Contest Gets Trainees Thinking About Care

What does research evidence say about the use of SSRIs during pregnancy? University of Michigan psychiatry resident Dharmesh Sheth, M.D., knew the answer, and his winning response to the question won him $25 for textbooks or lunch with a faculty member and the recognition of his fellow residents and faculty.

The question and Sheth's answer (see box) were part of a monthly interactive contest designed by residents and faculty at the school's residency program to stimulate interest in evidence-based medicine as well as discussion about evidence-based medicine among trainees and their teachers.

“We try to focus on those areas where there is no uniform answer,” said second-year resident Howard Liu, M.D., who presented a summary of the interactive contest during a poster session in March at the annual meeting of the American Association of Directors of Psychiatric Residency Training in San Diego.

“Evidence-based medicine is an effort to translate research into practice, and residency programs try to teach it in a systematic way,” he said. “But we wanted to create a fun way to explore issues around evidence-based medicine, and we wanted to provide a venue for disparate voices to talk to each other. Residents need to learn to sort out opposing opinions about subjects that are relevant to their patients, and it can't always happen in a lecture when one person is talking.”

Liu's co-coordinators on the project include his faculty advisor Helen Kales, M.D., geriatric fellow Lewis Krain, M.D., and Michelle Riba, M.D., past APA president and associate chair for academic affairs at the university.

Here's how it works: Questions are generated by faculty and residents focusing on psychosomatic medicine topics with emerging or limited evidence. The question is sent by e-mail to trainees, who are then asked to submit entries in abstract format with at least two references. Responses are judged by a panel including a resident, fellow, faculty advisor, and guest experts.

In addition to a choice of $25 for textbooks or lunch with a faculty member, winning contestants have their response and biography e-mailed to the entire department. “So the prizes promote education, mentorship, and departmental recognition,” Liu said.

The contest began in December 2005 with the following question: What is the evidence for the paradoxical effect of benzodiazepines in delirium? That was followed in January by the question about SSRIs in pregnancy and in February by this question: What is the evidence that depression increases the risk of coronary artery disease?

Liu said the quality of responses has been excellent with each winning entry citing at least eight references.

“Faculty participation is a key to the project,” Liu said.“ Before the contest began, our faculty members contributed a pool of 21 questions and continue to suggest new questions each month. We've also had spirited e-mail discussion sparked by winning responses.”

This was especially the case in January, Liu said, when the topic of SSRIs and pregnancy triggered a series of faculty comments about developmental and genetic implications.

“We are considering the expansion of this project to include medical students and the development of a Web page to post winning responses,” Liu said. “In the long term, we will survey residents to find out whether this project led to increased mentorship, knowledge about psychosomatic medicine, and interest in the application of evidence based medicine.” ▪