APA, AADPRT Offer Course On Professionalism on Internet

An early career psychiatrist discovers a highly negative review of him on a physician-rating website. He is worried about what the review will do to his professional reputation and considers whether to fabricate several more positive reviews using pseudonyms.

A male psychotherapy patient angrily confronts his male therapist with material he found on the Internet, which reveals that the treating psychiatrist is homosexual. The psychiatrist is not “out” to his patients and had been unaware of the material on the Internet about him.

Those are two vignettes, drawn from real-life scenarios, that illustrate the ethical, legal, and clinical dilemmas raised by the interface between the practice of medicine and online technology. They are among the cases addressed in a new online continuing medical education course, “Professionalism and the Internet,” available on APA’s online learning management system.

The course material was developed by a task force of the American Association of Directors of Psychiatric Residency Training (AADPRT). Revenue from the course, which costs $19, will be shared by AADPRT and APA.

“Online technology has become a part of all of medicine—not only administrative aspects, but in working with patients,” said Sandra DeJong, M.D., chair of the AADPRT task force that developed the course material. “Patients can Google-search their physicians and vice-versa. And psychiatrists are communicating with their patients via text and e-mail. Yet there are very few guidelines for how to do this appropriately and professionally.”

DeJong said that the course had its origins in a workshop at the 2010 AADPRT annual meeting after she and other training directors began hearing concerns from residents about the problems and dilemmas they experience related to digital technology. At the workshop, some general information was presented, and comments were invited from the audience.

It opened the floodgates, as audience members—residents, training directors, and program coordinators—related story after story about the legal, ethical, and clinical perils associated with online technology in psychiatric practice. “We were overwhelmed with vignettes,” DeJong said.

In response to the outpouring, then-AADPRT President Sheldon Benjamin, M.D., appointed DeJong head of a task force charged with developing a curriculum to help psychiatrists navigate the perils and pitfalls of the digital age in medical practice. (Other members of the task force were Sheldon Benjamin, M.D., Joan Anzia, M.D., Bob Boland, M.D., Nadyah John, M.D., Jim Lomax, M.D., and Tony Rostain, M.D.) What she and her colleagues came up with is a compilation of vignettes, 15 of which are in the online course on APA’s learning management system, supplemented with articles from scholarly journals as well as the lay media, PowerPoint slides, organizational guidelines, sample institutional policies, and other resources.

Clearly, too, the best venue to offer a curriculum about online technology would be, naturally, online. Present at the workshop in 2010 was APA Director of Education Deborah Hales, M.D., who saw a course on professionalism and the Internet as a natural offering for APA’s online learning management system. So the partnership between AADPRT and APA was, as DeJong said, “a perfect fit.”

Hales said the partnership is a model for what APA would like to do with other allied groups, offering APA’s online learning management system as a portal for CME products of all kinds that would be useful to lifelong learning and maintenance of certification (MOC).

She also emphasized that the learning management system is a member benefit of significant value: it offers a convenient, easy-to-use system for archiving CME courses and credits for instant access and retrieval. The APA CME transcripts are sent regularly to the American Board of Psychiatry and Neurology (ABPN), so that those participating in MOC do not have to reenter credits needed to meet ABPN requirements. Moreover, CME credits automatically entered into the system through APA CME activities will not be audited by the ABPN. Psychiatrists are able to enter CME credits obtained elsewhere into their records, but self-reported credits may be subject to audit.

Participants enrolled in “Professionalism and the Internet” who wish to earn AMA PRA Category 1 Credit or a certificate of participation can do so by completing all sections in the course outline, including the evaluation. An opportunity for decision making is provided following each of the vignettes; a passing score of 60 percent must be achieved. Retakes are available for each assessment.

After evaluating the program, course participants will have an opportunity to claim hours of participation and print an official CME certificate showing the date of completion and hours earned. Based on anecdotal response, the course should be popular. And increasingly, issues around use of the Internet are becoming risk-management issues for physicians.

“Everywhere we go, we hear that people need help on how to manage these very difficult ethical, legal, and clinical issues that come up when using Internet technology in our clinical work as psychiatrists,” DeJong told Psychiatric News. “A study of data from the Federation of State Medical Boards found that over 90 percent of state boards have had complaints filed around these issues, and they are increasingly taking action against physicians for these kinds of issues. So it’s an important risk-management aspect of our ongoing continuing medical education.” ■