APA’s Psychiatric Self-Assessment and Review (PSA-R) program helps psychiatrists test their understanding of recent advances in psychiatry and improve their diagnostic skills. The PSA-R may also be a useful aid in preparing for examinations such as the American Board of Psychiatry and Neurology (ABPN) recertification examination, which will be required beginning in 2004.

"While PSA-R was developed quite independently of the ABPN, it does rely on materials planned for use in recertification, such as the APA practice guidelines," indicated James Thompson, M.D., who directs the APA division that includes CME programs. "It also focuses on advances in the field and is in multiple-choice format, both of which should prove useful to those studying for recertification," he noted. "As the recertification exam process evolves, we plan to have PSA-R evolve in the same direction."

The PSA-R packet includes an examination booklet with an answer sheet and a syllabus that comes in print form and on CD-ROM.

Program participants can earn up to 25 hours of category 1 CME credit in the comfort of their homes or offices by completing the examination.

On October 1, 1994, the ABPN implemented a requirement that psychiatrists must be recertified every 10 years. The first recertification examinations will take place in 2004 and will be given annually after that, which means that psychiatrists certified in late 1994 and after will need to be recertified.

Mark Rapaport, M.D., associate professor of psychiatry at the University of California at San Diego and chair of the APA Committee on Self-Assessment Exams, stressed that the PSA-R is unbiased. "It is also an excellent source of continuing medical education," he noted. "This is particularly important because it is difficult for many individuals to take the time to get continuing medical education by going to meetings or attending teleconferences."

The examination booklet contains 125 multiple-choice questions developed by the PSA-R planning subcommittee with assistance from the National Board of Medical Examiners (NBME). The questions cover myriad disorders, treatment scenarios, and treatments for psychiatric patients.

After taking the self-examination, the participant mails the answer sheet to APA, which submits it for scoring to the NBME. The deadline for submitting answer sheets is October 31, 2001, after which tests will no longer be accepted for scoring.

After the test is scored, APA sends each participant a personal score report, showing his or her test results. It will also send a critique and a reference book that provides the correct answers to the examination, along with commentary and supporting references. In addition, this report is accompanied by personal interpretation guidelines, which allow the psychiatrists to compare their aggregate scores with those of their peers. Participants receive their personal score report and the other information approximately two months after the submission deadline that most closely follows the completion and mailing of the answer sheet to APA.

APA has for many years produced self-examination programs for psychiatrists. What is now the PSA-R used to be known as the Psychiatric Knowledge and Skills Self-Assessment Program (PKSAP), which was used in the 1980s. Since the publication of the last PKSAP, there have been major advances in psychiatry that have warranted the development of a new and updated system to test psychiatrists’ knowledge of current research and practice. The PSA-R incorporates some of these developments, such as the practice guidelines, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and descriptions of newer classes of medications such as SSRIs and atypical neuroleptics.

Reactions to the PSA-R program from members have been positive, according to Kristen Moeller, APA’s CME project manager. One member urged the program to "continue questions related to the medical interface with psychiatry, as well as questions related to substance abuse issues. This was an excellent review."

The PSA-R will adapt to the times. As psychiatry and psychiatric treatments continue to progress, the PSA-R program developers plan to incorporate new information. Commented Rapaport, "There have been a series of self-assessment exams developed by APA. Our hope is to develop a process by which we would be able to produce topical examinations every two years or so. We would like to stay current and facilitate learning as well as we can."

The format of the examination will also change—it is now a paper-and-pencil test, but Rapaport would like to make it available to members on CD-ROM and on a Web-based interactive program within the next few years.