Technology at the Forefront: Shaping the Future of Psychiatry Certification

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How can artificial intelligence enhance psychiatry certification, and how do we implement it?

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Building on my initial commentary “Reimagining ABPN Board Certification: A Fusion of Tradition and Technology,”1 in this article, I further explore and detail the advanced technological solutions that could significantly enhance the American Board of Psychiatry and Neurology (ABPN) certification process, with particular emphasis on the Maintenance of Certification (MOC) process.2-4

As we navigate a future in which artificial intelligence (AI) and digital communication redefine medical practices, there is a clear opportunity to transform the methodology for certifying new psychiatrists. By integrating sophisticated technologies such as AI, video, virtual reality (VR), and augmented reality (AR), we aim to evolve the certification process from a simple game of checkers to the complex, multidimensional strategy of 3-dimensional chess.5

Transitioning to a Multidimensional Strategy

Current certification methods primarily utilize multiple-choice questions, which, although efficient, are akin to a game of checkers: simple, direct, and somewhat predictable. The introduction of video-assisted live examinations and AI-driven automated scoring would add layers of complexity and sophistication, akin to the strategic depth of 3-dimensional chess.

Implementing these technologies would enable a nuanced evaluation of candidates’ abilities to navigate clinical challenges, assessing verbal and non-verbal communication, ethical decision-making, and clinical reasoning in real-time. This approach would not only streamline the evaluation process but enhance its objectivity, reducing biases that were often inherent in the “bad old days” of live patient interviews and examinations.

Enhancing Initial Certification With Sophisticated Tools

The shift from traditional in-person evaluations to video-assisted examinations offers a promising avenue for modernizing the certification process. Using high-quality, secure video communication technologies allows for remote observation of candidate performance during live patient interactions. This method significantly cuts down on the logistical challenges and costs associated with examiners and candidates traveling to examination centers.

In the medical arena (actually, the surgical arena), there is precedent for “virtual” examinations. The General Surgery Certifying Examination (GSCE) is conducted remotely via video conferencing technology, allowing the candidates and the 2 examiners to meet “virtually” in 3 consecutive 30-minute sessions.6 This is in addition to the rigorous 8-hour, multiple choice exam.

This is the case in other fields, as well. In order to obtain a driver’s license in most states, it is essential to pass a real-life driving test. Similarly, to obtain a Commercial Pilot License (CPL),7 airline pilots need to demonstrate their flying skills by passing real-life practical flight tests called “checkrides” in addition to passing written exams.

Implementing AI for In-Depth Candidate Assessment

AI technologies are set to transform ABPN’s approach to assessing candidate performances through an advanced analysis of video recordings of patient interactions. Employing machine learning algorithms, these systems precisely evaluate critical competencies such as diagnostic reasoning, empathy, and decision-making.

This technology excels in identifying subtle patterns in candidates’ responses, predicting their success in real-life scenarios and offering detailed feedback. The immediate and comprehensive nature of this feedback not only highlights areas needing improvement but also reinforces candidates’ clinical strengths, fostering a deeper and more precise understanding of their professional capabilities.

Virtual and Augmented Reality for Practical Skills Enhancement

For practical skills enhancement, VR8 and AR9 can provide immersive experiences in which psychiatrists can engage in complex interactive scenarios with virtual patients, thereby honing their skills in a risk-free environment. This approach is particularly useful for training in rare psychiatric conditions and managing challenging patient interactions.

Advanced MOC

Adaptive learning platforms10 serve as intelligent, ever-adapting chess tutors. These platforms analyze individual learning styles, performance metrics, and professional needs, customizing educational content to optimize learning outcomes. By continually adjusting to the psychiatrist’s evolving knowledge base, adaptive platforms ensure that MOC is not only about maintaining certification but genuinely advancing a psychiatrist’s abilities and readiness for contemporary challenges.

Akin to a skilled chess player anticipating an opponent's moves, predictive analytics11 help foresee a psychiatrist’s professional development needs. By evaluating performance trends and educational outcomes, these tools predict potential gaps in knowledge or skills before they impact clinical practice, allowing for tailored educational interventions.

Security and Integrity in Technological Implementation

As certification processes become more reliant on technology, ensuring the security and integrity of sensitive data is paramount. Advanced encryption, secure data storage, and stringent access controls must be implemented to protect both patient and professional data, maintaining trust in the certification system.

Economic and Practical Implementation Considerations

Although adopting these technologies requires significant upfront investment, the long-term benefits, such as reductions in operational costs and enhanced training efficacy, could outweigh these initial costs. Ensuring accessibility and fairness is crucial; the ABPN must ensure that all candidates have equal access to the necessary technology. This may involve providing equipment or subsidies, especially for candidates from lower-resource settings.

Overcoming Implementation Challenges

Resistance from stakeholders who are comfortable with the status quo can be significant. Transparently showcasing the benefits of these technologies through detailed pilot studies and involving stakeholders in the transition process are critical for overcoming this resistance. Collaborations with legal and ethical experts will be crucial for maintaining compliance and upholding the high standards of the psychiatric profession.

The above is merely a framework for incorporating new technologies into the ABPN initial board certification and MOC process. It should in no way should be interpreted as the final word, as the implementation details must be carefully worked out by the board.

Concluding Thoughts

Integrating AI, video technology, VR, and AR into the ABPN certification processes promises a revolutionary shift from basic procedural learning to a dynamic, strategic, and highly effective system. This approach mirrors the transition from playing checkers to engaging in 3-dimensional chess, where each move builds on a sophisticated understanding of the myriad factors affecting modern psychiatric practice.

By addressing these technological innovations thoughtfully and proactively, the ABPN can ensure that it remains at the forefront of psychiatric education and certification, preparing clinicians to meet the multifaceted challenges of mental health care in the 21st century. This expansive revision represents a bold stride toward a future in which technology and tradition converge to foster a higher standard of psychiatric practice and professional competency.

Dr Hyler is professor emeritus of psychiatry at Columbia University Medical Center.

References

1. Hyler SE. Reimagining ABPN board certification: a fusion of tradition and technology. Psychiatric Times. April 24, 2024. Accessed May 1, 2024. https://www.psychiatrictimes.com/view/reimagining-abpn-board-certification-a-fusion-of-tradition-and-technology

2. Continuing certification. American Board of Psychiatry and Neurology. Accessed May 1, 2024. https://www.abpn.com/maintain-certification/

3. Certification and licensure. American Psychiatric Association. Accessed May 1, 2024. https://www.psychiatry.org/psychiatrists/education/certification-and-licensure

4. Faulkner LR, Tivnan PW, Winstead DK, et al. The ABPN Maintenance of Certification program for psychiatrists: past history, current status, and future directionsAcad Psychiatry. 2008;32(3):241-248.

5. Three-dimensional chess. Wikipedia. Last edited May 17, 2024. Accessed May 1, 2024. https://en.wikipedia.org/wiki/Three-dimensional_chess

6. Examinations. The American Board of Surgery. Accessed May 1, 2024. https://www.absurgery.org/get-certified/general-surgery/exams/

7. How do I get a commercial pilot license (certificate)? Federal Aviation Administration. Accessed May 1, 2024. https://www.faa.gov/faq/how-do-i-get-commercial-pilot-license-certificate

8. Yellowlees PM, Cook JN. Education about hallucinations using an internet virtual reality system: a qualitative surveyAcad Psychiatry. 2006;30(6):534-539.

9. Bruno RR, Wolff G, Wernly B, et al. Virtual and augmented reality in critical care medicine: the patient's, clinician's, and researcher's perspectiveCrit Care. 2022;26(1):326.

10. Gupta D. 7 best adaptive learning platforms in 2024. Whatfix. September 27, 2023. Accessed May 1, 2024. https://whatfix.com/blog/adaptive-learning-platforms/

11. What is predictive analytics? benefits, examples, and more. Coursera. Last updated February 26, 2024. Accessed May 1, 2024. https://www.coursera.org/articles/predictive-analytics

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