Since 2003, the Duke University Hospital Psychiatry Residency Training Program has protected a half-day per week for residents in all years of training, and the Biological Psychiatry (BIOPSY) course has been a cornerstone of the curriculum since then. In keeping with the training program's dedication to continuous programmatic assessment and improvement, the BIOPSY course is constantly evolving; changes have occurred over time in response to updates in ACGME requirements, the psychiatry milestones, scientific advancements, educational theories on learner behavior, and especially in response to feedback from resident exit interviews revealing mastery of core concepts and skills taught in BIOPSY is critical to their development. The curriculum has constantly evolved iteratively from year to year with a greater emphasis on psychopharmacology starting in 2011. Resident-led active learning and evidence based practice discussions were incorporated in 2012, and the addition of sessions aimed at neurobiology was introduced in the 2013-2014 academic year. For the 2014-2015 academic year, all of the aforementioned changes as well as multiple newly chosen topics were incorporated into the current four-year comprehensive curriculum.

In its current form, the BIOPSY curriculum comprises three year-long courses for three separate resident groups: PGY1 residents, PGY2-PGY3 residents, and PGY4 residents. The class sessions occur on Thursday mornings for 80 minutes. There are approximately 33 weeks total for BIOPSY classes during a given year. Given various combined sessions between classes, the course masters plan 55 unique class sessions annually. Nineteen class sessions include the entire residency program (all four years), 4 class sessions include only the PGY1s and PGY4s, and 1 class session includes the PGY2s, PGY3s, and PGY4s. The goal of the mixed resident sessions is to help foster interaction and teaching between residents. Group-specific class sessions also allow for targeted education topics to be given that is based on the resident group's current level of knowledge and clinical experience. Regardless of the topics being covered, residents are expected to come to class prepared to engage in the discussion and presenters were asked to make their classes interactive. Readings are assigned via email one-week prior to class which is maintained on a secure educational website.

The majority of the class sessions throughout the general psychiatry curriculum (approximately 5-8 sessions per each topic) pertain to five main clinical topics: schizophrenia, mood disorders, anxiety spectrum disorders, cognitive disorders, and addictions. Topics with less class time (3 sessions per each topic) include: sleep disorders, delirium, catatonia, toxidromes, personality disorders, and neurological disorders. Topics not covered during one academic year are included in the next year, such that curriculum topics repeat every 18-24 months. For example, in the 2014-2015 calendar year the PGY2-PGY3 course covered only two main topics, cognitive disorders and anxiety spectrum disorders, while the 2015-2016 year will include schizophrenia, mood disorders, and addictions.

Authors SS and AM are co-course masters for BIOPSY and maintain responsibility for determining the selection of topics, scheduling of sessions, and identification of relevant literature and topic content experts. Supplementary Table 1 (in the online-only Data Supplement) includes the 2014-2015 BIOPSY course calendars. The course for PGY1 residents is organized into “boot camps” centered on topics overviewing core brain anatomy, neurobiology, psychopharmacology, and treatment guidelines. Pivotal psychiatry trials including CATIE, CUTLASS and STAR*D provide a strong foundational knowledge base on the fundamentals of neurobiology of psychiatric disorders, pharmacology of psychotropic medications, recognition and management of adverse effects, and the relevance of this to clinical trial outcomes and treatment guidelines.

The PGY2-PGY3 course is designed to expand on the knowledge gained during the BIOPSY courses in the PGY1 year and knowledge gained during clinical rotations to facilitate a deepening of residents' understanding of the neurobiology and treatment of psychiatric illness. Residents are taught to engage with the evidence base to support informed clinical decisions. The PGY2-PGY3 course is essentially designed with separate modules for each psychiatric disorder. For instance, one session within a module focuses on a non-scientific paper (NY Times, New Yorker), two to three sessions cover neurobiology and assessment, and three to four sessions cover psychopharmacology. Topics in this course repeat every two years with expert faculty members serving as both facilitators and presenters to help course masters identify relevant articles for discussion.

The course for the PGY4+ residents was developed from results using a “learning needs assessment” from senior residents that were eager to prepare for their post-residency careers and motivated to solidify good habits for lifelong learning and evidence-based practice during their final years of training. The PGY4+ course focuses exclusively on the real-time use of evidence-based practice in the clinic with discussions geared towards the “clinical pearls” of practice. Residents gain a deeper understanding of how to pose a clinical question, obtain appropriate articles, and appraise recent publications in the relevant literature base.

Feedback from graduates of the residency program has been used to prepare topics covered in all years from PGY1-4. The inclusion of “boot camps on neuroanatomy” was done based on such feedback given by graduates. Efforts have also been made to focus on psychopharmacology and neurobiology principles that can be used by trainees in daily clinical practice. Some additional topics that evolved from this feedback are weaning benzodiazepine dependent people off them, understanding neurobiology of stimulant action, principles of medication adherence and compliance, management of pain medication dosing and management of dementia. When examined broadly these are all practical and relevant topics that are encountered in daily practice, the relevant neurobiological mechanisms and evidence base is instrumental in forming foundational knowledge that trainees will need following residency training in psychiatry. Prevalence rates dictate that a large portion of dementia and schizophrenia patients are seen in outpatient or inpatient practices, thus a detailed understanding of neurobiology of schizophrenia including discussions on cognitive deficits, working memory challenges, and social cognition becomes extremely relevant. The neurobiology of posttraumatic stress disorder, anxiety disorders, mood disorders, and addiction, including that of suicide, are incorporated in generating discussions on relevant research literature using animal models and emotional processing tools for greater understanding of the psychopharmacologic bases of drug effects in these disorders. Critical appraisal of literature such as clinical drug trials requires exposure to discussions on evaluations on RCTs, systematic reviews and meta-analyses. On the whole the curriculum makes an attempt to cover topics in line with RDoC in featuring broad domains of reward, perception, sleep-wakefulness, social processes, and cognitive processes.

Several online application tools were used to help course masters identify curriculum topics with presenters, provide access to literature, and to bring presenters into the classroom via video conference when necessary. The relevant literature for chosen topics are gleaned from a variety of places including: online resources such as articles found in PubMed, treatment guidelines from the American Association of Psychiatry, chapters from the Textbook of Psychopharmacology, and articles in the New Yorker and New York Times.

Presenters come from a diverse group of talented and multidisciplinary individuals; they are recruited from both within and outside Duke University School of Medicine. There are approximately 42 unique presenters per course year. Presenters in 2014-2015 came from four different departments within the Duke School of Medicine and from 11 different institutions outside of Duke. Presenters usually are identified based on their expertise or reputation in a topic area. Skype is used to bring in presenters outside of Duke to lead class discussions for both resident-group specific and all-resident sessions. The use of Skype allows course masters to bring in leading experts, creates a greater variety of presenters, and gives the residents an opportunity to learn others' (non-Duke faculty) perspectives and to learn about clinical practice in another part of the United States or in another country. Practicing clinicians from the counties surrounding our institution also can be brought in to discuss “real-world” (non-academic) practice related issues. Presenters are strongly encouraged to use the majority of time to engage the residents in active learning (such as group case work, reflection, and posing challenging clinical questions) and classroom discussions.

Attitudinal survey Thirty-eight out of 51 residents (75%) completed the attitudinal survey. Division of residents by year of training is 13, 7, 9, 8, 1 in the first, second, third, fourth and fifth years of training. There are 32 residents from categorical psychiatry residency and 6 from the combined medicine-psychiatry residency program. Among participants, 12 out of 38 residents (31.6%) had advanced academic degree. A large portion of residents who took the survey (10) anticipated becoming academic educators and 6 of them anticipated going into private practice. Table 1 contains residents' responses to demographic questions, while their responses to attitudinal questions are found in Table 2. Greater than 90% of the psychiatry residents at Duke University taking the attitudinal survey agreed or strongly agreed with needing a course that helped them develop an understanding of neurobiology, psychopharmacology, and evidence-based practice concepts. Most residents also indicated a less than adequate understanding of the neurobiology and psychopharmacology of psychiatric disorders. Residents agreed or strongly agreed with statements supporting an active-learning approach to classroom learning, feeling responsible for their own learning and for their fellow residents' learning, and volunteering to contribute to a classroom discussion.

Residents completed a five question assessment with Likert-type responses for each weekly class session. A total of 137 evaluations were completed. Overall, following class completion, residents reported an increase in their level of understanding of a topic and felt confident communicating what they learned to others. The majority of residents indicated a high level of participation in classroom discussions and rated the class sessions from good to excellent. Table 3 contains residents' responses to these questions. Nearly 90% of residents felt they could communicate to the information they learnt to their colleagues, to patients and their relatives after the class. 85% felt they understood the topic much better after class.