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Keeping pace with advances in neurosciences is, in part, predicated upon an adequate knowledge of neurology obtained during the psychiatrist's residency training. Results from a questionnaire assessing resident abilties in neurology and psychiatry were compared with Psychiatry Resident In-Training Examination (PRITE) scores. Self-confidence for treating neurological disorders declined with the progression of training; however, neurology PRITE scores improved significantly. Psychiatric PRITE scores and psychiatric selfconfidence also improved over time. These findings have implications for current residency training criteria and education. (Academic Psychiatry 1999; 23:77-81)
Increases in neuropsychiatric knowledge have dramatically impacted the practice of clinical psychiatry (1-4), leading educators to question whether psychiatric residency training programs adequately prepare their trainees to deal with these changes (5,6). The increased emphasis on neurosciences is reminiscent of a time when neurology and psychiatry were highly related disciplines. During the late 1920s and early 1930s, when the nascent national examining bodies were forming, the majority of physicians who passed the first examination were board-certified in both specialties (3,7-9). After World War II, both neurology and psychiatry witnessed a gradual separation, such that by 1970 the American Board of Psychiatry and Neurology (ABPN) temporarily dropped the internship year requirement for psychiatric residents, and by 1981 neurology was completely eliminated from Part II of the board exam. This legacy of separation between the two fields still pervades psychiatric training programs, perhaps negatively impacting on residents' abilities to diagnose and treat neurological and neuropsychiatric disorders (10,11).
At the University of Michigan Department of Psychiatry, we currently provide 2 months of a neurology rotation (both inpatient and outpatient) in the first year of training as recommended by the Residency Review Committee (RRC). We wanted to examine whether this type of training ensured both good performance on standardized testing, as well as a high degree of resident self-confidence in the diagnosis and treatment of neurological and neuropsychiatric disorders. Our concern is that although the practice of psychiatry has changed rapidly over the last several decades, residency programs still devote only 2 months during the first year to neurology training. This at a time when psychiatrists increasingly need a better command of neurology to assess and treat patients with neurological and neuropsychiatric disorders. Residents also need a solid understanding of neuroanatomy, neuroendocrinology, and...