Clinical Assessment in Psychiatry. Mastering Skills and Passing ExamsRichard Balon, MD
Wayne State University, Detroit, MI, USA
Edited by Rajesh R. Tampi, Sunanda Muralee, Natalie D. Weder, and Kirsten M. Wilkins. Philadelphia, PA: Wolters Kluwer/Lippincott Williams and Wilkins; 2010; ISBN: 978-0781799096; pp 219; $69.95 (paperback).
Anyone who teaches medical students and residents knows that many of them love to just get by and to obtain a simple tool or advice on how to pass an examination without much effort. Therefore, as long as we have examinations, we are going to have texts intended to help pass them with as little effort and study as possible. Clinical assessment in psychiatry. Mastering skills and passing exams strives to be such a text. The cover of this volume states that it “focuses on the key clinical skills emphasized by the American Board of Psychiatry and Neurology in residency training and on the oral board examination” and that it is derived from a successful course at Yale University, which suggests that the authors do not examine the American Board of Psychiatry and Neurology (ABPN) oral examination.
The book consists of a Preface, 3 chapters, Appendix, and Patient Interview Video available online. Chapter 1, “Preparing for clinical examination in psychiatry,” basically is a brief, simplistic summary of the ABPN oral examination with vague suggestions on what to study and recommendations on how to prepare for the patient interview and clinical vignettes. Chapter 2, “Conducting the psychiatric interview,” is a typical detailed discussion of a standard psychiatric interview that includes setting the stage, introductions, conducting the interview with all of the usual components, advice on what to do when one forgets to ask important information during the interview, case presentation, presenting the multiaxial diagnoses and differential diagnosis, case formulation, presenting treatment options, conducting a risk assessment, and answering difficult questions during the examination. The text is a bit formulaic, but useful. Chapter 3, “Case vignettes and discussions,” is the largest part of the book. It includes case vignettes and discussions of psychotic disorders, mood disorders, anxiety disorders, substance abuse disorders, cognitive disorders, personality disorders, somatoform disorders, and sleep disorders. Each disorder presentation includes case history, multiaxial diagnosis, and formulation (diagnostic, etiologic, therapeutic, and prognostic). The text here is dense, full of information, and simplistic at times. The section on anxiety disorders includes only obsessive-compulsive disorder and posttraumatic stress disorder. Similarly, the discussion of personality disorders includes only 2—borderline personality disorder and antisocial personality disorder. This chapter also discusses several psychotherapies—psychodynamic, cognitive-behavioral, dialectical behavior, interpersonal, group, and family psychotherapy. The chapter closes with a brief hodgepodge treatise on cross-cultural psychiatry. The Appendix includes a 30-minute interview template, a 30-minute interview checklist, a table on the cytochrome P450 system, and a table of common psychotropic medications (from which sertraline is missing). As noted, the book includes online access to full text of the book and a video demonstrating interviewing skills. I have to admit that I did not watch the video because I got discouraged after the Web site started to ask me for personal information, despite the fact that I had a password. The reader should know that the chapters are not referenced, but include lists of suggested reading. I am not sure how useful these lists are because they do not include works cited in the text, but do include, for instance, a 1987 Archives of General Psychiatry article (p 43) and the 1998 8th edition of Kaplan and Sadock’s synopsis of psychiatry (the 10th edition is already available) (p 178).
I am not clear who is the intended audience of this book. The authors claim that this book is geared towards trainees taking clinical examinations in psychiatry and is helpful for anyone who wants to learn skills needed to be a good clinician/diagnostician. This suggestion sounds like the entire crowd of psychiatric educators failed their trainees and this book is going to fix it. The authors also state that “psychiatric trainees will not have to spend a lot of extra time and money to acquire the clinical interviewing skills that are important to their career” (p ix). This is true, but not because of this book; the oral part of the ABPN examination will cease to exist and all trainees will take the Clinical Skills Verification exam during their training, for which no outside training program preparation will be necessary. Also, I am not clear what this book really strives to be, either a textbook or a guide to take an exam. It is hardly a textbook considering it is not comprehensive and, in addition to all my criticism above, is incomplete because it does not cover all aspects of clinical psychiatry (eg, adjustment disorders, eating disorders, sexual disorders, or the psychotherapy modality probably most frequently used by psychiatrists, ie, supportive psychotherapy). In my opinion, there are better guides for taking the disappearing exam, such as the fourth edition of Morrison and Munoz’ Boarding time.1
Maybe I am too old, but aren’t trainees and others supposed to read regular books and textbooks and not briefer texts? And aren’t we too focused on shorter and shorter manuals teaching how to pass exams, rather than broadening our knowledge by reading comprehensive texts? The latter would certainly help our patients and maybe ourselves. I hope that the reader can figure out my final judgment.
- Morrison J, Munoz RA.. Boarding time. The psychiatry candidate’s new guide to Part II of the ABPN examination. 4th ed. Arlington, VA: American Psychiatric Publishing, Inc.; 2009.
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