Prescriptive Training: Where We Are and Where We're Going

1
Prescriptive Training Where We Are and Where
We're Going

• Robert E. McGrath
• School of Psychology
• Fairleigh Dickinson University

2
APA Model Curriculum Practicum Guidelines

• The clinical practicum is designed to be an
  intensive, closely supervised experience
  involving exposure to a range of patients and
  diagnoses. Ideally, it will take place in both
  inpatient and outpatient settings, and allow the
  practitioner to gain exposure to acute,
  short-term, and maintenance medication
  strategies. Age, gender, disability, and
  ethnicity should be important factors in
  determining an appropriate patient mix. The
  trainee should treat a sufficient range and
  number of patients to gain experience across
  these dimensions. To achieve competency in
  treating a sufficiently diverse patient
  population, a minimum of 100 patients, for whom
  the trainee assumes direct clinical
  responsibility or participates in case
  conferences, should be the goal of training. The
  patient mix should be relevant to the
  psychologists current and future practice.
  Additional didactics, such as the sequence in
  Pharmacotherapeutics outlined above, may be
  included as seminars or colloquia during clinical
  training, as should additional training in
  physical and laboratory assessment. Supervision
  should be provided by qualified practitioners
  with demonstrated skills and experience in
  clinical psychopharmacology.
• Requirements
• Minimum of 100 patients seen for medication
• Inpatient and outpatient placements
• Inclusion of appropriate didactic instruction
• Minimum of 2 hours weekly of individual
  supervision

3
Problems

• Difference in tone between first and second
  sections
• Inpatient and outpatient requirements
• 2 hours of supervision

4
The Result?

• New Mexico
• The program provides on-line access to a library
  to support the advanced study of the
  psychopharmacological treatment of mental
  disorders from wherever the student resides
• 80-hour practicum of physical and health
  assessment
• 400-hour practicum
• 100 patients with mental disorders, 4 hours per
  patient
• Only time with patient and collaboration with
  other providers counts
• Patients must be diverse in gender, age,
  diagnoses, chronicity, ethnicity, culture, and
  SES
• At least 80 hours on SMI or acutely ill in a
  restrictive environment
• The primary supervising physician must be on site
• All charts must be reviewed
• 2 hours of supervision per week
• Must be completed within 6 months-3 years

5
Recommendations

• Balancing rigor with practicality
• Individuals involved in training should be
  consulted in all activities having to do with
  structuring practicum requirements
• We should aim for consistency in practicum
  requirements
• We must accept that the APA model is unfeasible
  at least until prescriptive authority is
  available
• When prescriptive authority becomes available,
  move towards more immersive experiences