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Brown JC, Dainton-Howard H, Woodward J, Palmer C, Karamchandani M, Williams NR, George MS. Time for Brain Medicine. J Neuropsychiatry Clin Neurosci 2023; 35:333-340. [PMID: 37021384 DOI: 10.1176/appi.neuropsych.21120312] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Unprecedented knowledge of the brain is inevitably contributing to the convergence of neurology and psychiatry. However, clinical training continues to follow a divergent approach established in the 19th century. An etiological approach will continue to shift more psychiatric patients to the care of neurologists who are untrained in psychiatric management. At the same time, this new era of diagnostic biomarkers and neuroscience-based precision treatments requires skills not readily available to those trained in psychiatry. The challenges in training the next generation of doctors include establishing competence involving aspects of the whole brain, fostering the subspecialized expertise needed to remain current, and developing programs that are feasible in duration and practical in implementation. A new 4-year residency training program proposed in this article could replace existing residency programs. The program includes 2 years of common and urgent training in various aspects of neurology and psychiatry followed by 2 years of elective subspecialty tracks. The concept is similar to internal medicine residencies and fellowships. No changes to existing departmental structures are necessary. In concert with the emerging biological approach to the brain, "brain medicine" is proposed as a new name to denote this practice in the simplest terms: a focus on all aspects of the brain.
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Affiliation(s)
- Joshua C Brown
- Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, R.I., and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Brown); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Medical University of South Carolina, Charleston (Dainton-Howard, Palmer, Karamchandani, George); Department of Neurology, Yale University, New Haven (Woodward); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Williams); Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston (George)
| | - Helen Dainton-Howard
- Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, R.I., and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Brown); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Medical University of South Carolina, Charleston (Dainton-Howard, Palmer, Karamchandani, George); Department of Neurology, Yale University, New Haven (Woodward); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Williams); Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston (George)
| | - Jared Woodward
- Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, R.I., and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Brown); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Medical University of South Carolina, Charleston (Dainton-Howard, Palmer, Karamchandani, George); Department of Neurology, Yale University, New Haven (Woodward); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Williams); Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston (George)
| | - Charles Palmer
- Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, R.I., and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Brown); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Medical University of South Carolina, Charleston (Dainton-Howard, Palmer, Karamchandani, George); Department of Neurology, Yale University, New Haven (Woodward); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Williams); Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston (George)
| | - Manish Karamchandani
- Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, R.I., and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Brown); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Medical University of South Carolina, Charleston (Dainton-Howard, Palmer, Karamchandani, George); Department of Neurology, Yale University, New Haven (Woodward); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Williams); Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston (George)
| | - Nolan R Williams
- Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, R.I., and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Brown); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Medical University of South Carolina, Charleston (Dainton-Howard, Palmer, Karamchandani, George); Department of Neurology, Yale University, New Haven (Woodward); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Williams); Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston (George)
| | - Mark S George
- Department of Psychiatry and Human Behavior and Department of Neurology, Warren Alpert Medical School of Brown University, Providence, R.I., and Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Brown); Department of Psychiatry and Behavioral Sciences and Department of Neurology, Medical University of South Carolina, Charleston (Dainton-Howard, Palmer, Karamchandani, George); Department of Neurology, Yale University, New Haven (Woodward); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, Calif. (Williams); Ralph H. Johnson VA Medical Center, Medical University of South Carolina, Charleston (George)
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Sandrone S, Berthaud JV, Chuquilin M, Cios J, Ghosh P, Gottlieb-Smith RJ, Kushlaf H, Mantri S, Masangkay N, Menkes DL, Nevel KS, Sarva H, Schneider LD. Neurologic and neuroscience education. Neurology 2018; 92:174-179. [DOI: 10.1212/wnl.0000000000006716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/21/2018] [Indexed: 01/06/2023] Open
Abstract
Neurologic disorders are among the most frequent causes of morbidity and mortality in the United States. Moreover, the current shortfall of neurologists is expected to worsen over the coming decade. As a consequence, many patients with neurologic disorders will be treated by physicians and primary care providers without formal neurologic training. Furthermore, a pervasive and well-described fear of neurology, termed neurophobia, has been identified in medical student cohorts, residents, and among general practitioners. In this article, members of the American Academy of Neurology A.B. Baker Section on Neurological Education review current guidelines regarding neurologic and neuroscience education, contextualize the genesis and the negative consequences of neurophobia, and provide strategies to mitigate it for purposes of mentoring future generations of health care providers.
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Mahajan A, Cahill C, Scharf E, Gupta S, Ahrens S, Joe E, Schneider L. Neurology residency training in 2017. Neurology 2018; 92:76-83. [DOI: 10.1212/wnl.0000000000006739] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/02/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo survey graduating US neurology residents on the topics of debt, fellowship interview process, future plans, and their readiness for practice and business management tasks.MethodsAn electronic survey was sent to all US American Academy of Neurology member adult and child neurology residents graduating in June 2017.ResultsThe response rate was 23.4% (n = 159). Of the 143 residents who provided information about student loans, 57% reported having debt (median $180,000). Ninety percent of respondents reported plans to pursue a fellowship after residency; 57% intended to stay at their home institution for additional training. Among respondents from adult neurology programs, 87% preferred to begin the fellowship application process after the first 6 months of the third postgraduate year. Almost half (46%) of adult neurology program residents felt they did not have enough outpatient exposure prior to making fellowship decisions compared to 14% of child neurology trainees. Although reported readiness to perform specific tasks (coding and office management) increased since 2007 (p < 0.05), only 36% of all respondents reported receiving business management training during residency.ConclusionTrainees completing residency report considerable educational debt. A large majority of residents feel the fellowship application process occurs too early. Despite improvements over recent years, the majority of residents continue to feel ill-prepared for specific practice management tasks. These results suggest a need to better understand the effect of educational debt on career choices, an examination of the timing of the fellowship application process, and the incorporation of additional business management training during residency.
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Singman EL, Srikumaran D, Green L, Tian J, McDonnell P. Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs. BMC MEDICAL EDUCATION 2017; 17:105. [PMID: 28651531 PMCID: PMC5485577 DOI: 10.1186/s12909-017-0941-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 06/13/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. METHODS A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored. RESULTS The response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated. CONCLUSIONS The majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The different degrees of faculty supervision outlined by this survey might provide a useful guide presuming they can be correlated with validated metrics of educational quality. Finally, this study could provide an adjunctive resource to current international efforts to standardize ophthalmic residency education.
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Affiliation(s)
- Eric L. Singman
- Wilmer Eye Institute General Eye Services Clinic, @ Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Divya Srikumaran
- Wilmer Eye Institute General Eye Services Clinic, @ Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Laura Green
- Ophthalmology Residency Program Director, Lifebridge Health Krieger Eye Institute, 2411 W. Belvedere Ave, Baltimore, MD 21215 USA
| | - Jing Tian
- Biostatistics Consulting Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room 3148, Baltimore, MD 21287 USA
| | - Peter McDonnell
- Wilmer Eye Institute, @ Johns Hopkins Hospital, Maumenee 727, 600 N. Wolfe St, Baltimore, MD 21287 USA
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