Neuroscience Education, CME Advanced Through Novel Online Modules
Abstract
To truly help clinicians change clinical behavior, continuing medical education needs to address not only knowledge but also attitudes and the skills necessary to make a change. This is the second in an occasional series of articles profiling psychiatric educators.
When Melissa Arbuckle, M.D., Ph.D., became assistant director of residency training in psychiatry at Columbia University and the New York State Psychiatric Institute in 2005, her outgoing predecessor, Lisa Mellman, M.D., gave her some invaluable advice: find something you are passionate about and can be invested in, or you will burn out in five years.
A good educational experience calls for partnership with learners wherein students have to actively use and manipulate new information, says Melissa Arbuckle, M.D., Ph.D., co-director of psychiatric residency training at Columbia University.
The unglamorous aspects of directing residency training—documenting compliance with the Accreditation Council for Graduate Medical Education, filling residency spots, supervising trainee performance, and the seemingly endless administrative tasks—were already evident to Arbuckle when she agreed to take the position, and she recognized that her colleague’s advice was sound. “I took her very seriously and began to really think about what is ‘my thing’, what is it that I really care about in psychiatry and education?” she said.
Since then, Arbuckle has found her passion and has been pushing the education of psychiatrists into previously unexplored fields—the introduction of novel online modules for teaching neuroscience to tomorrow’s psychiatrists and for improving continuing medical education (CME), as well as the application of quality improvement measures to education and CME.
As co-chair of the National Neuroscience Curriculum Initiative (NNCI), she is helping create, pilot, and disseminate a comprehensive set of shared resources that will train psychiatrists to integrate a modern neuroscience perspective into every facet of their clinical work. (David Ross, M.D., Ph.D., of Yale University School of Medicine and Michael Travis, M.D., of the University of Pittsburgh School of Medicine are also NNCI co-chairs.)
And as the director of a project funded by the American Board of Psychiatry and Neurology (ABPN) to look at outcomes in CME, Arbuckle is looking to advance traditional CME by developing a cutting-edge understanding of how people learn using online teaching tools. She is also working with colleagues to develop a new curriculum in “high-value care,” emphasizing quality, cost, and resource management.
APA Director of Education Tristan Gorrindo, M.D., told Psychiatric News that her work is transformative. “Melissa has pushed us all to think differently about how we engage in online education,” he said. “The National Neuroscience Curriculum Initiative has raised the bar for us all.”
Creating Partnerships With Learners
Psychiatric education is a road less travelled by most psychiatrists, and Arbuckle is probably not alone in coming to it somewhat by chance. “I didn’t even really think about it as a career option,” she said. “I had thought about going into research and being a clinical researcher, but as a resident I began to move away from that.”
After completing her residency at Columbia University, then-Director of Residency Training in Psychiatry Ronald Rieder, M.D., asked her to step in as the assistant director of the program. (She is now the co-director.) It was only then that Arbuckle realized education presented itself as a career option.“It was exciting to think about because as a teacher, you can also vicariously continue to be a student, and I loved being a student,” she said.
Her ideas about education and about how people optimally learn reflect the passions she has pursued. “A good learning experience has clear goals and objectives and measurable expectations,” she told Psychiatric News. “I think it is also really about creating partnerships with learners, in which learners have to actively use and manipulate new information—that’s the thing that will make it stick, as opposed to passively listening and absorbing.”
Arbuckle believes one of the most promising new trends in education is the “flipped classroom.” As she explained, “Historically, the way the classroom is structured, students listen to a lecture and then go home and do homework. The idea of the flipped classroom is that students do independent learning, and then they come to class and do reinforcing interactive exercises.”
In March 2014, Arbuckle—along with fellow co-chairs Ross, Travis, and other educational leaders—helped to form the NNCI in collaboration with the American Association of Directors of Psychiatric Residency Training and the APA Council on Lifelong Learning and Medical Education. The program aims to provide resources for effectively teaching neuroscience to psychiatry trainees and offer faculty training on how to use them.
NIMH Director Thomas Insel, M.D., wrote in praise of the curriculum initiative on his “Director’s Blog” on May 26: “The research of 2015 suggests that the clinician of 2025 and certainly the clinician of 2035 will need to know about cortical dynamics, neural networks, and genomic variation. Those entering the field today will need to know how to think about the brain and how to critique brain science. By changing the training of the next generation, we not only prepare for the future, we create it.”
CME Needs to Engage Attitudes, Skills
Quality improvement is Arbuckle’s other distinctive contribution to psychiatric education. As with teaching neuroscience, she brings to this a contemporary perspective on the use of online materials in CME and in measuring results.
Working with the ABPN, she hopes to transform CME into an effort that does not simply impart knowledge, but actually helps change clinical behavior.
Behavior is driven by knowledge, skills and attitudes, she explains. “Historically, CME has focused only on knowledge,” Arbuckle said. “There has been no focus on attitudes. Every year anyone who has an academic appointment is required to take all kinds of online training programs that don’t really engage whether the learner is interested. It’s assumed that you are interested in the topic even though you are being mandated to do it and may not have any real personal investment in it.”
Today’s CME also misses out on the opportunity to help users identify skills necessary to change clinical practice. “CME traditionally tells the learner ‘you should do such and such in your clinical practice,’” Arbuckle said. “But there is nothing that challenges the learner by saying, ‘How would you integrate this into your current practice?’ ”
So, she has developed randomized, controlled trials to test online training modules designed to engage learners’ interest—here is why you should care about making a change in your practice—and also take them through the steps required to actually implement a change in clinical behavior.
In an imaginative leap, the modules draw on the proven success of advertising. “If you watch television, advertisers have a few seconds to draw you in and tell a compelling story,” Arbuckle said. “I think CME could draw from ad strategies to engage learners in what they are learning in a more meaningful way.
“Most people practice the way they were trained,” she said. “But the learning modules are designed to get learners to uniquely reflect on what it would take to make a change in their clinical practice.” ■
