Neuroscience, neuropsychiatry, and neurology are increasingly recognized as important for the future of psychiatry. Neuroscience encompasses neuroanatomy, neurodevelopment, neuroimaging, cellular and molecular pathology, genetics, animal models, and basic pharmacology (1). Neuropsychiatry is that branch of medicine dealing with mental disorders attributable to neurologic disorders (2). The Accreditation Council for Graduate Medical Education (ACGME) requires that psychiatry residents complete 2 months of neurology training, defined as diagnosis and treatment of patients with neurological disorders. The American Board of Psychiatry and Neurology (ABPN) was formed in 1934 when the two constituent specialties were not highly differentiated. That ABPN continues to certify both specialties in spite of the divergence of the fields suggests an overlap in the clinical skills required to practice in either one. Unfortunately, no widely available model curriculum exists for clinical or didactic experience in these areas.

Our literature review revealed one article on the extent of neuroscience training within psychiatry residency programs. Roffman et al. (1) reported that the amount of neuroscience in psychiatry residency curricula has increased since the early 2000s, and their survey of psychiatry training directors demonstrated that further increases were expected. Directors reported that neuroscience constituted, on average, 12% of their residency curricula, but felt that it should comprise 20%.

We also found one article describing neuropsychiatry training within psychiatry residency programs. Duffy and Camlin (2) conducted a survey of psychiatry training directors and concluded that many psychiatry programs fail to provide adequate training in the evaluation and treatment of patients with neuropsychiatric disorders. Neuropsychiatry training objectives for psychiatry residents have been authored by the American Neuropsychiatric Association Education Committee (3). However, it is unclear how many psychiatry residency directors are aware of this document, which has not been widely distributed.

Some articles have also been published detailing suggestions for enhanced collaboration between psychiatry and neurology educators. Duffy and Camlin (2) suggest shared curricula for residents in the clinical neurosciences (psychiatry, neurology, and neurosurgery) that address core skills such as neuroimaging, neuropsychology, and the clinical examination. Matthews et al. (4) describe “neurobehavior rounds” that include a behavioral neurologist, neuroradiologist, neuropsychologists, and consultation–liaison psychiatrists. Chemali (5) suggests that, as part of psychiatry residents' longitudinal experience, their training could include a neuropsychiatry continuity clinic beginning in the PGY2 year and continuing throughout residency.

We found no studies assessing the type and extent of instruction in clinical neurology per se that occurs within psychiatry residency programs. We know that resident confidence in treating neurologic disorders declines during residency (6), and that although 78% of psychiatry training directors favor neurology rotations that occur in outpatient or consultation settings, most programs are not able to offer that type of training (7). Also, we know that psychiatry training directors have preferences for neurology content areas to which they would like their residents exposed during their neurology rotations (7). However, we found no studies that focus specifically on what programs actually offer during neurology rotations or on neurology didactic exposure.

Thus, the aim of this study was to address the literature gap in neurology didactic curricula for psychiatry residents. We surveyed psychiatry residency training directors to assess didactic instruction offered in this clinical area. Our goal was to gather specific data that could prove useful to psychiatry residency programs attempting to enhance their own neurology didactic curricula.

We anonymously surveyed the 172 directors of U.S. psychiatric residency training programs in the 2008–2009 American Association of Directors of Psychiatric Residency Training Membership Directory. Directors were sent an e-mail invitation in 2009 to complete a web-based survey on neurology didactic curricula for psychiatry residents. We sent an electronic reminder to complete the survey 1 month later.

The survey consisted of 10 multiple-choice and free-response style questions. The Institutional Review Board (IRB) of the University of Wisconsin granted an exemption from full IRB review.

Fifty-seven of 172 program directors (33%) ultimately completed the survey. The results revealed that, in addition to a neurology clinical experience, psychiatry residents formally received didactic instruction in neurology in many ways (Figure 1). The majority of psychiatry residents attend neurology didactics specifically designed for psychiatry residents (71%) and neurology didactics designed for neurology residents (54%). When psychiatry residents attend didactics designed for neurology residents while on a neurology service, most (41%) do so for an average of 1–2 hours per week.

The greatest number of neurology didactic hours are offered during the PGY1 and PGY4 years; 57% of respondents said that their programs offer more than 10 hours during the PGY1 year. In the PGY4 year, 32% of programs offer more than 10 hours, with another 25% offering 5–10 hours.

Many neurology topics are covered in those neurology didactics specifically designed for psychiatry residents. Those topics taught as part of neurology didactics by more than 75% of program respondents are the following: stroke/vascular disorders, epilepsy, dementia, movement disorders, and headache. Neurology didactics designed for psychiatry residents are frequently taught by neurology faculty (72% of programs) and psychiatry faculty (39%), with most programs using a combination of the two. Dually-appointed faculty and psychiatry and neurology residents less commonly teach these topics. The majority of respondents (85%) require or recommend the same textbook: Clinical Neurology for Psychiatrists by Kaufman (8).

Many programs use other educational resources or technologies, especially neuroradiology rounds or consultation (51% of programs), neuroanatomy lab (e.g., “brain-cutting;” 34%), and other electronic formats (e.g., CD-ROM [14%]) to teach their residents neurology; 97% of psychiatry programs utilize neurology scores on the Psychiatry Resident In-Training Examination (PRITE) to assess their residents' neurology knowledge. Over half also use ABPN performance (56%) and performance evaluations by faculty (51%).

Fifty-five percent of program directors believe that their programs offer adequate neurology didactics for their psychiatry residents. Over half of respondents offered answers to what they would change about their neurology didactics. Many desire more integration of psychiatry and neurology didactic instruction and more involvement of neurologists as a routine manner. Several also would like more case-based instruction.

Psychiatry residents receive neurology didactic education from their own psychiatry faculty, as well as from neurology faculty. An impressive array of topics is covered, and many programs use educational methods other than didactics, notably, neuroradiology rounds and brain-cutting. The list of commonly-covered topics could serve as a useful starting-point for programs wanting to cover all salient neurology topics in their didactic curricula. At the very least, programs should teach the topics on this list that overlap with those on Selwa et al.'s list (7) of neurology topics felt by psychiatry training directors to be most important to cover during neurology rotations. Those topics that are both commonly taught and perceived as important would thus include the following: dementia (especially differential diagnosis and biological substrates), movement disorders (including diagnosis and treatment and especially, drug-related disorders), sleep disorders (especially apnea, insomnia, and sleep deprivation), and stroke (especially, late complications).

Opportunities exist for improvement in neurology didactic curricula. Although many programs take advantage of already-available neurology didactic educational experiences, approximately one-half do not. Many training directors desire more involvement with neurology faculty. One possibility for collaborative learning is to involve neurology trainees, especially neurology chief-residents and fellows, in delivery of didactic instruction. In turn, psychiatry trainees could offer teaching to their neurology counterparts. Such an interchange could afford important teaching opportunities for trainees and a sense of collegiality and interdisciplinary teamwork with colleagues at similar training levels.

Most psychiatry residency programs offer their neurology rotations during the PGY1 year. Many then offer neurology instruction in PGY4 Board-review courses. However, it might make sense to offer a longitudinal neurology didactic curriculum. In fact, Albucher et al. (6) call into question the tendency of psychiatry residency programs to offer the bulk of their neurology experiences early in residency. They point out that training in neurology should provide sufficient didactic and clinical experience to develop expertise in the diagnosis of neurological conditions encountered in psychiatric practice and that must be considered in the differential diagnosis of psychiatric conditions. We note that PGY1s are just starting to learn, in-depth, about psychiatric disorders, and, later in training, they might have a broader understanding of nuanced presentations of psychiatric illness, and thus a broader context for consideration of neurologic differential diagnoses.

Most psychiatry residency programs use the PRITE to assess neurology knowledge. This is potentially problematic, since the correlation of PRITE scores to the final ABPN examination is better in psychiatry than it is in neurology (9). Further study should examine better tools to assess neurology competency.

Our study has potential limitations: Responder bias is a possibility; those with interest in neurology education for psychiatry residents may be more likely to participate. The relatively low response rate (33%) may also limit the generalizability of our findings and recommendations. We have no way of knowing whether those directors who responded represent a unique subset in any way, as our survey was not designed to assess characteristics such as the locations, size, or affiliation of respondents' programs.

In conclusion, the majority of psychiatry residency programs offer neurology didactic instruction to their residents, as provided by both neurology and psychiatry faculty, in various settings and covering many topics. Although finding this is reassuring, there is room for improvement. Directions for future research include effectiveness of increased collaboration between neurology and psychiatry departments in offering didactic instruction and enhanced integration of neurology and psychiatry didactic curricula.

Several areas for possible collaboration and integration between psychiatry and neurology exist. For example, combining the training that neurology residents receive in dementia and psychiatry residents receive in geriatric psychiatry into a single didactic experience might benefit both specialties. Likewise, research on methods to optimally assess neurology competence in ways that correlate with PRITE and ABPN outcomes is needed. Finally, we should determine the impact of strong neurology training on ultimate PRITE and ABPN scores and other markers of clinical success. For now, our hope is that this article will help psychiatry residency programs optimize their own neurology didactic curricula.

Manuscripts authored by an editor of Academic Psychiatry or a member of its editorial or advisory board undergo the same editorial review process, including blinded peer-review, applied to all manuscripts. Also, the editor is recused from any editorial decision-making.