(PS7-18) Development and Implementation of an Eating Disorders Curriculum for Psychiatry Residency Training

Eating disorders are an important part of psychiatry residency training.  EDs are associated with significant morbidity and mortality, and these patients can be medically complex and have ambivalence toward treatment.  Unfortunately, it is much less likely for trainees to obtain education in EDs in residency compared with mood or anxiety disorders.  Additionally, at our institution, some residents have reported decreased “confidence” in working with EDs, and exposure to these patients varies based on Consultation-Liaison and outpatient service caseloads.  While we have robust general CBT training, training in CBT for EDs is limited.

We enhanced our existing PGY-1/PGY-2 residency ED curriculum based on resident feedback and the updated 2023 APA ED practice guidelines.  The number of didactics was increased from one to five.  Two PhDs and two MDs teach the course, which also models collaboration for residents. 

The two PGY-1 didactics cover 1) background information (i.e., prevalence, multifactorial etiology, risk factors, co-occurring conditions, illness course, mortality), screening/assessment and diagnosis, signs and symptoms, psychopharmacology, labs and tests, complete APA ED practice guidelines, and 2) enhanced CBT for EDs (CBT-E), Maudsley family-based therapy, and strategies for engagement and motivation.  The three PGY-2 didactics focus on APA clinical examples (anorexia nervosa, bulimia nervosa, binge eating disorder), and therapy and medication options for each.  Clinical examples are co-taught by PhDs and MDs.  A PhD discusses application of CBT-E in detail, including psychoeducation, engagement/motivation, self-monitoring, regular eating, and numerous cognitive and behavioral strategies (i.e., cognitive restructuring and mindset, increasing valued activities versus preoccupation with weight and shape, weight concerns and feelings of fatness, exposure to feared foods, managing access to binge foods, binge analysis, self-esteem, assertive communication), and relapse prevention.  An MD also discusses psychopharmacological options, including APA treatment algorithms for when to consider medications and/or therapy, and use of medications to address ED and co-morbid mood symptoms.   

ED training continues in PGY-3 and PGY-4.  We will continue to develop advanced PGY-3 ED didactics.  Residents are encouraged to seek outpatient ED cases and treat ED symptoms with CBT and/or medications in third and fourth years.  Feedback on our new curriculum will be obtained and reviewed.  Several PGY-2s spontaneously mentioned the curriculum during their mid-year evaluations and reported it was "helpful."  One resident provided formal, anonymous feedback on one of the didactics ("lots of clinical pearls").