Transcript Document

Developing Psychiatric Residents as Critical Consumers of
the Psychiatric Literature
Tana A. Grady-Weliky MD, Linda H. Chaudron MD, MS, Sue K. DiGiovanni, MD and
Jeffrey M. Lyness MD
University of Rochester Medical Center
Department of Psychiatry
Abstract
2006-2008 Journals and Topics
Curriculum Description
Course Goals
•Develop skills in critically appraising primary
medical literature (=‘educated consumer’ of the
literature)
•Promote an atmosphere of intellectual curiosity
and respectful debate among the entire residency
cohort, including fostering inter-class working
relationships
•Develop skills in integrating critical literature
appraisal with the other elements of evidence-based
practice
•Develop skills to serve as a base for further
development as a scholar or researcher (=‘producer’
of scholarly output)
Journal club held 10/12 months
•Noon session
•Lunch provided
Session Format
•‘Mini-lecture’ on topic of the month-by faculty
facilitator (5-7 minutes)
•Paper presentation – by resident (~10 minutes)
•Guided group discussion – facilitated by resident
(~35-40 minutes)
With the rapid pace of change and new developments in the
diagnosis and treatment of psychiatric illness, it is essential for residents to
be critical consumers of the psychiatric literature. The importance of
developing these skills during residency has been underscored by common
residency requirements including, training in evidence-based medicine and
demonstrated research literacy and scholarly activity. With these factors in
mind, we developed a monthly journal club with an overarching goal of
developing general psychiatry residents as careful and thoughtful
consumers of the literature. General psychiatry residents (PGY-1 through
PGY-4) are required to attend a monthly journal club, which is facilitated
by two senior psychiatric educators. Initial sessions are devoted to
understanding components of a good paper including journal choice (its
impact factor and what that means), type of research funding and how that
might influence how one reads the paper, as well as an overview of the
hierarchy of evidence in evidence based medicine. Following these
introductory sessions, the remaining sessions are devoted to review of each
element of a paper. First, the “structure and function” of the abstract for a
journal article are reviewed. The next sessions are devoted to the
introduction, methods, results and discussion sections of a journal article.
Subsequent sessions include discussion of various types of papers, e.g.
systematic reviews, meta-analyses, randomized controlled trials.
A
standard procedure exists for each journal club. There is an assigned
facilitator and resident for each topic. The assigned facilitator is
responsible for creating a 5-7 minute overview of the topic. The assigned
resident selects an article that seems relevant for the topic and works with
the assigned facilitator in the development of appropriate questions about
the article for the large group to consider prior to meeting. Our poster will
describe the journal club and process in detail. Additionally, quantitative
and qualitative data will be presented.
Impact Factor = 15.98
N= 2 (11%)
Impact Factor = 2.43
N= 1 (5.6%)
35
30
25
Percent
Educational Objectives
Impact Factor = 4.561
N= 1(5.6%)
Impact Factor = 9.17
N= 14 (77.8%)
20
2006-2008
15
10
Introduction
With the rapid pace of change and new developments in the
diagnosis and treatment of psychiatric illness, it is essential for
residents to be critical consumers of psychiatric literature. The
importance of developing these skills during residency has been
underscored by common residency requirements including
training in evidence-based medicine and demonstrated research
literacy and scholarly activity.1 Many residency programs utilize
journal clubs, as the venue to teach components of evidencebased medicine. However, the popularity and interest in this type
of educational modality vary. In fact, several recent articles
address ways to make journal clubs more interesting for
participants.2-5 The earliest North American reference to the use
of journal clubs is that of Osler’s use of this teaching format in
Montreal during the mid-1870’s.3 Swift and Alguire both argue
for the use of adult learning principles in the development of
journal clubs.3,4 Swift also describes the role of the learning
environment and setting such as the provision of food to
encourage attendance and the avoidance of keeping attendance.3
The general psychiatry resident journal club at the University
of Rochester Medical Center was developed in its current format
in response to resident feedback as well as a need to enhance our
training in critical appraisal of the literature. There has not been a
formal assessment of the journal club component of the research
curriculum, but oral feedback from residents has been generally
positive. We have also made several changes in response to
resident feedback.
The course was held over two academic years with 10
sessions/year for a total of 20 sessions. Each year the final
session was devoted to course review and evaluation. Selected
topics for the course include:
•Rationale
•Reading a Paper
•Hierarchy of Evidence
•Interventions
•Basic Statistics
•Pharmacological Randomized Controlled Trials
•Pharmacological Clinical Trials
Internet Based
Psychotherapy
Genetics/Suicidality
rTMS/ECT
Quality of Life
SPMI Alternatives/Violence
Selected Course Modules
Women's Mental Health
3.
0
Augmentation/Treatment
Resistant Depression
2.
5
Identify
common
residency
program
requirements that incorporate research literacy
and scholarly activity.
Describe at least three components of a journal
club and their role in enhancing research literacy.
Describe advantages and disadvantages of having
two core faculty facilitators for a general psychiatry
residency journal club.
Bipolar D/OPsychopharmacology
1.
Resident Feedback
Verbal feedback from our residents about journal club has been generally positive. Interestingly, after the
first year of the revised journal club, a group of residents were very interested in having the faculty facilitators come
up with a group of “classic” articles that would be discussed in the journal club. We asked department faculty
members to send in one article they believed was a “classic” for the field and passed that list along to the residents.
It was left up to the individual residents to select a “classic” as opposed to a recent article for discussion.
Following this request none of the residents elected to present a “classic” article.
There was also a specific request to incorporate more clinical discussion about what the facilitators may do
in their practice rather than discussion of the specific elements of the article. The facilitators decided not to honor
that request as there are many components of the curriculum where specifics on clinical decision making are
addressed. However, we continue to address the relevant clinical aspects of a selected article.
Feedback following the second year of the journal club curriculum included a desire to utilize a specific
textbook for the course. We decided to use the text, Evidence-Based Psychiatry, by Gregory Gray, for this
academic year. Upper level residents already received this book from the department and we had covered ~1/2
of the book over the course of the initial two years of the curriculum. Residents again requested additional
discussion of clinical aspects of the facilitators’ practices as well as a request that the facilitators’ select the article
for review. The facilitators agreed that these requests were not in concert with several of the course
goals/objectives. Therefore, these requests were not incorporated into this year’s curriculum.
Discussion
Selected References
1.
2.
3.
4.
5.
Accreditation Council on Graduate Medical Education. General Psychiatry Residency Training
Requirements. July 2007. pp. 23 and 28.
Wright J: Journal Clubs – Science as Conversation. New Engl J Med 351(1): 10-13, 2004.
Swift G: How to make journal clubs interesting. Adv Psychiatric Treatment 10:67-72, 2004.
Alguire PC: A Review of Journal Clubs in Postgraduate Medical Education. J Gen Intern Med, 13:347-353.
Zisook S et al. : Alternate Methods of Teaching Psychopharmacology. Acad Psychiatry 29: 141-154, 2005.
Our journal club curriculum incorporates many recommendations designed
to engage learners for participation in this particular learning format, e.g. utilization
of adult learning principles – resident selection of article and primary facilitation of
session, provision of food, consistent format.3-5 Two significant limitations to our
curriculum to date are the absence of a formal, anonymous course evaluation and
the lack of specific instruments to fully assess if the course has genuinely enhanced
the critical appraisal skills of our residents. The next step in our curriculum
development will be the inclusion of formal course evaluations as well as working
on a method to assess if the course really improves critical appraisal of the literature
by our residents.