There has been an explosion of new information about the brain, especially over the past 25 years—new information that, to a great extent, other than psychopharmacology (1, 2), has not been incorporated in the ways psychiatrists and other physicians conceptualize mental illness (3). Residents’ preresidency education about neuroscience is more contemporary than that of their instructors and may vary in extent and type of exposure. Furthermore, whatever is taught in the residency will soon become obsolete, incomplete, or even incorrect as further research is published. Consequently, it is more important that residents learn how to update their knowledge of the neurosciences than it is to learn what is currently known.

The newer information about the biology of the mind has been accompanied by parallel discoveries in learning (4). We are learning about how brains work to create the mind and also discovering ways in which the mind learns. It is important that psychiatric educators develop new curricula that address both issues—the emerging information in the neurosciences as well as new understandings of teaching and learning—especially as medical education becomes more intentional, prospective, and accountable (5).

We have been working to address these issues within our program at the Michigan State University/Kalamazoo Center for Medical Studies Department of Psychiatry with a course in neurosciences for second-year residents, and its design and implementation has been challenging. The emerging information is difficult to understand for both residents and faculty members. It spans numerous domains, involves a wide range of constructs, and often uses jargon that can be daunting. Another challenge is that residents have studied the CNS in ways that stress the discovery of lesions and similar distortions of gross anatomic structures underlying CNS pathology during their neurology rotations and preclinical courses, but in psychiatry they have been immersed in an entirely different way of thinking about the brain and the distress of psychiatric patients. The DSM categories of mental illnesses based on phenomenologic descriptions; psychodynamic, behavioral, and family systems models of therapy; theories of the actions of psychotropic medications; and epidemiology dominate the didactic schedule. Furthermore, our residents are diverse in background and educational and life experiences. Finally, resources in our community do not include an eager, talented, and available stock of neuroscientists who might present more or less traditional lectures in neurosciences, let alone a course that might provide a wide range of content delivered in discrete packets to help students integrate the new information with their personal knowledge base or clinical cases.

Second-year residents gathered weekly for 20 weeks with one or two preceptors for 75-minute sessions with the expectation that they would take turns teaching one another neurosciences, exploring relevant, current literature according to a set list of topics distributed at the beginning of the course (Appendix 1). Just prior to the course, participating residents and facilitators shared dinner, watched a film (6), and briefly explored constructs related to the characters’ “mindsets” to establish a tone of imaginative and thoughtful exploration. In addition to their topical presentations, each participant read a book written for the lay public about applications of the neurosciences to an understanding of the mind and reported to the class about the book. The course preceptor(s) facilitated discussion and presented his or her own relevant subject matter. (In addition to the author, two faculty members have participated in the course as team-teachers for 3 of the 5 years the course has been offered. An interested colleague from neurosurgery also participated through one sequence.) By the end of the course, participants selected patients they had seen and framed three to four neurosciences questions related to their patients’ histories. They then queried the contemporary literature to explore these questions and submitted this as a “final exam.”

This course is intended to address students with considerable experience with psychiatric patients, who have become comfortable with traditional ways of thinking about and treating them, and to extend the model of illness they have been creating in their minds to incorporate a neurosciences perspective. It is intended to fit a model based on the development of expertise in which new information is increasingly incorporated into a scaffold built on previous knowledge and experience. Each student’s conceptual frame is expected to fit his or her level of professional development and to be unique to him or her in some regard.

This course incorporates several of the following emerging constructs related to the development of expertise: learner-centered education, case-based teaching, diagnostic teaching, the importance of metacognition, progressive formulation, expert versus novice conceptualization, and transfer of learning (7–10). Participation also leads to using telecommunications and information processing technology, teaching one another using computer presentation software, and extended literature searching.

The objectives of this study are to review the experience of establishing this course in relation to departmental and curricular needs by surveying participants for their precourse expectations and postcourse experience, to utilize this information in making course modifications, and to make the course description and results available to an audience of educators.

Participants

Psychiatric residents in our program who had successfully completed the first 18 months of their training (including at least 6 months of inpatient psychiatry training) participated by completing the required second-year course “Introduction to Neurosciences.” Four residents completed the course in each of the years 2003–2007 (N=20). The study protocol was approved by the institutional privacy board to safeguard participants’ personal and academic performance boundaries.

Instruments

Pre- and postcourse surveys (Appendix 2) were collected and collated by an administrative assistant who had no role in determining successful completion or resident course performance evaluations. Participants also were contacted by the administrative assistant for more remote follow-up, up to 4 years after completion of the course. The sample set is small, and results are predominately qualitative.

Of the 20 participants, 13 were women and three spoke English as their first language. Four completed bachelor’s degrees in the United States. Twelve of the participants had completed their training at the time of this report, and two had left the program. Of those participants who have graduated, four were hired by our program as academic faculty, three pursued further subspecialty training in child and adolescent psychiatry, two specialized in geropsychiatry, and one specialized in women’s studies.

The surveys asked participants initially to reflect on the role basic science played in their day-to-day work in psychiatry. After the course, the survey asked residents to reflect on ways their work in this course might influence their day-to-day work. Participants were also asked to comment on the importance of a knowledge of neurosciences in psychiatry and their current understanding of what the neurosciences are; an assessment of their current understanding of them; to reflect on their own learning style; and, at the completion of the course, on their experience in the course in this regard. Selected responses are shown in Appendix 2.

The original course objectives included building a personal conceptual framework of the contributions of contemporary neuroscience to an understanding of the functioning of the human brain through an exploration of the literature to assigned topics. The course also asked students to search and critically read the current scientific literature regarding the basic sciences relevant to psychiatric practice, estimate other learners’ understanding of neuroscience, and teach to those individuals’ understanding. In addition, the course aimed to develop a repertoire of student skills in the use of information processing systems and telecommunications technology for learning, teaching, and being able to listen to a patient’s history, perform appropriate examinations, and frame questions about that individual’s presentation that permit an exploration of pertinent basic science principles. The responses of participants suggest that several, at least, experienced a significant shift in their understanding of the neurosciences and the brain, although there is certainly no measure of a “personal conceptual framework.” Most of the other objectives seem to have been met, although it is my impression that the participants presented more constructs derived from material easily available on the Internet than through a close reading of the “scientific literature.” Learning to teach one another was a challenge for many participants, and the quality of preparation and presentation varied considerably from session to session and from year to year, but the presentations of all participants improved in pertinence, quality, and consistency over the time of the course.

The genesis of this course stems, first of all, from my attendance at 24 annual meetings of the Association for Research in Nervous and Mental Diseases in Manhattan and my subsequent struggle to determine relevance between those presentations and my clinical practice. This was combined with a direction suggested by an editorial of Hymen and Fenton (11) in Science, in which they commented:

Their suggestion for research provided a useful roadmap to a beginner’s exploration of these sciences and an invitation to use clinical information to frame potentially useful and searchable questions (which became the final examination for the course!). In some ways, then, our course parallels emerging constructs of dimensional and translational research. The addition of a more specific roadmap for the course, derived from the organization of Kandel et al.’s (12) basic text, helped launch the course.

The course fits comfortably within the framework of the ACGME’s competencies if one accepts the notion that a resident’s “practice” includes not only his or her work with patients, but also the construction and direction of his or her education and that of colleagues. Our “final exam” project fits well within the more conventional interpretation of the practice-based competency, and the work leading up to that has the participants immersed in the acquisition of a working knowledge base, the first of the “competencies.” The work of the participants required them to explore their own educational styles and knowledge base, as well as those of their colleagues, to actively explore and construct new learning on the scaffold of that understanding, and to work together to enhance the learning of all.

The residents seem to have appreciated their student-centered learning experience. They became less anxious and more competent in searching for literature, acquiring and reading basic science and review articles, making slide presentations, and explaining what they learned to their peers. Most believe that the substantial effort required of them was justified in its impact on their learning. Integrating the basic sciences with clinical cases also was welcomed by most residents.

Earlier aspects of the project described in this article were presented in a workshop at the October, 2004, annual meeting of the Association for Academic Psychiatry in Albuquerque, N.M., and at the March, 2005, annual meeting of the American Association of Directors of Psychiatric Residency Training in Tucson, Ariz.

The author is grateful to the Association for Research in Nervous and Mental Diseases for stimulating the ideas leading to this project; to Erik Wong, M.D., Lisa Gold, Ph.D., Galen Carey, Ph.D., Mihaly Hajos, Ph.D., Elizabeth Cox, M.D., and Ziad Kronful, M.D., for their model didactic presentations from which this project was derived; to faculty colleagues Stephanie Heard, M.D., Michael Liepman, M.D., and Robert Strung, M.D., who supported development of the project; and to the residents and faculty members who participated and helped to shape it.

At the time of submission, Dr. Dunstone declared no competing interests.