Kavanagh Eileen P, Cahill John, Arbuckle Melissa R, Lenet Alison E, Subramanyam Kalyani, Winchel Ronald M, Nossel Ilana, DeSilva Ravi, Caravella Rachel A, Ackerman Marra, Park Henry C, Ross David A
Columbia University Medical Center, New York, NY, USA.
Yale University, New Haven, CT, USA.
Acad Psychiatry. 2017 Aug;41(4):491-496. doi: 10.1007/s40596-017-0662-z. Epub 2017 Feb 13.
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.
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.
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).
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..
传统的基于讲座的药理学教学方法可能无法转化为与患者有效沟通用药所需的技能。作为回应,作者为三年级精神病学住院医师开发了一门互动课程,以强化处方技能。
住院医师参加小组讨论并结合角色扮演练习,在练习中他们向同伴模拟开处方。每节课聚焦于一种药物或一类药物,重点关注知情同意的各个方面(如描述适应症、剂量、预期益处、潜在副作用以及必要的检查和随访)。在第二个地点实施该课程的过程中,对原始形式进行了修改,纳入了自我评估措施以及经验丰富的教员对模拟患者开处方的视频示例。
该课程最初在一个地点开发,此后已传播到其他一些机构。2010年至2016年期间,144名住院医师在作者所在的两个机构参加了该课程。根据对一部分住院医师进行的课前/课后调查,该课程显著提高了他们在处方各个方面的舒适度。尽管住院医师也可能随着经验的积累而在开处方方面更得心应手(因为该课程与主要的门诊临床培训年相吻合),但对于住院医师相对缺乏起始经验的药物,其舒适度也有提高。在这一年结束时,一半的住院医师表示,除了直接临床经验和监督外,该课程是他们学习精神药理学的三大首选方法之一(没有人将讲授法列为首选)。
一个互动式处方研讨会可以提高住院医师开处方的舒适度,并且可能比传统的基于讲座的方法更受青睐。该课程对于那些不太常用的药物可能特别有帮助。根据我们的经验,这种方法可以很容易地在各机构间实施。