Acad Psychiatry (2014) 38:135–140 DOI 10.1007/s40596-014-0051-9
EMPIRICAL REPORT
Neuropsychiatry and Neuroscience Education of Psychiatry Trainees: Attitudes and Barriers Sheldon Benjamin & Michael J. Travis & Joseph J. Cooper & Chandlee C. Dickey & Claudia L. Reardon
Received: 22 June 2013 / Accepted: 4 November 2013 / Published online: 19 March 2014 # Academic Psychiatry 2014
Abstract Objective The American Association of Directors of Psychiatric Residency Training (AADPRT) Task Force on Neuropsychiatry and Neuroscience Education of Psychiatry Residents was established in 2011 with the charge to seek information about what the field of psychiatry considers the core topics in neuropsychiatry and neuroscience to which psychiatry residents should be exposed; whether there are any “competencies” in this area on which the field agrees; whether psychiatry departments have the internal capacity to teach these topics if they are desirable; and what the reception would be for “portable curricula” in neuroscience. Methods The task force reviewed the literature and developed a survey instrument to be administered nationwide to all psychiatry residency program directors. The AADPRT Executive Committee assisted with the survey review, and their feedback was incorporated into the final instrument. Results In 2011–2012, 226 adult and child and adolescent psychiatry residency program directors responded to the survey, representing over half of all US adult and child psychiatry training directors. About three quarters indicated that faculty
S. Benjamin (*) University of Massachusetts Medical School, Worcester, MA, USA e-mail: [email protected] M. J. Travis University of Pittsburgh School of Medicine, Pittsburgh, PA, USA J. J. Cooper University of Chicago, Chicago, IL, USA C. C. Dickey V.A. Boston Healthcare System, Brockton, MA, USA C. L. Reardon University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
resources were available in their departments but 39 % felt the lack of neuropsychiatry faculty and 36 % felt the absence of neuroscience faculty to be significant barriers. Respectively, 64 and 60 % felt that neuropsychiatry and psychiatric neuroscience knowledge were very important or critically important to the provision of excellent care. Ninety-two percent were interested in access to portable neuroscience curricula. Conclusions There is widespread agreement among training directors on the importance of neuropsychiatry and neuroscience knowledge to general psychiatrists but barriers to training exist, including some programs that lack faculty resources and a dearth of portable curricula in these areas. Keywords Psychiatric residency education . Curriculum development . Neuropsychiatry . Next Accreditation System . Milestones For at least 50 years, leading psychiatrists have called for psychiatry to embrace the inclusion of additional training in neurology, neuropsychiatry, and neuroscience as part of psychiatry training [1–14]. Whereas the majority of psychiatry programs offer seminars in neurology for psychiatrists [15] and neuropsychiatry training objectives for psychiatrists have been promulgated [16], the number of programs offering neuropsychiatry and psychiatric neuroscience education per se is not known. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology (ABPN) specify that psychiatry residency must include at least 2 months of neurology training, defined as “supervised clinical experience in the diagnosis and treatment of patients with neurological disorders/ conditions” [17]. As part of the ACGME’s Next Accreditation System [18], all medical specialties will measure progress toward competency by the achievement of training milestones. The inclusion of milestones in clinical neuroscience
136
Acad Psychiatry (2014) 38:135–140
means that, for the first time, the content of neurology, neuropsychiatry, and neuroscience training of psychiatry residents will be specified [19]. We conducted the American Association of Directors of Psychiatric Residency Training (AADPRT) Neuropsychiatry and Neuroscience Education of Psychiatry Residents Survey to determine the views of adult and child and adolescent psychiatry residency directors on the importance of neuropsychiatry and neuroscience education of general psychiatrists and the barriers that may exist to wider implementation of related educational content.
and competency in neuropsychiatric clinical skills. Respondents were queried as to the amount of didactic time and type of teaching currently dedicated to these areas and to the degree they felt that availability of resources in their departments posed barriers to enhancing neuropsychiatry and neuroscience training. Respondents were then asked about their interest in the development of portable neuroscience curricula. We carried out between-group comparisons using independent samples t tests. Some of the questions in the survey intentionally overlapped with a survey by Fung et al. [21] to facilitate comparison with responses by general psychiatry practitioners, department chairs, and residents.
Methods All 486 US general adult psychiatry and child and adolescent psychiatry residency directors and associate residency directors were sent invitations to an anonymous online survey. Nonresponders were sent three follow-up invitations. For purposes of this survey, we defined neuroscience as the study of the nervous system and behavior using cellular and molecular biology, animal models, neuroanatomy, neuroimaging, genetics, neuropsychology (cognitive neuroscience), and basic pharmacology (not clinical pharmacology) and neuropsychiatry as the clinical study of brain–behavior relationships as revealed through the psychiatric manifestations of neurological disorders and the neurobiology of psychiatric disorders. We based the survey content on a review of relevant literature and vetted it with the AADPRT Executive Committee. The survey instrument included inquiry as to available department resources (neuropsychiatry residency or fellowship programs, neuroscience doctoral and postdoctoral programs, faculty identified as neuropsychiatrists or psychiatric neuroscience researchers), respondent attitudes (number of years until neuroscience advances will change treatment, importance of neuropsychiatric and neuroscience knowledge to residents entering psychiatry training in 2012, differentiation of neuropsychiatry from general psychiatry), and importance to psychiatry trainees of familiarity with research findings linked to the NIMH Research Domain Criteria (RDoC) [20]
Results Two hundred twenty-six people responded to the survey, representing over 58 and 55 % of adult and child and adolescent psychiatry programs, respectively. Respondent characteristics are listed in Table 1. Sixty-two percent of the respondents were at university-based programs, and 38 % represented a variety of public and private sector programs. Resources Seventy-four percent of the respondents had one or more faculty members who identified themselves as neuropsychiatrists, and 81 % had one or more psychiatric neuroscience researchers. Sixty-four percent were affiliated with institutions offering doctoral or postdoctoral work in psychiatric neuroscience, 22 % were part of institutions offering neuropsychiatry or behavioral neurology fellowships, and 7 % said their institutions offered psychiatry/neurology “double board” programs. Attitudes Thirty-two percent of respondents felt that neuroscience advances would lead to significant new treatments or the
Table 1 Characteristics of survey respondents (N = 226 unique respondents including 32 respondents identifying as both adult and child psychiatry educators; 47% response rate) Adult psychiatry (N = 169)
Child and adolescent psychiatry (N = 89)
Training directors
Associate directors
Chair/vice chair/ division head
Training directors
Associate directors
Chair/vice chair/ division head
106 (58 % of programs) >20 years since residency: 45
43 > 20 year since residency: 8
20 > 20 year since residency: 14
67 (55 % of programs) >20 years since residency: 25
14 >20 years since residency: 1
8 >20 years since residency: 5
0–5 years in position: 72
≥6 years in position: 80
0–5 years in position: 38
≥6 years in position: 44
Acad Psychiatry (2014) 38:135–140
personalized application of existing therapies in 5 years, 50 % in 10 years, 14 % in 20 years, and 4 % in greater than 20 years. Asked to consider residents beginning training in 2012, 64 % considered neuropsychiatry knowledge and 60 % considered knowledge of psychiatric neuroscience findings to be either very important or critically important to the provision of excellent psychiatric care (4 or 5 on a five-point scale). It should be noted that only 19 % of the respondents felt that neuropsychiatry was clearly differentiated from general psychiatry from their perspective, with twice as many respondents unable to see the difference and three times as many with no opinion, despite having been provided with the definitions given in the “Methods” section above. Respondents were asked to rate the familiarity with the topics in the National Institute of Mental Health (NIMH) RDoC that should be expected upon graduation of a psychiatry resident beginning training in 2012 (Table 2). They were also asked about the competence that should be expected for clinical neuropsychiatry skills by the time of graduation for a resident entering training in 2012 (Table 3). Despite no difference in years since residency graduation, child and adolescent psychiatrists felt that familiarity with the following areas was significantly more important for residents than did general adult psychiatrists: genetics and genomics, t(145)=−3.4, p=0.001; epigenetics, t(140)=3.13, p=0.002; attention/cognition, t(159)=−3.39, p=0.001; emotion regulation, t(143)=−2.26, p=0.025; neurobiology of attachment, t(146)=−3.43, p=0.001; and developmental neurobiology, t(171)=−4.42, p
EMPIRICAL REPORT
Neuropsychiatry and Neuroscience Education of Psychiatry Trainees: Attitudes and Barriers Sheldon Benjamin & Michael J. Travis & Joseph J. Cooper & Chandlee C. Dickey & Claudia L. Reardon
Received: 22 June 2013 / Accepted: 4 November 2013 / Published online: 19 March 2014 # Academic Psychiatry 2014
Abstract Objective The American Association of Directors of Psychiatric Residency Training (AADPRT) Task Force on Neuropsychiatry and Neuroscience Education of Psychiatry Residents was established in 2011 with the charge to seek information about what the field of psychiatry considers the core topics in neuropsychiatry and neuroscience to which psychiatry residents should be exposed; whether there are any “competencies” in this area on which the field agrees; whether psychiatry departments have the internal capacity to teach these topics if they are desirable; and what the reception would be for “portable curricula” in neuroscience. Methods The task force reviewed the literature and developed a survey instrument to be administered nationwide to all psychiatry residency program directors. The AADPRT Executive Committee assisted with the survey review, and their feedback was incorporated into the final instrument. Results In 2011–2012, 226 adult and child and adolescent psychiatry residency program directors responded to the survey, representing over half of all US adult and child psychiatry training directors. About three quarters indicated that faculty
S. Benjamin (*) University of Massachusetts Medical School, Worcester, MA, USA e-mail: [email protected] M. J. Travis University of Pittsburgh School of Medicine, Pittsburgh, PA, USA J. J. Cooper University of Chicago, Chicago, IL, USA C. C. Dickey V.A. Boston Healthcare System, Brockton, MA, USA C. L. Reardon University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
resources were available in their departments but 39 % felt the lack of neuropsychiatry faculty and 36 % felt the absence of neuroscience faculty to be significant barriers. Respectively, 64 and 60 % felt that neuropsychiatry and psychiatric neuroscience knowledge were very important or critically important to the provision of excellent care. Ninety-two percent were interested in access to portable neuroscience curricula. Conclusions There is widespread agreement among training directors on the importance of neuropsychiatry and neuroscience knowledge to general psychiatrists but barriers to training exist, including some programs that lack faculty resources and a dearth of portable curricula in these areas. Keywords Psychiatric residency education . Curriculum development . Neuropsychiatry . Next Accreditation System . Milestones For at least 50 years, leading psychiatrists have called for psychiatry to embrace the inclusion of additional training in neurology, neuropsychiatry, and neuroscience as part of psychiatry training [1–14]. Whereas the majority of psychiatry programs offer seminars in neurology for psychiatrists [15] and neuropsychiatry training objectives for psychiatrists have been promulgated [16], the number of programs offering neuropsychiatry and psychiatric neuroscience education per se is not known. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology (ABPN) specify that psychiatry residency must include at least 2 months of neurology training, defined as “supervised clinical experience in the diagnosis and treatment of patients with neurological disorders/ conditions” [17]. As part of the ACGME’s Next Accreditation System [18], all medical specialties will measure progress toward competency by the achievement of training milestones. The inclusion of milestones in clinical neuroscience
136
Acad Psychiatry (2014) 38:135–140
means that, for the first time, the content of neurology, neuropsychiatry, and neuroscience training of psychiatry residents will be specified [19]. We conducted the American Association of Directors of Psychiatric Residency Training (AADPRT) Neuropsychiatry and Neuroscience Education of Psychiatry Residents Survey to determine the views of adult and child and adolescent psychiatry residency directors on the importance of neuropsychiatry and neuroscience education of general psychiatrists and the barriers that may exist to wider implementation of related educational content.
and competency in neuropsychiatric clinical skills. Respondents were queried as to the amount of didactic time and type of teaching currently dedicated to these areas and to the degree they felt that availability of resources in their departments posed barriers to enhancing neuropsychiatry and neuroscience training. Respondents were then asked about their interest in the development of portable neuroscience curricula. We carried out between-group comparisons using independent samples t tests. Some of the questions in the survey intentionally overlapped with a survey by Fung et al. [21] to facilitate comparison with responses by general psychiatry practitioners, department chairs, and residents.
Methods All 486 US general adult psychiatry and child and adolescent psychiatry residency directors and associate residency directors were sent invitations to an anonymous online survey. Nonresponders were sent three follow-up invitations. For purposes of this survey, we defined neuroscience as the study of the nervous system and behavior using cellular and molecular biology, animal models, neuroanatomy, neuroimaging, genetics, neuropsychology (cognitive neuroscience), and basic pharmacology (not clinical pharmacology) and neuropsychiatry as the clinical study of brain–behavior relationships as revealed through the psychiatric manifestations of neurological disorders and the neurobiology of psychiatric disorders. We based the survey content on a review of relevant literature and vetted it with the AADPRT Executive Committee. The survey instrument included inquiry as to available department resources (neuropsychiatry residency or fellowship programs, neuroscience doctoral and postdoctoral programs, faculty identified as neuropsychiatrists or psychiatric neuroscience researchers), respondent attitudes (number of years until neuroscience advances will change treatment, importance of neuropsychiatric and neuroscience knowledge to residents entering psychiatry training in 2012, differentiation of neuropsychiatry from general psychiatry), and importance to psychiatry trainees of familiarity with research findings linked to the NIMH Research Domain Criteria (RDoC) [20]
Results Two hundred twenty-six people responded to the survey, representing over 58 and 55 % of adult and child and adolescent psychiatry programs, respectively. Respondent characteristics are listed in Table 1. Sixty-two percent of the respondents were at university-based programs, and 38 % represented a variety of public and private sector programs. Resources Seventy-four percent of the respondents had one or more faculty members who identified themselves as neuropsychiatrists, and 81 % had one or more psychiatric neuroscience researchers. Sixty-four percent were affiliated with institutions offering doctoral or postdoctoral work in psychiatric neuroscience, 22 % were part of institutions offering neuropsychiatry or behavioral neurology fellowships, and 7 % said their institutions offered psychiatry/neurology “double board” programs. Attitudes Thirty-two percent of respondents felt that neuroscience advances would lead to significant new treatments or the
Table 1 Characteristics of survey respondents (N = 226 unique respondents including 32 respondents identifying as both adult and child psychiatry educators; 47% response rate) Adult psychiatry (N = 169)
Child and adolescent psychiatry (N = 89)
Training directors
Associate directors
Chair/vice chair/ division head
Training directors
Associate directors
Chair/vice chair/ division head
106 (58 % of programs) >20 years since residency: 45
43 > 20 year since residency: 8
20 > 20 year since residency: 14
67 (55 % of programs) >20 years since residency: 25
14 >20 years since residency: 1
8 >20 years since residency: 5
0–5 years in position: 72
≥6 years in position: 80
0–5 years in position: 38
≥6 years in position: 44
Acad Psychiatry (2014) 38:135–140
personalized application of existing therapies in 5 years, 50 % in 10 years, 14 % in 20 years, and 4 % in greater than 20 years. Asked to consider residents beginning training in 2012, 64 % considered neuropsychiatry knowledge and 60 % considered knowledge of psychiatric neuroscience findings to be either very important or critically important to the provision of excellent psychiatric care (4 or 5 on a five-point scale). It should be noted that only 19 % of the respondents felt that neuropsychiatry was clearly differentiated from general psychiatry from their perspective, with twice as many respondents unable to see the difference and three times as many with no opinion, despite having been provided with the definitions given in the “Methods” section above. Respondents were asked to rate the familiarity with the topics in the National Institute of Mental Health (NIMH) RDoC that should be expected upon graduation of a psychiatry resident beginning training in 2012 (Table 2). They were also asked about the competence that should be expected for clinical neuropsychiatry skills by the time of graduation for a resident entering training in 2012 (Table 3). Despite no difference in years since residency graduation, child and adolescent psychiatrists felt that familiarity with the following areas was significantly more important for residents than did general adult psychiatrists: genetics and genomics, t(145)=−3.4, p=0.001; epigenetics, t(140)=3.13, p=0.002; attention/cognition, t(159)=−3.39, p=0.001; emotion regulation, t(143)=−2.26, p=0.025; neurobiology of attachment, t(146)=−3.43, p=0.001; and developmental neurobiology, t(171)=−4.42, p
