application of complex thinking: diagnostic assessment, therapeutic indication, communication with the patient, and interprofessional, with 47 tasks in total. Results: It was found that the mean average in the categories of complex thinking were between 8.1 ± 1.8 and 9.3 ± 0.9, also, that the percentages of students who completed the different tasks were from 80% to 94%. There were no statistical differences between the groups. Conclusions: The implementation of an interprofessional formative design becomes a learning and evaluation strategy that contributes to the development of complex thinking in the clinical performance of health science students

Improving psychiatric medication use through the Michigan e-psychopharmacology course for nurse practitioners: A pre-post/follow-up study.

PURPOSE: Increasing demands for mental health treatment represent a key opportunity for nurse practitioners (NPs) to provide more psychiatric medication treatment (psychopharmacology). Given this need, NPs could benefit from opportunities to enhance knowledge and skills in psychopharmacology. DESIGN AND METHODS: A novel videoconference course was developed and tested, with 6 weekly sessions taught by a facilitator and a speaker, evaluated by multiple outcomes. FINDINGS: Course feasibility and evidence of improved NP confidence and performance in psychopharmacology were both demonstrated. PRACTICE IMPLICATIONS: Continuing education providers should consider adopting this model for effective and accessible NP psychopharmacology education, potentially expanding NP mental healthcare delivery.

Advancing Our Understanding of Narrative Comments Generated by Direct Observation Tools: Lessons From the Psychopharmacotherapy-Structured Clinical Observation.

BACKGROUND: While prior research has focused on the validity of quantitative ratings generated by direct observation tools, much less is known about the written comments. OBJECTIVE: This study examines the quality of written comments and their relationship with checklist scores generated by a direct observation tool, the Psychopharmacotherapy-Structured Clinical Observation (P-SCO). METHODS: From 2008 to 2012, faculty in a postgraduate year 3 psychiatry outpatient clinic completed 601 P-SCOs. Twenty-five percent were randomly selected from each year; the sample included 8 faculty and 57 residents. To assess quality, comments were coded for valence (reinforcing or corrective), behavioral specificity, and content. To assess the relationship between comments and scores, the authors calculated the correlation between comment and checklist score valence and examined the degree to which comments and checklist scores addressed the same content. RESULTS: Ninety-one percent of the comments were behaviorally specific. Sixty percent were reinforcing, and 40% were corrective. Eight themes were identified, including 2 constructs not adequately represented by the checklist. Comment and checklist score valence was moderately correlated (Spearman's rho = 0.57, P < .001). Sixty-seven percent of high and low checklist scores were associated with a comment of the same valence and content. Only 50% of overall comments were associated with a checklist score of the same valence and content. CONCLUSIONS: A direct observation tool such as the P-SCO can generate high-quality written comments. Narrative comments both explain checklist scores and convey unique content. Thematic coding of comments can improve the content validity of a checklist.

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.

Top Ten Tips Palliative Care Clinicians Should Know About Psychopharmacology.

Palliative care (PC) providers often prescribe psychotropic medications to address psychological and physical suffering of patients with serious medical illness. Consideration must be given to the significant medical comorbidities of the patient when selecting a medication. This article seeks to provide guidance on how to safely and effectively select a psychotropic agent for depression, anxiety, and other distressing symptoms for patients with serious illness. To do so, we draw upon a team of physicians and a pharmacist with training in psychiatry and PC to highlight the "Top 10" tips for selecting a psychotropic medication to provide relief for patients with serious medical illness.