by Jan Ciuccio
History of PEP's Development
In 1998 the College of Professional Psychology, with the support of the APA Committee for the Advancement of Professional Practice (CAPP) and the APA Council of Representatives, began to put the pieces in place that would result in a comprehensive examination of the knowledge base required for the safe and effective practice of psychology involving psychotropic medications. The Psychopharmacology Examination for Psychologists (PEP), an examination for practitioners, was the outcome.
Members of the College and CAPP knew that, as the profession moved forward in achieving prescriptive authority for properly trained psychologists, state legislatures and state licensing boards would be in need of a mechanism to evaluate the knowledge base required to protect the public. A properly-developed examination would meet this need and would greatly facilitate the evolution of practice. A long-term commitment to assist state regulators with this important piece of the credentialing process was made.
The structure of the PEP, areas of knowledge tested, relative emphasis of each area within the exam as a whole, recommended passing score, and the ongoing monitoring and updating of the PEP are all based on procedures that are widely considered protective against legal challenges involving validity and fairness. Those standards include the technical guidelines described in the Standards for Educational and Psychological Testing of the AERA/APA and the NCME and relevant sections of the Uniform Guidelines on Employee Selection Procedures of the EEOC, Civil Service Commission, U. S. Department of Labor and the U. S. Department of Justice.
Briefly, compliance with these standards involves the use of an exam development methodology that results in the measurement of knowledge that is truly related to the job being performed. In other words, the exam has validity for its intended purpose and use. The exam's content accurately reflects what you need to know to do the job safely and effectively. The exam's recommended passing score, similarly, reflects the absolute level of knowledge required for safe and effective practice.
In beginning the work of developing the PEP, there were two initial tasks, both of which, if performed properly, would build the necessary solid foundation. The College needed to contract with a testing firm with a proven track record of adhering to the required step in developing a quality examination that was both valid and defensible. A highly qualified and representative panel of experts to work with the selected contractor was also required.
The Panel of Experts
The College made extensive efforts to obtain nominations for what is now a 19-member expert panel. A broad representation in terms of geographic location, gender, race, practice setting, years of experience, and area of expertise was sought. Practitioners, scientific researchers, and psychologists with dual credentials such as psychologist/physician, psychologist/pharmacologist, or psychologist/nurse were sought to provide the necessary diversity of expertise, experience, and perspective. 467 letters were sent inviting nominations. Groups receiving invitations included:
State and Provincial Psychological Association Presidents and Executive Directors
APA Practice Divisions and Division 28
APA accredited educational program directors
Department of Defense Fellows
Association of State and Provincial Psychology Boards
Society of Psychologists for Prescriptive Authority
Prescribing Psychologists' Register
Association of Medical School Psychologists
American College of Neuropsychopharmacology
Fifty-four nominations were received. Nine nominees declined and the remaining nominees were carefully reviewed with regard to education and training in psychopharmacology, neuroscience, pharmacology, medicine and nursing and with regard to experience.
The original expert panel in early 1998 consisted of 15 individuals, including a representative from the Association of State and Provincial Psychology Boards, which develops the state licensing examination for the practice of psychology, the EPPP. Four more experts were added in 1999 as the process advanced. Seven of the 10 military prescribing psychologists participate on the expert panel along with pharmacists, physicians, pharmacologists, researchers, practitioners, and a nurse anesthetist. From time to time additional experts write examination items.
Members of the expert panel have specializations in areas such as behavioral medicine, chronic mental illness, neurological disorders, developmental disorders, psychoimmunology, drug abuse, child and pediatric psychology, adolescent therapy, geriatric psychology, pain & pain management, and HIV/AIDS. The breadth of experience and expertise represented on the panel is unquestionably representative. More than 600 professionals were enlisted to validate the knowledge base that is tested, including physicians, psychiatrists, and nurses.
The Testing Firm
While involved in constituting the expert panel, the College was also fully involved in selecting a testing firm that would guide the development of the first versions of the PEP and that could be counted on to continue to work on the PEP over the years to analyze both candidate and item performance and to guide the necessary periodic updating of the exam to reflect changing knowledge. The College solicited proposals from several highly regarded national testing firms. Each firm was asked to describe its proposed methodology for determining the knowledge domain to be tested, for obtaining multiple-choice items in sufficient number and quality, for demonstrating the validity and fairness of the examination, and for setting an appropriate passing score. The College required a description of each firm's item banking capabilities and procedures, including procedures for ongoing monitoring and periodic reporting of exam statistics, as well as a description of procedures for protecting and maintaining test security, both during development and on an ongoing basis. Finally, the College looked at each firm's proposed staffing plan and at the cost proposal.
After carefully evaluating each proposal, the Professional Examination Service (PES) of New York was selected. With over 50 years of experience, PES is nationally regarded for the quality of its many licensing and certification examinations including examinations for licensure in physical therapy, marriage and family therapy, veterinary medicine, medical laboratory personnel, certification examinations for critical care nurses, nurse practitioners, clinical social workers, eye surgeons, opticians, dental hygienists and many more. Especially of note is PES's national licensing examination for psychologists, the EPPP.
In June 2000, the PEP was administered to the first candidate. Since then, approximately 120 psychologists have taken the PEP. The PEP has been updated three times to ensure that it measures the knowledge needed in today's health care environment. It will again be updated in 2006. According to PES, the passing rate (using the College's recommended passing score for state licensure) indicates that the exam is selective and is consistent with what is expected for use in licensing.
After thorough investigation of the PEP's quality and defensibility, the states of New Mexico and Louisiana have decided to use it in awarding prescriptive authority to properly trained psychologists under the newly enacted prescriptive authority laws passed in those states.
Psychopharmacology Knowledge Base Tested
The extensive knowledge base tested has been validated as essential for safe and effective prescribing of psychotropic medications by doctoral-level, licensed psychologists who have completed required psychopharmacology training. It includes:
1. Integrating clinical psychopharmacology with the practice of psychology
3. Nervous system pathology
4. Physiology and pathophysiology
5. Biopsychosocial & pharmacologic assessment & monitoring
6. Differential diagnosis
8. Clinical psychopharmacology
10. Legal, ethical, and interprofessional issues
An expanded delineation of this knowledge base is available at www.APApractice.org (click on Practice Organization and then pPsychopharmacology Examination) or by calling the APA Practice Organization, College of Professional Psychology at 202-336-6100 or email firstname.lastname@example.org.
Applying for the PEP
Admission to the PEP requires a doctoral degree in psychology, evidence of provision of health services in psychology, a current psychology license in good standing to engage in the independent practice of psychology, and successful completion of a post-doctoral program of psychopharmacology education in an organized program of intensive didactic instruction.The PEP is computer-administered at more than 500 Prometric testing centers nationwide, using state-of-the-art security precautions. Scores on the PEP are securely maintained and are reported to state licensing boards or other entities upon written request. For more information about the PEP as well as a downloadable application, go to www.APApractice.org or contact the APA Practice Organization.