Developing Psychiatric Residents as Critical Consumers of the Psychiatric

LiteratureTana A. Grady-Weliky MD, Linda H. Chaudron MD, MS, Sue K.

DiGiovanni, MD and Jeffrey M. Lyness MDUniversity of Rochester Medical Center

Department of Psychiatry

1. Accreditation Council on Graduate Medical Education. General Psychiatry Residency Training Requirements. July 2007. pp. 23 and 28.

2. Wright J: Journal Clubs – Science as Conversation. New Engl J Med 351(1): 10-13, 2004.

3. Swift G: How to make journal clubs interesting. Adv Psychiatric Treatment 10:67-72, 2004.

4. Alguire PC: A Review of Journal Clubs in Postgraduate Medical Education. J Gen Intern Med, 13:347-353.

5. Zisook S et al. : Alternate Methods of Teaching Psychopharmacology. Acad Psychiatry 29: 141-154, 2005.

Resident Feedback

Selected References

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.

Abstract 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)

IntroductionVerbal 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.

2006-2008 Journals and Topics

Impact Factor = 9.17N= 14 (77.8%)

Impact Factor = 2.43N= 1 (5.6%)

Impact Factor = 4.561N= 1(5.6%)

Impact Factor = 15.98N= 2 (11%)

Selected Course Modules

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

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2006-2008Educational Objectives1. Identify common residency program

requirements that incorporate research literacy and scholarly activity.

2. Describe at least three components of a journal club and their role in enhancing research literacy.

3. Describe advantages and disadvantages of having two core faculty facilitators for a general psychiatry residency journal club.

DiscussionOur 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.

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 evidence-based 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.