ABPN Not Ready to Change Evil Ways

I just got the message from the American Board of Psychiatry and Neurology (ABPN) yesterday:

ABPN Logo

“ABPN Quarterly Update

July 7, 2015 ~ Volume 1 ~ Number 2

ABPN Makes MOC Part IV Feedback Module Optional

  • The ABPN Board of Directors has made the Feedback Module an OPTIONAL component of Part IV of its MOC Program.  As of January 1, 2016, the Feedback Module will become a highly recommended yet optional component for all ABPN diplomates enrolled in Maintenance of Certification.
  • Only those diplomates in the 2013-2015 C-MOC block must complete a Feedback Module. The Part IV Clinical Module component will remain a requirement for all, with additional approved activities now available.

Questions from our Diplomates: Making the Transition from the 10-Year to C-MOC Program

  • Read the latest flyer that outlines the differences and requirements for the two programs.

Applications Due August 10 for 2016-17 Faculty Innovation in Education Awards

  • Visit the ABPN Awards Program page on our website for eligibility, requirements, funding and other information about the Faculty Innovation in Education Awards.”

I’ve also read quite a few email messages from doctors who object to the ABPN decision to keep the controversial Part IV Clinical Module. I object to it as well, mainly because, after again reviewing them, most of the approved activities are still not relevant to my practice.

I must say I’m intrigued by the notification about the Faculty Innovation in Education Awards. I’m probably not eligible because I’m a full Clinical Professor, I like the idea in principle. This is mainly because I’ve been maintaining our own Practice-Based Learning and Improvement core competency project for many years, the Clinical Problems in Consultation Psychiatry (CPCP) case conference. This was started by one of my best faculty educations back in the mid-1990s, Dr. Bill Yates, MD, who is still going strong after “retiring” several years ago. He and Dr. Terri Gerdes (who was the Chief Resident when I began my residency) published a paper about it:

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.
Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.

Bill suggested I write another paper as an update, and I’m considering it. The summary of our CPCP is below and in general it’s still current although the major differences nowadays are that, in the digital age, we don’t need to circulate paper copies and medical students participate more actively. I frequently publish them on my blog:

Practice-based Learning and Improvement: (describe educational activities of service):

The Clinical Problems in Consultation Liaison Psychiatry is a weekly case conference at which residents and medical students can present an interesting case the team saw which raised a question about how the service could improve service delivery.

Clinical Problems in Consultation Psychiatry (CPCP):

A weekly case conference held Wednesdays from 8:00 a.m. to approximately 8:45 a.m. Each week, a case is selected from the Daily Review Rounds Records to illustrate a clinical problem for the next week’s meeting.  The residents are assigned dates when they rotate. The medical students are welcome and even encouraged to participate as well.

This is a practical way to approach teaching the Practice-Based Learning & Improvement Core Competency. This helps develop the habit of reflecting on and analyzing one’s practice performance; locating and applying scientific evidence to  the care of patients; critically appraising the medical literature; using the computer to support learning and patient care; facilitating the education of other health care professionals. This is applying principles of evidence-based medicine (EBM) to clinical practice.

  • Evidence-based medicine is a systematic approach to use up to date information in the practice of medicine
  • Skills are needed to integrate the available evidence with clinical experience and patient concerns
  • Application and evaluation of EBM skills will provide a frame-work for life-long learning.

Self-evaluation is vital to the successful practice of EBM:

  • Am I asking answerable clinical questions?
  • Am I searching the literature?
  • Am I becoming more efficient in my searches?
  • Am I integrating my critical appraisals into my practice?

The assigned resident is responsible for searching the literature and selecting one or two teaching papers for the conference. Presentations will begin with a review of the case, followed by a summary of the references with subsequent round table discussion.

Circulate copies of 2-4 pertinent articles to team members including psychiatric nurses and faculty. A copy machine is available in the departmental administration office. Consult staff can also assist with obtaining copies.

Presentations begin with a 5-minute summary of the case with discussion of both psychiatric and medical aspects of evaluation and management. The remaining time is spent summarizing the pertinent data in the articles. Residents and medical students are encouraged to use the case conference material as preparation for submitting a case report or letter to the editor.

The CPCP is more relevant to my practice than any ABPN approved activity so far. What this announcement seems to do is persuade more physicians to promote the idea of moving certification to the National Board of Physicians and Surgeons (NBPAS).

I guess I’m still not ready to change what the ABPN probably believes are my evil ways. The same goes for the ABPN, evidently.

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Comments

  1. Donna Barker says:

    I originally thought they had dumped all of part IV but then I read it more closely. I will not do re-cert in 2020 since I don’t really feel that I have to do so to stay in private practice. So far payers out here in the West don’t seem to care about certification. I will also be close to retiring so why do it? I will consider joining National Board of Physicians and Surgeons. Can’t hurt.

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