Neurology Training for Psychiatry Residents: Practices, Challenges, and Opportunities

Abstract

Historically, neurology, psychiatry, and neuroscience overlapped; it is only recently that disciplinary silos have divided these fields. In the eighteenth and nineteenth century, many significant figures in neurology and psychiatry, including Freud, Charcot, Alzheimer, and Kraepelin, emerged from a shared epistemological background [1]. In the early twentieth century, a period of rapid medical specialization, most physicians in these fields enjoyed board certification in both specialties [2]. However, in the second half of the twentieth century, training pathways for neurology and psychiatry diverged [1]. By the 1980s, there was little emphasis on cross-training between neurology and psychiatry [2].Over the past three decades, there has been an increase in residency training emphasis on neuroscience, "a broad discipline encompassing the study of the nervous system and behavior using cellular and molecular biology, animal models, neuroanatomy, neuroimaging, genetics, neuropsychology, and basic pharmacology (as opposed to clinical pharmacology)" [3]. Since 2006, there has been a boom in neuroscience education with the rapidly developing National Neuroscience Curriculum Initiative [4], but the challenge of clinical application remains [5].Neuroscience, neuropsychiatry, and neurology are distinct entities [3,5,6]. Neuroscience in psychiatry involves understanding psychiatric illness through the lens of neuroscientific knowledge ranging from functional anatomy to genomics; examples include microstructural neurodevelopmental aspects of schizophrenia and the neurobiology of suicide. Neurology and neuropsychiatry are fundamentally clinical. Neurology refers to the care of patients with disease of the brain, spinal cord, and peripheral nerves. Neuropsychiatry refers to the care of patients with affective, behavioral, and cognitive symptoms in the setting of neurologic disorders such as stroke or epilepsy, as well as to the care of patients with psychiatric illness that have comorbid or iatrogenic neurologic symptoms [5].Neurology and neuropsychiatry training for psychiatry residents is not yet standardized. In this article, we critically review the current state of neurology and neuropsychiatry training for psychiatric residents: we explicitly consider the goals of such training, identify the gaps in training and the barriers to achieving these goals, and present suggestions for improving the neurology and neuropsychiatry training of psychiatrists. The State of Neurology Training and Evaluation for Psychiatry ResidentsSince 1987, psychiatry trainees have been mandated by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Psychiatry and Neurology (ABPN) to complete two months of full-time clinical neurology training [7]. The ACGME does not have guidelines for the neurology off-service rotation months with respect to clinical setting or didactic content [6].There are no formal clinical requirements for neurology or neuropsychiatry beyond the two-month requirement. In a 2011-2012 survey o...

Neuropsychiatry Training in Nepal: Experiences of Trainees and Psychiatrists

“…It has been widely acknowledged that neurology training for psychiatry residents remains poorly standardized and clinical neurology experiences can have wide variations in terms of exposure and settings. 16 Shalev and Jacoby 16 suggested standardisation and evaluation of the full-time clinical neurology experience, longitudinal neuropsychiatry experience and collaborative didactic and clinical experience working alongside neurologists and neuropsychiatrists to improve neuropsychiatry skills among psychiatry residents. In our study, participants rated the relationship between psychiatrists and neurologists as 4.4± 2.06.…”

Attitudes of Psychiatry Residents in Canadian Universities toward Neuroscience and Its Implication in Psychiatric Practice

“…Thus, Canadian trainees recognize a gap in their neuroscience training and consider neuroscience education useful in patient care, an opinion shared by psychiatry trainees and program directors in other countries. 17,23 A number of authors have proposed methods of improving neuroscience education in psychiatry residency training, [14][15][16]24,25 and various programs are already being developed to improve neuroscience education for psychiatry trainees and psychiatrists, including the National Neuroscience Curriculum Initiative in the United States and the Royal College of Psychiatrists in the United Kingdom. Although most residency directors appreciate the importance of integrating neuroscience into psychiatry training, 23 most programs still do not teach neuroscience in a systematic and comprehensive manner.…”

Modernizing Psychiatry Training for Neurologists—From Off-Service to In-Service

“…Off-service training (clinical experiences in which a trainee is embedded in a service other than their primary specialty) in psychiatry for neurology residents has been a long-standing requirement of the Accreditation Council for Graduate Medical Education (ACGME). 1 The ACGME mandates neurology residents complete 1 month of full-time clinical experience in psychiatry without further specification. Neurology is the only field besides psychiatry with mandated psychiatry training.…”

“…The ACGME Milestones for neurologists emphasize understanding the interplay between neurologic and psychiatric disorders and addressing psychiatric symptomatology. 1 This emphasis, coupled with feedback of neurology residency graduates seeking psychiatric training relevant to their practice setting, suggests the need for a curriculum focused on assessment and management of psychiatric symptoms and conditions common in neurologic settings and emphasizing cross-disciplinary collaboration and novel models of care.…”

“…Neurology is the only field besides psychiatry with mandated psychiatry training. This requirement is a reflection of the shared history of neurology and psychiatry, the pathophysiologic overlap of brain disease, and the frequency of psychiatric comorbidity among individuals with neurologic disease . However, the current model of psychiatry training does not meet the needs of neurology trainees with the majority of neurology residency graduates underprepared for providing psychiatric care in routine neurologic practice …”