Psychopharmacology

Submitted by brodym on 18 April 2008 - 10:00pm.

This online course examines the neurobiological basis for psychopharmacological decision-making, and is intended to provide a foundation in psychopharmacology for psychiatric mental health nurse practitioners. In a variety of learning activities, including interactive case studies, students will analyze current research and clinical evidence to guide clinical decisions for prescribing and managing psychopharmacological interventions for a variety of psychiatric illnesses. Students will incorporate all of the following into clinical decisions: diagnostic assessments, target symptoms, information regarding neurobiological circuits indicated for these symptoms, and practice guidelines.

Course Information

Course Number/ID:

NRS 574

Course Length (number of weeks):

Course Delivery Mode:

Distance

Average Number of Enrolled Students:

Between 10 and 30 students

Course Level:

Graduate

Course Development & Delivery

Course Contributors:

This course was created and taught by Dr. Michael Brophy. Beyond this the remaining words are his. Patricia Cornman, Instructional Designer in Teaching and Learning Services assisted me with the course design and implementation within the Sakai environment. John Ansorge, with the Sakai Help Desk at OHSU, assisted with specific HTML coding for internal navigation.

Course Development:

The development has been an iterative process that we started five years ago. I received a grant to provide education in rural areas for nurse practioners in Psych Mental Health. Previously the course was taught only in-class in Portland, Oregon. The grant asked us to provide the course as seamlessly as possible to nurses who were practicing in rural areas and unable to come to Portland. My natural teaching style in class is to be very interactive. My approach is to draw out the learners extant knowledge base – which is formidable at times because they have a great deal of clinical experience already. I also wanted to engage their curiosity. The challenge in developing a distance course was to find a way to inspire conversation even though we weren’t in the same room at the same time. When OHSU moved to Sakai it lent itself to developing both large group discussions and small case-based conversations which we call Grand Rounds. I wanted to make sure this online course was not just a flat resource or clearing house of readings, but a place where people could engage in interactive learning activities through discussion, peer evaluation and assessment. I see my role as the moderator. What’s different is this is a very content-oriented, science-based, prescribing course. The only prescribing course that students get in their advanced practice curriculum. Yet, even with all that content the most important part of the course is the conversation and the development of good clinical judgment.

Course Delivery:

The tool we use the most is the forum. I created a rubric that would help to establish a consistent set of expectations around conversations in the course. It helps students understand that I am not interested in how many posts a student makes to these discussions. I am interested in three primary elements: 1) to what extent the student incorporated the evidence base into the contributions of the discussion; 2) to what extent the student addressed his or her peers and their contributions; and 3) what level of critical thinking and clinical decision-making did the student demonstrate as a result of the conversation.
Psychopharmacology is a competency-based course. The main competency is to be able to make good clinical decisions around prescribing psychotropic medications. The way in which we assess these outcomes is to incorporate self-tests throughout that are multiple-choice content oriented, so students can get a sense of whether they are learning the content as they should be. The competencies include clinical judgment in prescribing psychotropic drugs. How do students do assessment and diagnosis prior to prescription? Example: When a student prescribes an anti-depressant are they also considering the possibility of bi-polar depression. Following diagnosis, how do students decide which medicines to prescribe and in what doses? How do students determine what side effects are likely, acceptable or not, and what to assess for in follow-up treatment?
Students use cases throughout the course via “Grand Rounds” which Sakai allows them to do in small private discussion groups. These cases form the backbone for practice of assessment, diagnosis, prescription, and follow-up. These “Grand Rounds” culminate in a final exam which provides the majority of their grade. The final exam is a set of cases where the student must write an appropriate prescription and describe their decision-making process. The process of content self-test, application through Grand Rounds discussions in small groups, culminating in individual assessment in the final exam allows students to move from working in a group to working independently when they have successfully completed the course.

Course Self-Assessment

Communication & Collaboration Self-Assessment:

Excellent

Communication & Collaboration Evidence:

Communication is paramount in this course. Students are notified first of enrollment and access through a welcome letter sent prior to the term start. I then provide constant guidance through announcements, participation in the discussion forum, and private one-on-one discussion time. The forums provide the primary vehicle for in-depth communication.
Class discussions that everybody can see are designated for topics not directly related to module content (i.e., Psych Mental Health conference news, new books a student finds, a NY Times article, etc.) Within each week the course is broken into content modules by diagnosis. There are all class discussions relating to the topic. i.e., relating specifically to depression. These are open for everyone to participate and see all responses.
Private group discussions are held within the “Grand Rounds” framework. Rather than content specific, these are case specific (i.e., a case study of a patient with a particular type of Depression). Because these discussions need to be in-depth, focused, and provide an avenue for practicing clinical judgment, these groups are limited to small group use and other students cannot see Grand Rounds outside of their small group. This was designed so as not to overwhelm the student with multiple in-depth discussions in a larger class.
Finally, students each have a one-to-one forum which is private with the instructor for personal, individual feedback or questions.

Learning Material Self-Assessment:

Excellent

Learning Material Evidence:

The content for the course is provided via an easily navigable modular format. Students may access content at any time. To test their knowledge they may engage in a number of self-assessment quizzes which help them to rate if they are understanding the content sufficiently. These quizzes are not graded and are for student self-assessment only. In addition, each topic has a discussion forum related to it that provides both content discussion opportunities and specific case-based, diagnostic, application opportunities. The latter are achieved through the "Grand Rounds" private discussions described above.

Learning Outcomes & Assessment Self-Assessment:

Excellent

Learning Outcomes & Assessment Evidence:

Students are provided formative assessment both by peers and the instructor during the Grand Rounds discussions, and in the private one-on-one forums with the instructor. This provides many practice opportunities for students to make mistakes and recover through cases relating to the prescribing needs for psychotropic drugs. The final assessment, and the majority of the students grade, is done through the final exam. The final exam repeats the case-based methodology where students must assess, diagonose, and prescribe the appropriate drug or drugs. They also must document their critical thinking and clinical judgment process within the final exam.

Course Look & Feel, Web Usability Self-Assessment:

Effective

Course Look & Feel, Web Usability Evidence:

I have made a considerable effort to focus on providing multiple links for students to navigate the course. I assist this process by being available through announcements, discussions, and email to remind students where to go and how to get to critical material. Where possible, appropriate graphics and links to resources have been provided. Certainly, there is still room for work in this area. It may not be slick, but students report it is effective.

Learner Support Self-Assessment:

Excellent

Learner Support Evidence:

OHSU, through the Sakai Helpdesk and through the Teaching and Learning Services at the School of Nursing provides a great deal of learner support. From the moment students enter the Sakai environment they receive access to discrete video and text-based tutorials on every tool and function they may need to use. The Helpdesk is available 24/7 in some format. The tutorials, FAQs, and help ticket messaging is available asynchronously at all times. Phone or chat assistance is available M-F 7am to 6pm, and by pager on the weekends which is usually answered within two hours of a page. In addition, students have links within the course navigation back to these resources.
As an instructor, I make myself available 7 days a week to respond to questions and assist students in guiding their process. I have found that a few minutes a day of help gives the students a sense of security and my availability. Yet, in the overall scheme of teaching takes actually less time than a traditional class where I would prepare an hour for each lecture and then lecture three hours per week.

Teaching Innovation

Teaching Innovation:

What is innovative and transformative in OHSU perspective is that we can teach one of the core courses in this curriculum in a way that has an economy of scale. While it takes a fair amount of time for faculty to develop the course, once it gets rolling I can give the students the impression of always being there by just spending a little time each day. The key role of the instructor is to help students stay calm and thinking clearly through the prescribing process. The feeling that the instructor is always there and my ability respond to them quickly really helps with the learning process. Ironically students report that they have this “companion” who is with them in a way that wouldn’t be available if this were a traditional classroom course.
Students are very nervous about this course, because it is dense with content knowledge and because the prescribing of medicine is critical to being an advanced practice nurse in the Psych Mental Health specialty. They crave real-world practice and being at a distance can feel like a difficult hurdle. With the use of many case-based scenarios and practice in assessment, diagnoses, prescription and follow-up, students are able to get many hours of application and debriefing within a safe environment. This coupled with their clinical internship provides a great opportunity for them to advance in critical skills.
I have tried to make sure that every assignment and every module is geared to the students developing a competency that we know is vital to their advanced practice.
From an instructors point-of-view, the online environment has given me the freedom to continue to teach while being in practice anywhere in the world and to bring that practice experience immediately back to my students. I have taught this course from Africa, Asia, and Central America. I have been able to find Internet cafes all over the world and still able to participate regularly with my students and share unique cultural and diversity experiences that neither I nor they would get if I were tied to the traditional classroom environment.
Students consistently rate this course the highest of any of the courses in the Psych Mental Health. I believe that is because it meets their needs. It’s very practical. These students are busy practicing nurses, often with full time careers, and we shouldn’t waste their time.
Finally, by providing the course completely online it allows busy, professional, people access to a nice streamlined portal to all kinds of evidence and data. A nice side benefit is that using the online environment helps students who have been away from formal education a long time to slowly acclimate to the technology. Through participation in the course and the use of different tools students achieve a comfort level with computer technology, which them translates to them becoming better clinicians in a growing technological environment.

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