How well does the psychiatry residency in-training examination predict performance on the American Board of Psychiatry and Neurology. Part I. Examination?

OBJECTIVE: Scores on the American College of Psychiatrists' Psychiatry Residency In-Training Examination (PRITE) were correlated with scores on the American Board of Psychiatry and Neurology (ABPN) Part I examination in psychiatry. METHOD: Pearson correlations between 1992 PRITE scores and 1994 ABPN Part I psychiatry scores were calculated. Analyses were based on 701 examinees. RESULTS: There was a moderate correlation between scores on the PRITE and ABPN Part I examination in psychiatry and a low correlation of neurology scores. CONCLUSIONS: These correlations were observed even though the two examinations differ in their purposes, content outlines, development, and administration.

Exploration of failure on the subspecialty examination for child and adolescent psychiatry.

OBJECTIVE: The purposes of this study were to compare first-time performance on the oral examination for certification in child and adolescent psychiatry with first-time performance on the written and oral examinations for certification in general psychiatry and to identify factors that contribute to failure on the child and adolescent psychiatry oral examination. METHOD: To address the first question, two successive cohorts of first-time child and adolescent psychiatry candidates were identified, and chi-square analyses were used to explore the relationship between first-time performance on the different examinations. For the second question, a special checklist was developed and completed for all candidates who failed any section of the oral examination for child and adolescent psychiatry three successive times. RESULTS: There was no relationship between passing or failing the written and oral examinations for general psychiatry on the first attempt and passing or failing the child and adolescent psychiatry oral examination on the first attempt. The checklist results suggested that the failing candidates had difficulty in organizing and integrating case material. Other weaknesses were related to the specific sections of the oral examination. CONCLUSIONS: The results suggest that the knowledge and skills that are required to pass the child and adolescent psychiatry oral examination are different from those of the general psychiatry examination. The information about weaknesses should be of interest to general and child and adolescent psychiatric educators, candidates, and service delivery agencies.

Reliability of the Part II board certification examination in psychiatry: examination stability.

OBJECTIVE: The aim of this study was to examine the reliability (examination stability) of the American Board of Psychiatry and Neurology (ABPN) Part II (oral) examination in psychiatry. METHOD: The authors analyzed the consistency (agreement between grades given by two independent examiners) for a 1-year examination cycle using a weighted kappa statistic and compared different parts of the examination (live patient and videotape), different examination sites, different days, and different times of the day. RESULTS: There was no significant difference in agreement between examiners by different parts of the examination, examination site, day of the week, or time of day. CONCLUSIONS: The stability of the Part II ABPN examination in psychiatry is not influenced significantly by the format or site of administration. Candidate performance is the predominant factor in the determination of passing or failing grades.

Reliability of the Part II Board Certification Examination in Psychiatry: interexaminer consistency.

OBJECTIVE: The aim of the study was to examine the reliability (interexaminer consistency) of the American Board of Psychiatry and Neurology (ABPN) Part II (oral) examination in psychiatry. METHOD: Grades were assigned independently by two examiners who observed the same examination in a 1-year cycle (1,422 candidates, two examinations each). The consistency between these pairs of grades (pass, condition, fail) was analyzed using a weighted kappa statistic. RESULTS: There was perfect agreement between examiners in 67% of examinations, minor disagreement in 26%, and major disagreement in 7% (weighted kappa = 0.54-0.56). CONCLUSIONS: The Part II ABPN examination demonstrates fair to good reliability as measured by interexaminer consistency. Development of more explicit grading criteria should further improve examiner agreement in future examinations.

Certification and recertification.

The American Board of Psychiatry and Neurology issues certificates for psychiatrists in general psychiatry, child and adolescent psychiatry, and added qualification in geriatric psychiatry. It will issue a certificate in added qualification in clinical neurophysiology in 1992. An application for a certificate in added qualification in addiction psychiatry is currently under review by the American Board of Medical Specialties. The American Psychiatric Association has requested that the ABPN consider forensic psychiatry for an added qualification. All new subspecialty certificates will have a ten year time limit. Beginning on October 1, 1994, all certificates will be time-limited. Time-limited certificates will lead to the requirement for recertification. Current requirements for certification are reviewed and strategies for planing for recertification are discussed.

Dialysis for schizophrenia: an uncontrolled study of 11 patients.

The authors evaluated hemodialysis as a treatment for schizophrenia in an uncontrolled study of 11 patients. Eight men and two women with chronic schizophrenia who had responded poorly to conventional treatments or who had sought alternate treatments received three dialyses weekly for 3 weeks; 1 additional subject dropped out after eight treatments. MMPI, Psychiatric Status Scale, and Inpatient Multidimensional Psychiatric Scale scores were obtained before, immediately following, and at intervals after the nine treatments. Preliminary results, including 1-month follow-up, suggest that subjects with pretreatment anxiety and depression improved. No endorphins were discovered in the dialysate.

Why should dialysis benefit schizophrenia?

If dialysis is successful for the treatment of schizophrenia, the artificial kidney must be removing something which the human kidney cannot, unless other nonspecific factors are involved. Either there is an abnormal compound present which is retained by normal renal tubular transport processes, or the kidney of a schizophrenic must be abnormal in that it fails to excrete a normally present compound. Since the latter explanation is less probable, biochemical research should focus on classes of compounds which are known to be handled differently by the artificial kidney than by the human kidney. A dialyzable "schizophrenic toxin" might be a nonprotein, nonprotein-bound of molecular weight below 500 daltons such as an organic acid or base. Proteins, peptides, amino acids, and trace elements are less likely possibilities.

Clinical and psychological test findings in cerebral dyspraxia associated with hemodialysis.

Cerebral dyspraxia associated with hemodialysis is a progressive, fatal syndrome. Patients suffer from a combination of psychiatric and neurological signs and symptoms. Psychiatric manifestations include anxiety, depression, paranoid ideation, and a progressive dementia with impaired concentration, decreased memory, personality changes, and hallucinations. Neurological findings include deliberate speech, stuttering, dysarthria, dyspraxia of speech and movement, tremulousness, myoclonic activity, asterixis, and seizures. These symptoms are aggravated during and immediately following dialysis. Patients usually die within 6 months of its onset. The etiology is unknown. Treatment efforts have failed to reverse its course. Recognition of this syndrome is highlighted so that informed, critical decisions can be made as to whether to continue dialysis therapy.