The use of algorithms and guidelines in residency education is in its early stages. Dan Stein, M.D., professor of psychiatry at the University of Stellenbosch, said, "Guidelines from Mental Health Information Center of South Africa are used in training residents and family medicine practitioners and are distributed to a fair number of primary care practitioners annually."
David Osser, M.D., and Robert D. Patterson, M.D., both of Harvard Medical School, have maintained and revised a teaching algorithm on the Internet since 1996. Since 1999, the Web site has been used extensively in the psychopharmacology course for residents in the department of psychiatry's Harvard South Shore Program. This two-year course emphasizes evidence-based medicine, algorithms and practice guidelines as important decision-making tools. Two surveys show that residents who have completed the course find the Web site valuable and use it frequently. The American Society of Clinical Psychopharmacology Model Curriculum for Psychopharmacology, 3rd edition (in press; American Society of Clinical Psychopharmacology, Inc.) includes a description of the Web site and flowcharts of its algorithms. Earlier editions of this curriculum were purchased by half of the U.S. residency programs.
Miles K. Crowder, M.D., director of psychiatric residency education at Emory University School of Medicine, department of psychiatry and behavioral science, says that instruction in using guidelines is not a formal part of the lecture program.
At Vanderbilt University School of Medicine, algorithms and guidelines are not currently routinely used in training residents in psychiatry, according to Oakley Ray, Ph.D. The literature has very little data regarding the level of awareness, much less the use, of algorithms and guidelines in psychiatry.
Dieter Naber, M.D., director of the Clinic for Psychiatry and Psychotherapy of the Psychiatric University Hospital in Hamburg, Germany, opines that there is much resistance to the use of guidelines among German psychiatrists.
However, in China, university and public officials are incorporating psychopharmacology algorithms in their curricula. Shu Laing, M.D., Peking University professor, has studied algorithm-based care in multiple hospitals. Yu Xin, M.D., also of Peking University, has proposed the use of psychopharmacology algorithms in residency training and for clinicians. The Harvard South Shore Psychopharmacology Algorithm Project is getting widespread notice and increased use. Its Socratic, consultative format recommends it. Osser reports that since the project went online, "There have been millions of hits. Individuals from 66 countries have identified themselves prior to downloading the algorithms for off-line use, and many more have viewed the site and used the algorithm programs without downloading. Translations of the algorithms into Chinese and Russian and placement on local Web sites in those countries have extended utilization … national algorithm projects in Argentina, China, and Japan have studied the Web site and its updates.
"Individuals from around the world have spontaneously e-mailed comments about the site, 98% of which are complimentary. A recently added feature of the algorithm software encourages users to make a one-click response to rate the usefulness of the specific information they obtained. While not many users have given feedback, their ratings are overwhelmingly 4 to 5 on a 5-point scale."
Osser also noted, "Non-physician use also appears to be significant. I received an Exemplary Psychiatrist Award in 2000 from the National Alliance for the Mentally Ill (NAMI) because of nomination by members of the Florida branch that use the Web site.