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
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
"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
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
"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