Introduction/Preface

As many readers know, Essential Psychopharmacology started in 1996 as a textbook (currently in its fourth edition) on how psychotropic drugs work and then expanded to a companion Prescriber’s Guide in 2005 (currently in its fifth edition) on how to prescribe psychotropic drugs. In 2008, a website was added (stahlonline.org) with both of these books available online in combination with several more, including an Illustrated series of several books covering specialty topics in psychopharmacology. In 2011 a case book was added, called Case Studies: Stahl’s Essential Psychopharmacology that shows how to apply the concepts presented in these previous books to real patients in a clinical practice setting. Now comes a comprehensive set of questions and answers that we call Stahl’s Self-Assessment Examination in Psychiatry: Multiple Choice Questions for Clinicians, designed to be integrated into the suite of our mental health/psychopharmacology books and products in the manner that I will explain here.

Why a question book?

Classically, test questions are used to measure learning, and the questions in this new book can certainly be used in this traditional manner, both by teachers and by students, and especially in combination with the companion textbook in this suite of educational products, Stahl’s Essential Psychopharmacology. That is, teachers may wish to test student learning following their lectures on these topics by utilizing these questions and answers as part of a final examination. Also, readers not taking a formal course may wish to quiz themselves after studying specific topics in the specific chapters of the textbook. The reader will also note that documentation of the answers to each question in the SAE book refers the reader back to the specific section of the textbook where that answer can be found and explained in great detail; outside references for the answers to the questions in the SAE book are also provided.

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Do questions just document learning?

For the modern self-directed learner, questions do much more than just document learning; they can also provide beacons for what needs to be studied and the motivation for doing that even before you read a textbook. Thus, questions are also tools for pre-study self-assessment. If you want to know whether you have already mastered a certain area of psychopharmacology, you can ask yourself these SAE questions BEFORE you review any specific area in the field. Many reading a textbook of psychopharmacology are not novices, but lifelong learners, and are likely to have areas of strength as well as areas of weakness. Getting correct answers will show you that a specific area is already well understood. On the other hand, getting lots of incorrect answers not only informs the self-motivated learner that a specific area needs further study, but can provide the motivation for that learner to fill in the gaps. Failure can be a powerful focuser for what to study and an energizing motivator for why to study.

“Adults don’t want answers to questions they have not asked”

The truth of this old saying is that taking a test AFTER study tends to feel like being forced to answer questions that the teacher has asked. However, modern readers with the mind-set of a self-directed learner want to focus on gaps in their knowledge, so looking at these same questions PRIOR to study is a way of asking the questions of yourself and thus owning them and their answers.

What is a “knowledge sandwich?”

Ideally, self-directed learners organize their study as a “knowledge sandwich” of meaty information lying between two slices of questions. The questions in this SAE book can be the first slice of questioning, followed by consuming the “meat” of the subject material in any textbook, including Stahl’s Essential Psychopharmacology, or if you prefer, from a lecture, course (such as the integrated Neuroscience Education Institute’s annual Psychopharmacology Congress), journal article, whatever. At the end of studying, another slice of testing shows whether learning has occurred, and whether performance has improved. You can utilize, for example, the continuing medical education (CME) tests that accompany either Stahl’s Essential Psychopharmacology (for up to 90 hours of CME credits) or Case Studies: Stahl’s Essential Psychopharmacology (for up to 67 hours of CME credits) as two options to test yourself
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after studying and document your learning (available at neiglobal.com). The rationale for this instructional design is also discussed in another relative newcomer to our suite of books, Best Practices in Medical Teaching, published in 2011. The SAE questions, additional “meaty” content on all the subject areas, plus posttests are also available as the “Master Psychopharmacology Program” at neiglobal.com for those who prefer online learning rather than a textbook.

Recertification/maintenance of certification by the American Board of Psychiatry and Neurology (ABPN)

Utilizing SAE questions as the first “slice” of the learning “sandwich” is not just theoretical, but is gaining prominence among expert educators these days, and indeed is now part of the requirements for maintenance of certification (MOC) in a medical specialty in the USA, including by the ABPN, which has accepted the questions in this SAE book not only for ABPN CME requirements but also for their SA/self-assessment activity requirement, a sort of pretest. For those of you familiar with the Case Studies book in our series, you will know that the Case Studies book also incorporates these educational ideas from the recent changes in MOC by the ABPN for those of you interested in recertification in psychiatry. That is, in the Case Studies book, there is not only a pretest self-assessment question at the beginning of every case, and a posttest knowledge-documenting question at the end of every case, but also practice for the first step of the newly required section from MOC called Performance in Practice (Clinical Module), a short analysis at the end of every case, looking back and seeing what could have been done better in retrospect, another sort of posttest.

Is your learning unforgettable?

Finally, and perhaps most importantly, tests prevent forgetting. Thus, the SAE questions here actually create long-term remembering, and do not just document that initial learning has occurred. It is a sorry fact that learning that occurs following one exposure/reading of material is rapidly forgotten. We have discussed this in the accompanying book in this series Best Practices in Medical Teaching. Perhaps 50% of what you learn after a single exposure to new, complex information is forgotten in 3 to 8 days, with some studies suggesting that little or nothing is remembered in 2 months! Exposing yourself to new material over time in bite-sized chunks and encountering the material again at a later time leads to more retention of information than does learning in a large bolus in a single setting, a concept sometimes called interval learning or
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spaced learning. Research has shown that when the re-exposure is done not as a review of the same material in the same manner, but as a test, retention is much enhanced. This results in the most efficient way of learning because the initial encoding (reading the material or hearing the lecture the first time) is consolidated for long-term retention much more effectively and completely if the re-exposure is in the form of questions. Thus, questions help you remember, and we hope that you utilize this SAE book to maximize the efficiency of your learning to leverage the time you are able to put into your professional development.
So, it is with the greatest wishes for your successful journey throughout psychiatry and psychopharmacology that I present this question book to you as one of the tools for your professional development, as well as for your fascination, learning, and remembering!
Stephen M. Stahl, MD, PhD
In memory of Daniel X. Freedman, mentor, colleague, and scientific father.
To Cindy, my wife, best friend, and tireless supporter.
To Jennifer and Victoria, my daughters, for their patience and understanding of the demands of authorship.
 

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