How Much Education and Training Do Residents Across Specialties Receive in Neuropsychology?

INTRODUCTION: Neuropsychologists play an important role on multidisciplinary teams with physicians from multiple specialties. The extent of residency training on the use of neuropsychological services is unclear. Medical residents across multiple specialties throughout the United States were surveyed to assess resident education, training, and understanding of neuropsychological services, along with their intent to consult neuropsychologists in the future. METHODS: A survey was sent to residents in accredited psychiatry, neurology, family medicine, and internal medicine programs. After data were collected, chi-square group level analyses with post-hoc pairwise comparisons were used to analyze the data. RESULTS: A total of 434 residents took the survey. The proportion of residents exposed to neuropsychology during residency varied significantly according to specialty (χ2 (3, N = 419) = 51.4, p < 0.001), with more psychiatry and neurology residents reporting exposure than residents in family medicine or internal medicine. Similarly, the proportion of psychiatry and neurology residents who 'agree' or 'strongly agree' that they understand the nature of neuropsychological services differed significantly from family medicine and internal medicine residents (χ2 (3, N = 415) = 40.4, p < 0.001). The majority of residents across all specialties (85.7%) reported they are likely to consult/order neuropsychological services in future practice. CONCLUSIONS: The majority of residents in all specialties reported exposure to neuropsychological services in some manner, but forms of exposure varied. Results indicated a need for increased education and training in neuropsychological services, especially within family medicine and internal medicine programs.

A plant-by-plant strategy for high-ambition coal power phaseout in China.

More than half of current coal power capacity is in China. A key strategy for meeting China's 2060 carbon neutrality goal and the global 1.5 °C climate goal is to rapidly shift away from unabated coal use. Here we detail how to structure a high-ambition coal phaseout in China while balancing multiple national needs. We evaluate the 1037 currently operating coal plants based on comprehensive technical, economic and environmental criteria and develop a metric for prioritizing plants for early retirement. We find that 18% of plants consistently score poorly across all three criteria and are thus low-hanging fruits for rapid retirement. We develop plant-by-plant phaseout strategies for each province by combining our retirement algorithm with an integrated assessment model. With rapid retirement of the low-hanging fruits, other existing plants can operate with a 20- or 30-year minimum lifetime and gradually reduced utilization to achieve the 1.5 °C or well-below 2 °C climate goals, respectively, with complete phaseout by 2045 and 2055.

Fusing subnational with national climate action is central to decarbonization: the case of the United States.

Approaches that root national climate strategies in local actions will be essential for all countries as they develop new nationally determined contributions under the Paris Agreement. The potential impact of climate action from non-national actors in delivering higher global ambition is significant. Sub-national action in the United States provides a test for how such actions can accelerate emissions reductions. We aggregated U.S. state, city, and business commitments within an integrated assessment model to assess how a national climate strategy can be built upon non-state actions. We find that existing commitments alone could reduce emissions 25% below 2005 levels by 2030, and that enhancing actions by these actors could reduce emissions up to 37%. We show how these actions can provide a stepped-up basis for additional federal action to reduce emissions by 49%-consistent with 1.5 °C. Our analysis demonstrates sub-national actions can lead to substantial reductions and support increased national action.

Residents Perceive Limited Education on Family Planning and Contraception for Patients with Severe and Persistent Mental Illness.

OBJECTIVE: The primary goal of this study was to assess perceived adequacy of training by residents from multiple specialties on contraceptive prescribing and family planning for patients with severe and persistent mental illness (SPMI). Secondary goals included the following: (1) explore resident knowledge, attitudes, and behavior towards patients with SPMI and (2) identify barriers to meeting the reproductive health needs of patients with SPMI. METHODS: The target population was 44,237 residents from four medical specialties. Participants were from a stratified, self-selected sample. Program coordinators were asked to forward a survey link to residents. Consenting residents were provided access to a questionnaire via a secure, web-based application (REDCap). The survey assessed resident education on the reproductive health needs of patients with SPMI and included demographics (age, gender, year of residency, and specialty), perceived adequacy of training, knowledge, and attitudes, and barriers regarding contraception and family planning. Responses were summarized with frequency and compared by medical specialty. RESULTS: A total of 768 residents consented: 49% female, 20% male, and 31% did not indicate their gender; 19% were first year residents, 21% second year residents, 21% third year residents, 8% fourth year residents, and 30% did not indicate their year of training. By specialty, 30.6% of residents were from family medicine programs (n = 235), 10.8% were from internal medicine programs (n = 83), 18.1% were from OBGYN programs (n = 139), and 10.4% were from psychiatry programs (n = 80); 231 (30.1%) did not indicate specialty. Regarding training, 60% of residents disagreed or strongly disagreed that they had proper training on prescribing contraceptives for patients with SPMI (363 of 599). Sixty two percent of residents disagreed or strongly disagreed that they had proper training about family planning for patients with SPMI (368/599). Over 83% of residents surveyed (405/486) would prescribe contraception for patients with SPMI if they had adequate training. CONCLUSIONS: Results indicate the need for curricular change on the reproductive health needs of patients with SPMI.