Student-created vignettes to enhance pharmacy student knowledge and skill in managing patients with neuropsychiatric disease

Backgound: Neuropsychiatric disease is common globally. It is vital train pharmacists to provide patient-centered care in neuropsychiatry. Objective: To evaluate the impact of student-created vignettes on their knowledge and abilities to assess and manage patients with neuropsychiatric diseases, and to evaluate their experience. Methods: Several learning/assessment methodologies within the Therapeutics III course were utilized, including a major assignment of student-created vignettes about neuropsychiatric diseases. A framework guided student in creating the vignettes; identifying conception, design, and administration. Created vignettes were evaluated based on a validated scoring guide. Mean scores in various assessments were compared using Spearman’s rank-order correlation. Students evaluated their experience on a 5-point Likert-type scale of 1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree. Results: Overall, students’ performance in the assignment was excellent, average score = 92%. A significant correlation existed between the vignette assignment and assessments covering neuropsychiatric disease. Most students agreed they were made aware of what needed to be done (95%), that the instructions about elements to include, designs, and delivery mechanisms were enough (93.4%, 86.7%, and 93.4%, respectively). Most students agreed that developing the vignette was stimulating, engaging and enjoyable (93.3% and 90%, 88.3% respectively). Students stated they felt confident in their scientific background knowledge (88.3%), in employing communication strategies with patients (85%) and their families (83.3%), and in their confidence in promoting and supporting patients with the diseases. (AU)

Development and Evaluation of an Innovative Neurology E-learning Didactic Curriculum for Psychiatry Residents.

OBJECTIVE: This article describes the development, implementation, and piloting of an e-learning neuropsychiatry curriculum for psychiatry residents. The primary outcome of interest was feasibility. Secondary outcomes were interest and confidence caring for patients with neuropsychiatric disorders, and knowledge about neuropsychiatry. METHODS: The curriculum was designed utilizing Kern's six-step framework. A ten-module, interactive, primarily vignette-based e-learning curriculum was developed focusing on the neurocognitive exam and neurocognitive disorders. The curriculum was piloted in two psychiatry residencies in Brooklyn, NY (n = 80 residents). The curriculum was evaluated using a survey adapted from the General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) and a 24-item neuropsychiatry examination prior to the intervention and 1-month post-intervention. Qualitative feedback was acquired through four open-ended items in the post-curriculum survey, which underwent a thematic analysis. RESULTS: Seventy-eight of eighty residents completed the full curriculum. Three of nine attitude items demonstrated significant differences, with residents feeling less frustrated managing dementia (pre-mean = 2.32, post = 2.68, t(2,59) = 2.00, p = 0.004), less frustrated due to not knowing how to effectively treat dementia (pre-mean = 2.05, post = 2.95, t(2,59) = 6.27, p = 0.000), and demonstrating less interest in pursuing further training in neuropsychiatry (pre-mean = 1.95, post = 2.18, t(2,59) = 1.70, p = 0.047), though still overall showing interest. There was no change in confidence ratings. There was a small but significant improvement in total number of knowledge items answered correctly. CONCLUSIONS: This study demonstrated the feasibility of implementing an e-learning neuropsychiatry curriculum. It also demonstrated an improvement in resident responses to two attitude items and an increase in neuropsychiatry knowledge.

The Neuropsychiatric Approach to the Assessment of Patients in Neurology.

Neuropsychiatry is a clinical neuroscience specialty focused on the evaluation and treatment of patients who present with symptoms at the intersection of neurology and psychiatry. Neuropsychiatrists assess and manage the cognitive, affective, behavioral, and perceptual manifestations of disorders of the central nervous system. Although fellowship training in behavioral neurology-neuropsychiatry exists in the United States and several other countries internationally, the need for neuropsychiatric expertise greatly outweighs the number of specialists in practice or training. This article serves as a primer for both neurologists and psychiatrists seeking to improve or refresh their knowledge of the neuropsychiatric assessment, including detailing aspects of the history-taking, physical exam, psychometric testing, and associated diagnostic work-up. In doing so, we urge the next generation of neurologists and psychiatrists to take on both the opportunity and challenge to work at the intersection of both clinical neuroscience specialties using an integrated neuropsychiatric perspective.

Trainee experiences in a specialist neuropsychiatry training position.

OBJECTIVE: To explore trainee perceptions of a specialist training post in neuropsychiatry. METHOD: Of 47 past trainees who had worked in the Neuropsychiatry Unit at the Royal Melbourne Hospital during the period 1993 to 2017, 32 (68%) completed an online questionnaire including 10 questions, 4 of which asked for open-ended responses. RESULTS: Most trainees provided positive feedback about their past experiences working on the unit, including utilizing knowledge and experience in their current practice. To an open question about how working on the unit influenced career choices 21/31 (68%) responses were positive. The remaining 10 responses highlighted areas of improvement for the trainee positions. CONCLUSIONS: The specialty training position within neuropsychiatry was very popular among past trainees, the majority of whom endorsed using the knowledge learnt in neuropsychiatry in their current practice and recommended work on the unit to future trainees.

An International Curriculum for Neuropsychiatry and Behavioural Neurology.

With major advances in neuroscience in the last three decades, there is an emphasis on understanding disturbances in thought, behaviour and emotion in terms of their neuroscientific underpinnings. While psychiatry and neurology, both of which deal with brain diseases, have a historical standing as distinct disciplines, there has been an increasing need to have a combined neuropsychiatric approach to deal with many conditions and disorders. Additionally, there is a body of disorders and conditions that warrants the skills sets and knowledge bases of both disciplines. This is the territory covered by the subspecialty of Neuropsychiatry from a 'mental' health perspective and Behavioural Neurology from a 'brain' health perspective. This paper elaborates the neuropsychiatric approach to dealing with brain diseases, but also argues for the delineation of a neuropsychiatric territory. In the process, it describes a curriculum for the training of a neuropsychiatrist or a behavioural neurologist who is competent in providing a unified approach to the diagnosis and management of this set of conditions and disorders. The paper describes in some detail the objectives of training in neuropsychiatry and the key competencies that should be achieved in such higher training after a foundational training in psychiatry and neurology. While aiming for an internationally relevant training program, the paper acknowledges the local and regional differences in training expertise and requirements. It provides a common framework of training for both Neuropsychiatry and Behavioural Neurology, while accepting the differences in skills and emphasis that basic training in psychiatry or neurology will bring to the subspecialty training. The future of Neuropsychiatry (or Behavioural Neurology) as a discipline will be influenced by the successful adoption of such a unified training curriculum.

Independent or Integrated? The Impact on Subject Examination Scores of Changing a Neuropsychiatry Clerkship to Independent Clerkships in Psychiatry and Neurology.

OBJECTIVE: This study was undertaken to assess any impact on National Board of Medical Examiners (NBME) neurology and psychiatry subject examination scores of changing from an integrated neuropsychiatry clerkship to independent neurology and psychiatry clerkships. METHODS: NBME psychiatry and neurology subject examinations scores were compared for all 625 students completing the required neuropsychiatry clerkship in academic years 2005-2006 through 2008-2009 with all 650 students completing the independent neurology and psychiatry clerkships in academic years 2009-2010 through 2012-2013. Statistical adjustments were made to ensure comparability across groups and over time. RESULTS: A significant improvement in subject examination scores was associated with the independent clerkships. CONCLUSIONS: The independent clerkship model was associated with a modest improvement in NBME subject examination scores. This finding may be attributable to many causes or combination of causes other than curricular design. Curricular planners need to pay attention to the potential impact of course integration on specialty-specific NBME subject examination performance.

Apuestas de razón. Residencia en Kant y Hegel / Stakes of reason. Residence in Kant and Hegel

La necesidad de pasar por un período de residencia para la formación como especialistas en psiquiatría pone de relieve la insuficiencia del conocimiento puramente teórico para orientar la práctica clínica. Para entender cómo pueda dicha residencia ofrecer el saber práctico del hombre que esta profesión requiere revisamos la concepción de la locura en Hegel junto a la propuesta de Kant para la aproximación a un mundo con sentido. En ambos reconocemos la insuficiencia de la razón para este cometido y la invitación a suponer que hay mundo y un sentido en él, a apostar que es así sin que pueda ser demostrado. A ello nos alienta la experiencia que tenemos de él, del mundo que habitamos, en el que residimos (AU)

The need to go through a residency training program to become specialists in psychiatry highlights the fact that purely theoretical knowledge is insufficient for guiding clinical practice. To understand how such training can provide the practical knowledge of man that this profession requires we review the concept of madness in Hegel along with Kant’s proposal of approaching a purposeful world. We recognize in them the insufficiency of reason for this purpose and an invitation to assume that there is a world and a sense in it, to wager that it is this way although it cannot be demonstrated. To this we are encouraged by the experience we have of the world we inhabit, in which we reside (AU)

Integrating Neuroscience Knowledge and Neuropsychiatric Skills Into Psychiatry: The Way Forward.

Increasing the integration of neuroscience knowledge and neuropsychiatric skills into general psychiatric practice would facilitate expanded approaches to diagnosis, formulation, and treatment while positioning practitioners to utilize findings from emerging brain research. There is growing consensus that the field of psychiatry would benefit from more familiarity with neuroscience and neuropsychiatry. Yet there remain numerous factors impeding the integration of these domains of knowledge into general psychiatry.The authors make recommendations to move the field forward, focusing on the need for advocacy by psychiatry and medical organizations and changes in psychiatry education at all levels. For individual psychiatrists, the recommendations target obstacles to attaining expanded neuroscience and neuropsychiatry education and barriers stemming from widely held, often unspoken beliefs. For the system of psychiatric care, recommendations address the conceptual and physical separation of psychiatry from medicine, overemphasis on the Diagnostic and Statistical Manual of Mental Disorders and on psychopharmacology, and different systems in medicine and psychiatry for handling reimbursement and patient records. For psychiatry residency training, recommendations focus on expanding neuroscience/neuropsychiatry faculty and integrating neuroscience education throughout the curriculum.Psychiatry traditionally concerns itself with helping individuals construct meaningful life narratives. Brain function is one of the fundamental determinants of individuality. It is now possible for psychiatrists to integrate knowledge of neuroscience into understanding the whole person by asking, What person has this brain? How does this brain make this person unique? How does this brain make this disorder unique? What treatment will help this disorder in this person with this brain?

Bridging the brain-mind divide in psychiatric education: The neuro-bio-psycho-social formulation.

Psychiatrists of the future need to have a strong working knowledge of the organ they work with-the brain. Neuropsychiatry is now more than a paradigm. Systems-level behavioral neuroscience, while still evolving, is mature enough to provide circuit-based foundation. Cellular and molecular neuroscience is starting to yield further mechanistic understanding. It is important to integrate such approaches into an evidence-based, bio-psycho-social formulation, with increasing implications for disease taxonomy, diagnosis and treatment.

A proposed solution to integrating cognitive-affective neuroscience and neuropsychiatry in psychiatry residency training: The time is now.

Despite increasing recognition of the importance of a strong neuroscience and neuropsychiatry education in the training of psychiatry residents, achieving this competency has proven challenging. In this perspective article, we selectively discuss the current state of these educational efforts and outline how using brain-symptom relationships from a systems-level neural circuit approach in clinical formulations may help residents value, understand, and apply cognitive-affective neuroscience based principles towards the care of psychiatric patients. To demonstrate the utility of this model, we present a case of major depressive disorder and discuss suspected abnormal neural circuits and therapeutic implications. A clinical neural systems-level, symptom-based approach to conceptualize mental illness can complement and expand residents' existing psychiatric knowledge.

DSM-5: ¿Cambios significativos? / DSM-5: Significant changes?

El DSM-5 salió a la luz en mayo de 2013, generando gran expectativa y controversia por sus cambios e inclusiones, como la eliminación de los ejes diagnósticos, la organización del manual en un modelo de “ciclo vital”, la aparición de nuevas entidades y el ajuste en los criterios de diagnóstico de muchos trastornos. El objetivo del presente artículo es presentar una aproximación al manual desde una perspectiva latinoamericana, exponiendo las opiniones personales de los autores respecto a los principales cambios (AU)

Since that DSM appeared on may of 2013, was generated an important expectative and controversy because of its changes in inclusions, the elimination of diagnostic axes, the manual’s organization in a model of “life cycle”, the emergence of new entities and the adjust in the criteria of diagnosis of many disorders. The aim of this paper is show an approach to manual from a Latin American perspective, and exposes the opinions of the authors regarding the major changes (AU)

Reflexiones para la memoria anual de residente de tercer año / Reflections for the annual report third-year resident

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Cooperar para innovar / Cooperate to innovate

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