Transcript Document
The Effect of Education on Psychology Trainee Opinions About Psychopharmacology Divy Ravindranath MD MS, Paul Pfeiffer MD, Brian Martis MD Department of Psychiatry, University of Michigan School of Medicine BACKGROUND The Eastern Michigan University Department of Psychology introduced a Psychopharmacology course for its MA and PhD clinical psychology students in partnership with the University of Michigan Department of Psychiatry (UMDP), in the Spring of 2008. The course was designed and taught by UMDP senior psychiatry residents (DR and PP). PURPOSE We hypothesized that, at the end of the course, students would view medications as an important component in the treatment of mental illnesses and that students would see themselves as better prepared to work with patients who are on psychotropic medications. DISCUSSION RESULTS Sample Characteristics 27 students 3 students elected not to respond to both surveys Number of participants is 24 Year in Graduate School First Second Third Fourth Fifth 11 9 1 2 1 16/24 respondents had some clinical experience with psychotropic medications. Rating of experiences averaged 4.44 (SD = 1.33). Anchors: 1 = “negative”, 4 = “fair”, 7 = “positive” Survey Results 1. What is the utility of medications in the resolution of mental health problems? METHODS This study was conducted with approval from the Eastern Michigan University Human Subjects Review Committee. Educational Intervention The course was conducted over two months, with two 2.5 hour sessions per week. Approximately 75 minutes were spent each session on lectures on various topics in psychopharmacology (basic human anatomy/physiology, pharmacodynamics/kinetics, antidepressant medications, antipsychotic medications, applications in geriatric populations, etc.). The rest of the session was spent in a modified team based learning format using five case vignettes processed in teams of 5 to 6 students to highlight important aspects of the lecture content. The course focused on basic psychopharmacology and practical aspects of treating patients with psychotropic medications in a collaborative care model. Students also delivered a group presentation on a topic of their choice. Assessment Students completed a mixed quantitative and qualitative survey administered pre and post course (on the day of the final examination). Quantitative portions used a 7-point anchored Likert scale to assess students’ past exposure and current beliefs regarding pharmacologic treatment of mental health disorders. Qualitative portions asked for participant comments explaining their responses to the quantitative portions. Anchors: 1 = “Detrimental”, 4 = “Neutral”, 7 = “Helpful Pre-intervention Mean Post-intervention Mean T-Statistic P (two-tailed) 4.96 5.52 -4.38 0.00 Overall, students found this course to satisfy the learning goals. Post – pre course evaluation revealed small but statistically significant increased appreciation for the role of medications in the treatment of mental illnesses and also increased student comfort with being a collaborating partner in the use of psychotropic medications. The magnitude of change for the questions regarding comfort with collaboration was large, suggesting that students perceived this course to be valuable in preparing them for their future careers as mental health clinicians. The literature addressing psychopharmacology instruction for clinical psychology students focuses primarily on what should be taught rather than on the effect of having a course on this topic. One letter did conclude that psychopharmacology instruction continues to have positive effects even years after the students have graduated from their programs.1 The literature on psychiatry resident education in cotreatment of patients with a therapist emphasizes the role of collaboration.2 Therefore, a course focusing on the collaborative aspects of care may be of particular value in preparing clinical psychology trainees for current practice realities. Pre-Intervention Comments: - “Though overused, medications can be helpful and are necessary for the treatment of many disorders.” RESULTS 2: and Less Experienced - “Good for some problems some patients at someInstructors time.” vs. More Experienced Instructor - “Particularly helpful for chronic mental illnesses such as schizophrenia. Also helpful for mood disorders among others.” Post-Intervention Comments: This study did not include objective measures of course content and involved a small sample size and single intervention. These factors should be considered in interpreting the findings. However, we feel that this is an important first step in stimulating further research into both the content and effects of psychopharmacology instruction for clinical psychology students. - “Depends on the disorder, 7 => schizophrenia.” - “I would venture to say ‘essential’.” CONCLUSION - “We’ve got a long way to go with the drugs, as with therapy.” 2. How comfortable do you feel answering questions about medications from your patients? Anchors: 1 = “Not at all”, 4 = “Somewhat”, 7 = “Very” Pre-intervention Mean Post-intervention Mean T-Statistic P (two-tailed) 2.58 4.50 -9.34 0.00 Findings from this preliminary study suggest that a carefully designed course in psychopharmacology can increase the future therapist’s understanding of the value of psychotropic medications in the treatment of mental illness and perceived comfort in working with patients taking medications in collaboration with prescribing providers. 3. How prepared do you feel for coordinating care with your patients’ prescribing providers? Anchors: 1 = “Not at all”, 4 = “Somewhat”, 7 = “Very” Pre-intervention Mean Post-intervention Mean T-Statistic P (two-tailed) 2.67 4.88 -12.57 0.00 References 1. El-Mallakh RS. Psychological Reports 74: 674, 1994. 2. Ellison JM. Academic Psychiatry 29:195–202, 2005. 4. How prepared do you feel finding answers to questions you may have about medications? Data analysis Comparison of means before and after the educational intervention was performed using paired T-tests. Answers that could not be paired were excluded from the analysis. Illustrative comments are reported here where applicable. Anchors: 1 = “Not at all”, 4 = “Somewhat”, 7 = “Very” Pre-intervention Mean Post-intervention Mean T-Statistic P (two-tailed) 4.25 6.29 -10.21 0.00 Acknowledgements: Special thanks to our students, Dr. Carol Freedman-Doan PhD of the EMU Department of Psychology, Dawn Bock of the EMU Department of Psychology for administrative support, Residency Research/Clinical Scholars Track colleagues at the University of Michigan for input into this project, and Dr. Amin Azzam MD for his comments on the survey design.