Neurology Didactic Curricula for Psychiatry Residents: A Survey of Program Directors Claudia L. Reardon, MD and Art Wa

1. Neurology Didactic Curricula for Psychiatry Residents: A Survey of Program Directors Claudia L. Reardon, MD and Art Walaszek, MD University of Wisconsin School of Medicine and Public Health Contact Information Claudia L. Reardon, MD University of Wisconsin Department of Psychiatry Madison, WI clreardon@wisc.edu Background: Literature on Neuro Training Results (Continued) Results (Continued) Abstract • Themes emerging from “What would you change about your program’s neurology didactics?”: • More integration of neurology and psychiatric didactics • More routine involvement of neurology faculty • More case-based neurology didactics • Do you feel your program offers adequate neurology didactics? • Yes (57%) • No (21.5%) • Maybe (21.5%) • Neuroscience (=neuroanatomy, neurodevelopment, neuroimaging, cellular/molecular pathology, genetics, animal models): Psychiatry PDs reported that neuroscience constituted 12% of their total residency-wide curricula but felt ideally it should comprise 20%.1 • Neuropsychiatry (=mental disorders attributable to neurologic disorders): Psychiatry PDs reported that many of their programs failed to provide adequate training in psychiatric management of patients with development disabilities, movement disorders, TBI, and other neuropsychiatric disorders.2 • Neurology: Psychiatry PDs reported overall satisfaction with neurologic education as 3.6/5. 78% favor neurology rotations that occur in outpatient or consultation settings.3 Resident confidence in treating neurologic disorders declines during residency, despite PRITE neurology scores improving during this time.4 Nothing published about neurology didactics in psychiatry residency. Figure 2: Topics taught in neurology didactics Objective: Minimal literature exists on the types and extent of neurology didactic instruction offered to psychiatry residents, and there is no standard, widely available neurology didactic curriculum offered as a model for psychiatry residency programs. Methods: We electronically surveyed 172 directors of U.S. psychiatric residency training programs to examine the types and extent of neurology didactic instruction offered to their residents. Results: The majority of psychiatry residency programs offer neurology didactic instruction to their residents, as provided by both neurology and psychiatry faculty, in a number of different settings and covering many topics. However, much room for improvement remains, especially in regards to collaboration between neurologists and psychiatrists in educating future specialists in these two areas. Conclusions: We hope this study will offer guidance to psychiatry residency programs aiming to optimize their own neurology didactic curricula. Further research should explore tools for assessing resident knowledge in neurology, and effectiveness of various types of neurology didactic curricula in increasing knowledge in neurology and improving clinical outcomes.. Conclusions/Discussion • Most psychiatry residency programs offer neurology didactics, as provided by both neurology and psychiatry faculty, in a number of different setting and covering many topics. HOWEVER, much room for improvement remains. • Figure 2 could serve as useful starting point for programs developing new neurology didactics. • Programs not taking advantage of pre-existing neurology didactics (e.g., those offered to neurology residents at the same hospital/clinic) might consider doing so. • Consider ways to enhance collaboration with neurology colleagues: neurobehavior rounds, involve neurology/psychiatry residents in didactic teaching to the other specialty, etc. • We need more valid/reliable ways to assess neurology competency, since PRITE correlation with final ABPN outcomes is much worse for neurology sub-scores.5 Displayed are the percentages of programs teaching each topic. Figure 3: Educational resources used to teach neurology (other than didactics) Methods • University of Wisconsin IRB Exemption from full review granted. • All 172 U.S. Psychiatry PDs contacted via email to complete 10-item web-based survey about neurology didactic curricula. • Reminder email sent at 1 month. • 57 PDs (33%) completed the survey. Results Introduction Figure 1: Methods of instruction in neurology Displayed are the percentages of programs using each resource. • Optimization of neurology training is important for psychiatry residents for a number of reasons: • The ACGME requires psychiatry residents to have neurology training. • The ABPN exam includes a high percentage of neurology questions, and the ACGME evaluates psychiatry residencies in part based on ABPN outcomes. • The divide between psychiatry and neurology is narrowing as neuroimaging becomes more mainstream. • Psychiatry residency program directors (PDs) anticipate even greater amounts of neuroscience in their curricula in the future.1 References • Other findings: • The most neurology didactics are offered to PGY1s and PGY4s. • 85% of programs recommend Kaufman’s text Clinical Neurology for Psychiatrists; 18% the Adams and Victor text Principles of Neurology; 16% no text. • Programs assess residents’ neurology knowledge base via: • PRITE (97%) • ABPN (56%) • Faculty performance evaluations (51%) Roffman JL, Simon AB, Prasad KM, et al. Neuroscience in psychiatry training: how much do residents need to know? Am J Psychiatry 2006;163:919-26. Duffy JD and Camlin H. Neuropsychiatric training in American psychiatric residency training programs. J Neuropsych Clin Neurosci 1995;7:290-4. Selwa LM, Hales DJ, Kanner AM. What should psychiatry residents be taught about neurology?: A survey of psychiatry residency directors. Neurologist 2006;12(5):268-70. Albucher RC, Maixner SM, Riba MB, et al. Neurology training in psychiatry residency: self-assessment and standardized scores. Acad Psych 1999;23:77-81. Webb LC, Juul D, Reynolds CF, et al. How well does the psychiatry residency in-training examination predict performance on the American Board of Psychiatry and Neurology Part I Examination? Am J Psychiatry 1996;153:831-2. Displayed are the percentages of programs employing each instructional method.