Clinical Skills Assessment: The Effects of Moving Certification Requirements Into Neurology, Child Neurology, and Psychiatry Residency Training.

BACKGROUND: A few years ago, when the American Board of Psychiatry and Neurology decided to phase out the patient-based oral examinations in its 3 primary specialties, requirements for assessing clinical skills during residency training were instituted. OBJECTIVE: The purpose of this report is to describe the experiences of training program directors and graduates with these new credentialing requirements (labeled CSEs) as well as other effects on the specialties. METHODS: Surveys were administered electronically in 2012 to all current neurology, child neurology, and psychiatry program directors, and to a convenience sample of graduates who applied for the 2012 certification examinations. RESULTS: Response rates for graduates were similar across the 3 specialties but low (28%-33%). Response rates were higher for program directors (53%-62%) and were similar across the 3 specialties. The results indicated that the CSEs were usually administered early in training, were completed toward the end, were often passed on first attempt, generally took place during routine clinical assignments, were used to assess additional competencies, almost always included feedback to the residents, and did not often lead to remediation. Furthermore, the CSEs were perceived to be useful components in the assessment of clinical skills. CONCLUSIONS: The results obtained from the early implementation of the CSEs suggest that they provide an opportunity to assess clinical skills with the additional benefit of feedback to trainees. Other effects included eventual incorporation into training program requirements, milestones, and related faculty development and research efforts.

Relationship between performance on child and adolescent psychiatry in-training and certification examinations.

BACKGROUND: Studies across a range of specialties have consistently yielded positive associations between performance on in-training examinations and board certification examinations, supporting the use of the in-training examination as a valuable formative feedback tool for residents and residency programs. That association to date, however, has not been tested in child and adolescent psychiatry residents. OBJECTIVE: This is the first study to explore the relationship between performance on the American College of Psychiatrists' Child Psychiatry Resident In-Training Examination (CHILD PRITE) and subsequent performance on the American Board of Psychiatry and Neurology's (ABPN) subspecialty multiple-choice examination (Part I) in child and adolescent psychiatry (CAP). METHODS: Pearson correlation coefficients were used to examine the relationship between performance on the CHILD PRITE and the CAP Part I examination for 342 fellows. RESULTS: Second-year CAP fellows performed significantly better on the CHILD PRITE than did the first-year fellows. The correlation between the CHILD PRITE total score and the CAP Part I examination total score was .41 (P  =  .01) for first-year CAP fellows; it was .52 (P  =  .01) for second-year CAP fellows. CONCLUSIONS: The significant correlations between scores on the 2 tests show they assess the same achievement domain. This supports the use of the CHILD PRITE as a valid measure of medical knowledge and formative feedback tool in child and adolescent psychiatry.

Review of the safety of second-generation antipsychotics: are they really "atypically" safe for youth and adults?

OBJECTIVE: There is general consensus that second-generation antipsychotics are at least as effective as and more tolerable than first-generation antipsychotics. We address questions of safety and tolerability in both the short-term and long-term use of these medications by reviewing the existing literature in youth and adults. DATA SOURCES: A MEDLINE search was conducted via PubMed using the following keywords (in various combinations): typical antipsychotics, atypical antipsychotics, children, adolescents, side effects, weight gain, diabetes, metformin, metabolic syndrome, and CATIE. Only English-language articles published from 2000-2010 were included. The bibliographies of papers identified through MEDLINE searches were also reviewed. RESULTS: Six adult studies were analyzed in detail. A summary of the data suggests that there may be a lower association of weight gain and diabetes with ziprasidone, aripiprazole, and haloperidol, while olanzapine, clozapine, quetiapine, and risperidone appear to be more highly associated. There may be less difference than originally thought concerning frequency of extrapyramidal side effects among these medications. All of these antipsychotics, including perphenazine, are similarly efficacious in treating psychosis, with the exception of clozapine, which demonstrates significantly more effectiveness. Although the studies on youth tend to be small (few subjects with large age ranges of 4 to 19 years) and short term in comparison to the adult studies, the data reviewed from 5 studies suggest that, in youth, olanzapine may be associated with the greatest weight gain, extrapyramidal side effects and metabolic changes are quite prevalent, and the antipsychotics studied seem to be similarly effective. CONCLUSIONS: Considering effectiveness, safety, and tolerability, this literature review suggests that in adults there may be a lower association of weight gain and diabetes with ziprasidone, aripiprazole, and haloperidol as compared with olanzapine, clozapine, quetiapine, and risperidone. Youth may be particularly sensitive to weight gain, especially with olanzapine, as well as extrapyramidal side effects and metabolic changes. The literature suggests similar effectiveness among the antipsychotics, perhaps with the exception of clozapine having greater effectiveness, at least in adults.

Recent trends in american board of psychiatry and neurology psychiatric subspecialties.

OBJECTIVE: this article reviews the current status and recent trends in the American Board of Psychiatry and Neurology (ABPN) psychiatric subspecialties and discusses the implications of those trends as well as several key questions whose answers may well determine subspecialty viability. METHODS: data are presented on specialty and subspecialty programs; graduates; and ABPN certification candidates and diplomates drawn from several sources, including the records of the ABPN, the websites of the Accreditation Council for Graduate Medical Education and the American Medical Association, and the annual medical education issues of JAMA. RESULTS: fewer than half of psychiatry graduates pursue subspecialty training. While most recent specialty graduates attempt to become certified by the ABPN, many subspecialists elect not to do so. There have been recent decreases in the number of fellowship programs and trainees in geriatric psychiatry and addiction psychiatry. The pass rates for fellowship graduates are superior to those for the "grandfathers" in all of the newer psychiatric subspecialties. Lower percentages of subspecialists than specialists participate in maintenance of certification, and maintenance of certification pass rates are high. CONCLUSION: the initial interest in training and certification in some of the ABPN subspecialties appears to have slowed, and the long-term viability of those subspecialties may well depend on the answers to a number of complicated social, economic, and political questions in the new health care era.

The ABPN Maintenance of Certification Program for psychiatrists: past history, current status, and future directions.

OBJECTIVE: To describe the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification Program, its underlying rationale, how it will be implemented now, and what it might look like in the future. METHODS: The authors describe the philosophical foundation, specific components, and the implementation timeline of the ABPN Maintenance of Certification Program; the development of specific products that might be used by ABPN diplomates to meet its requirements; and several unanswered questions about its current status and future development. RESULTS: The ABPN Maintenance of Certification Program consists of specific requirements pertaining to professional standing, self-assessment and lifelong learning, performance in practice, and cognitive expertise that will be implemented incrementally over the next decade. CONCLUSION: The ABPN Maintenance of Certification Program has been implemented in a manner that is as consistent as possible with its underlying philosophical beliefs as well as the current and expected public and political concerns, diplomate needs, and the requirements of organizations responsible for licensure, credentialing, privileging, accreditation, professional development, and physician reimbursement.