LAUSR

Historically, neurology, psychiatry, and neuroscience overlapped; it is only recently that disciplinary silos have divided these fields. In the eighteenth and nineteenth century, many significant figures in neurology and psychiatry, including Freud, Charcot, Alzheimer, and Kraepelin, emerged from a shared epistemological background [1]. In the early twentieth century, a period of rapid medical specialization, most physicians in these fields enjoyed board certification in both specialties [2]. However, in the second half of the twentieth century, training pathways for neurology and psychiatry diverged [1]. By the 1980s, there was little emphasis on cross-training between neurology and psychiatry [2]. Over the past three decades, there has been an increase in residency training emphasis on neuroscience, “a broad discipline encompassing the study of the nervous system and behavior using cellular and molecular biology, animal models, neuroanatomy, neuroimaging, genetics, neuropsychology, and basic pharmacology (as opposed to clinical pharmacology)” [3]. Since 2006, there has been a boom in neuroscience education with the rapidly developing National Neuroscience Curriculum Initiative [4], but the challenge of clinical application remains [5]. Neuroscience, neuropsychiatry, and neurology are distinct entities [3, 5, 6]. Neuroscience in psychiatry involves understanding psychiatric illness through the lens of neuroscientific knowledge ranging from functional anatomy to genomics; examples include microstructural neurodevelopmental aspects of schizophrenia and the neurobiology of suicide. Neurology and neuropsychiatry are fundamentally clinical. Neurology refers to the care of patients with disease of the brain, spinal cord, and peripheral nerves. Neuropsychiatry refers to the care of patients with affective, behavioral, and cognitive symptoms in the setting of neurologic disorders such as stroke or epilepsy, as well as to the care of patients with psychiatric illness that have comorbid or iatrogenic neurologic symptoms [5]. Neurology and neuropsychiatry training for psychiatry residents is not yet standardized. In this article, we critically review the current state of neurology and neuropsychiatry training for psychiatric residents: we explicitly consider the goals of such training, identify the gaps in training and the barriers to achieving these goals, and present suggestions for improving the neurology and neuropsychiatry training of psychiatrists.