Development of a Diverse Learning Experience for Diverse Psychiatry Resident Needs: A Four-Year Biological Psychiatry Curriculum Incorporating Principles of Neurobiology, Psychopharmacology, and Evidence-Based Practice

Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

OBJECTIVES

This scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored.

DESIGN

Scoping review of literature from January 2017 to June 2021.

SETTING

Any setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online).

PARTICIPANTS

Doctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway.

METHODS

Searches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included studies described training and outcomes of either EBM, SDM or both. Reported outcomes included EBM knowledge and skill tests, attitude surveys, SDM checklists and surveys and patient and doctor experience data obtained from surveys, focus groups and interviews.

RESULTS

Of the 26 included studies, 15 described EBM training courses, 10 described SDM training courses and 1 course combined both EBM and SDM. Courses were heterogeneous in their content and outcomes, making comparisons difficult. EBM courses prioritised quantitative outcome assessments and linked knowledge and skills, such as critical appraisal, but overlooked other key elements of patient-centred care including SDM.

CONCLUSIONS

SDM and EBM are taught separately in most training courses. The inclusion of SDM, evaluated by qualitative assessments, is currently omitted, yet could provide a more person-centred care focus in EBM courses and should be investigated to increase our knowledge of the effectiveness of such courses and their role in improving doctors' skills and patient care.

PROTOCOL

A protocol for this review has been published and contains further details of the methodology.

Teaching Psychopharmacology in the Medically Ill: A Problem-Based Learning Card Game for Consultation-Liaison Psychiatry Didactics

INTRODUCTION

Our educational report discusses a unique card game that provides an engaging, and competitive strategy for teaching psychopharmacology in the medically ill. It engages the players and helps them learn how to justify medical decisions in the context of complicated medical comorbidity.

METHODS

We describe a problem-based learning approach where learners are presented with randomized diagnoses and complications and are then forced to make prescription decisions for treatment from a limited and randomized supply of medication cards. Each round is facilitated by the teacher, who engages the teams and/or individual players in discussions regarding the rationale and justification of the medication decisions. These treatment plans are scored according to the appropriateness of the medication choice and the process is repeated.

DISCUSSION

The game is flexible regarding players' levels of education and has been played by medical students, psychiatry residents, and fellows throughout their years of training. Overall feedback has been positive from facilitators and trainees and the game has been a valuable source of engaging learners in the process of making complex medication decisions in the medically ill.

[Catatonia education in France: A cross-sectional study]

OBJECTIVES

Catatonia is a transnosographic syndrome described by K. Kahlbaum in 1874. Catatonia can be life-threatening due to its complications and in case of malignant catatonia. Safe and effective treatments have been identified (benzodiazepines and electro-convulsive-therapy). The prevalence of this syndrome is important and represents about 10% of inpatients in an acute psychiatric ward. However, this syndrome appears to remain under-diagnosed and poorly known. We were, therefore, interested in the current knowledge of French psychiatry residents and young psychiatrists as well as the education they had received about catatonia.

METHODS

A questionnaire was submitted to French psychiatry residents and young psychiatrists with fewer than 5 years of experience. It included questions about knowledge of the symptoms, complications, causes and treatments of catatonia. Participants were also asked about their confidence in the management of a patient with catatonia and about the number of catatonic patients they had already met. The type of lecture and teaching about catatonia was also assessed.

RESULTS

Among the 376 psychiatrists that completed the questionnaire, 37.5% never had received any specific teaching about catatonia. Concerning the 62.5% who benefited from a specific lecture, this was mainly delivered as part of psychiatry DES. Heterogeneity in the education delivery on the French territory had been highlighted. In addition, participants' knowledge of catatonic syndrome seems incomplete. However, knowledge of catatonic symptoms and first intention treatments was significantly better among respondents who were part of the "with education" group. The confidence in catatonia recognition and management, as well as the number of catatonic patients they met, are also significantly higher in the group "with education".

CONCLUSION

Specific education seems to improve the knowledge of young doctors and their ability to diagnose and treat catatonic patients. This education remains poorly provided and heterogeneous on the French territory. Catatonia deserves a place in the teaching program of the psychiatry DES, thus to become systematic.

Research Domain Criteria: Cutting Edge Neuroscience or Galen's Humors Revisited?

The Research Domain Criteria (RDoC) scheme has guided the research agenda of the National Institute of Mental Health for the past decade. The essence of RDoC is its dimensional conception of mental illness, with the assumption that psychopathology is a manifestation of extremes along axes of neuropsychological variation. Research, it follows, should emphasize normal neuropsychological function and its associated neurocircuitry. We argue that RDoC, dressed in terms of modern neurobiology, is in fact a return to the humoral theory of Galen, a dimensional approach in which physical and mental health requires a balance of the four basic bodily humors (blood, black bile, yellow bile, and phlegm). The RDoC/Galenic approach may be useful in understanding those conditions best understood as extremes along a continuum, such as personality disorders. However, we contend that for the most severe psychiatric disorders - categorically defined diseases such as schizophrenia, bipolar disorder, and autism - RDoC's Galenic dimensionalism is a retreat from the biomedical approach that seeks to find rational therapeutic targets by identifying etiologic factors and pathogenic pathways. Abandoning this medical model now, in the context of remarkable advances in genetics, neuroimaging, and neuroscience, is a major setback for the advancement of scientific psychiatry.