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

Neuroimaging education in psychiatric training

As the histories of psychiatry, neurology, and neuroimaging interweave through time, psychiatry has only recently started to recognize the need to embrace neuroimaging like its sibling specialty. While imaging in psychiatric research is well accepted, there is current clinical utility as well. Standards for psychiatry residency and board certification in the USA and abroad have carved out a place for neuroimaging, but the implementation is variable and sparse in the USA. The few publications that describe neuroimaging teaching to psychiatrists have barriers to widespread adoption, and no comprehensive curricular solution has been developed. In this context, we describe some of the barriers and propose solutions to shape the future of neuroimaging education for psychiatrists.

Development and Evaluation of an Innovative Neurology E-learning Didactic Curriculum for Psychiatry Residents

OBJECTIVE

This article describes the development, implementation, and piloting of an e-learning neuropsychiatry curriculum for psychiatry residents. The primary outcome of interest was feasibility. Secondary outcomes were interest and confidence caring for patients with neuropsychiatric disorders, and knowledge about neuropsychiatry.

METHODS

The curriculum was designed utilizing Kern's six-step framework. A ten-module, interactive, primarily vignette-based e-learning curriculum was developed focusing on the neurocognitive exam and neurocognitive disorders. The curriculum was piloted in two psychiatry residencies in Brooklyn, NY (n = 80 residents). The curriculum was evaluated using a survey adapted from the General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) and a 24-item neuropsychiatry examination prior to the intervention and 1-month post-intervention. Qualitative feedback was acquired through four open-ended items in the post-curriculum survey, which underwent a thematic analysis.

RESULTS

Seventy-eight of eighty residents completed the full curriculum. Three of nine attitude items demonstrated significant differences, with residents feeling less frustrated managing dementia (pre-mean = 2.32, post = 2.68, t(2,59) = 2.00, p = 0.004), less frustrated due to not knowing how to effectively treat dementia (pre-mean = 2.05, post = 2.95, t(2,59) = 6.27, p = 0.000), and demonstrating less interest in pursuing further training in neuropsychiatry (pre-mean = 1.95, post = 2.18, t(2,59) = 1.70, p = 0.047), though still overall showing interest. There was no change in confidence ratings. There was a small but significant improvement in total number of knowledge items answered correctly.

CONCLUSIONS

This study demonstrated the feasibility of implementing an e-learning neuropsychiatry curriculum. It also demonstrated an improvement in resident responses to two attitude items and an increase in neuropsychiatry knowledge.

Experience of surgical subspecialty residents on general surgery rotations

BACKGROUND

Surgical subspecialty residents complete 5-6 years of training which includes general surgery rotations. A lack of data exists evaluating these rotations. This study aims to identify discrepancies in subspecialty training and improve the quality of surgical education.

METHODS

Case logs for surgical subspecialty residents and general surgery residents at our institution were analyzed and queried for cases performed on general surgery rotations. A survey was distributed to subspecialty residents regarding their perceptions of these rotations.

RESULTS

50 residents were included in the study and the majority were male (n = 27, 54%). Subspecialty residents perform fewer cases per month compared to general surgery residents (13 vs 21, p < 0.001). 75% of subspecialty residents were satisfied with their experience on general surgery rotations.

CONCLUSIONS

Subspecialty residents perform fewer operations on general surgery rotations. Despite this, most are satisfied with off-service rotations and believe they are an important part of their education.

How Am I Doing in Small Group? Student Perceptions of Feedback in Case-Based Learning Sessions

Introduction

Small group case-based learning (CBL) facilitators are content experts that may provide feedback to students on cognitive reasoning skills and knowledge acquisition. However, student feedback-seeking behavior and response toward faculty feedback in CBL sessions are not known, and it is essential to maximize feedback in this setting where it can be a challenge to observe student performance while groups may have varied emphasis on individual versus team performance. We explored student perceptions of the effectiveness of faculty feedback processes during CBL sessions.

Methods

This qualitative study used semi-structured interviews with ten second year medical students enrolled in the Geisel School of Medicine preclinical neurology course. Investigator triangulation was used with interpretation comparisons that included independent content analysis. The constructed themes were discussed and final theme consensus was reached.

Results

Three major themes arose: (1) students value frequent feedback on their understanding of key clinical case concepts; (2) the CBL learning environment is not conducive to individual feedback; and (3) student feedback-seeking behavior and response are influenced by self-perceived level of preparedness for the sessions and overall comfort with the CBL facilitator and learning environment.

Conclusions

Students value content-based feedback from CBL sessions and need more individualized feedback. The style of the facilitator and overall learning environment can vary widely in the small group setting and has direct impact on feedback opportunities and student feedback-seeking behavior.

Neuroimaging Education in Psychiatry Residency Training: Needs Assessment

OBJECTIVE

The authors investigated the attitudes, self-perceived knowledge, and the need for a dedicated neuroimaging curriculum among psychiatrists-in-training.

METHODS

An anonymous voluntary 20-item Web-based survey was distributed to psychiatry residents at seven university-based USA programs between December 2017 and February 2019.

RESULTS

Of 302 psychiatry residents, 183 (response rate, 60.5%) completed the survey. Although a large majority of residents (83%) believed that neuroradiology education is important to psychiatric training, only 7% reported that they are receiving adequate training in this discipline. The majority (80%) believed that there should be a formal neuroimaging curriculum during their training. Self-perceived competence and comfort level was found to be low with several psychiatrically relevant neuroimaging modalities. In particular, regarding CT head/brain MRI, there was a marked difference in self-perceived competence at interpreting the actual brain images (8%) versus the radiological reports/impression summaries (48%). Comfort level with functional neuroimaging was especially low (7%). Clinically, only 26% reported confidence at being able to explain neuroimaging topics to patients. Compared to junior residents, senior residents rated higher confidence at interpreting the radiological reports/impression summaries of CT head/brain MRI (p = 0.008) and PET/SPECT (p = 0.014), but no difference was found with the actual brain images. Further, senior residents were less likely to identify with "neurophobia" (p = 0.028) and more likely to believe that a neuroimaging curriculum should be included in psychiatric residency training (p = 0.027) when compared to junior residents.

CONCLUSIONS

Psychiatrists-in-training have a very strong interest in neuroimaging education. Future educational interventions should address this need.

The future of psychiatric education

Mental health disorders cause a large burden on global public health, with many patients living years with the disability. However, many doctors are ill-equipped to treat mental health disorders given inadequate training during their undergraduate years. In some countries, psychiatry is even considered an elective course rather than a core module. There is, therefore, a pressing need to improve the training of medical students in managing mental health disorders. Measures need to be implemented to attract students to choose psychiatry as their career. Given the developments in the fields and the challenges currently faced by trainees and early career psychiatrists, changes may also be made to the training programme in the postgraduate stage to unify the variations across the world in terms of the training duration and format. This paper will describe the ways that undergraduate and postgraduate psychiatry training may be ameliorated to improve the delivery of mental healthcare around the world and to equip doctors to face challenges in the future.

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

OBJECTIVE

Despite recent advances in neuroscience highlighting its potential applications in the assessment and treatment of psychiatric disorders, the training of psychiatrists in neuroscience is lacking. However, it is not clear to what extent Canadian trainees are interested in further learning and using neuroscience in their daily clinical practice. This study explored the attitudes of Canadian psychiatry trainees with regard to neuroscience education and training by asking them to assess their own understanding of neuroscience and the perceived relevance of neuroscience knowledge to effective psychiatric practice.

METHODS

An online questionnaire was sent to psychiatry residents at Canadian universities. This questionnaire consisted of self-assessments of neuroscience knowledge, attitudes toward neuroscience education, preferences in learning modalities, and interest in specific neuroscience topics.

RESULTS

One hundred and eleven psychiatry residents from psychiatry residency programs at Canadian universities responded to this survey. Participants represented trainees from all 5 years of residency. Almost half of all trainees (49.0%) reported their knowledge of neuroscience to be either "inadequate" or "less than adequate," and only 14.7% of trainees reported that they feel "comfortable" or "very comfortable" discussing neuroscience findings with their patients. 63.7% of Canadian trainees rated the quantity of neuroscience education in their residency program as either less than adequate or inadequate, and 46.1% rated the quality of their neuroscience education as "poor" or "very poor." The vast majority of participants (>70%) felt that additional neuroscience education would be moderately-to-hugely helpful in finding personalized treatments, discovering future treatments, destigmatizing patients with psychiatric illness, and understanding mental illness.

CONCLUSIONS

Canadian trainees generally feel that their neuroscience knowledge and the neuroscience education they receive during their psychiatry residencies is inadequate. However, as the first step for any change, the majority of future Canadian psychiatrists are very motivated and have a positive attitude toward neuroscience learning.