Educational Objectives
Behavioral neurology and neuropsychiatry are clinical neurosciences that focus on the care of patients with cognitive, emotional, and/or behavioral problems related to neurological illnesses. Recent advances in structural and functional brain imaging, clinical electrophysiology, and experimental psychology have fostered unprecedented growth in the clinical neurosciences and have enlightened our understanding of both normal and disturbed cognition, emotion, and behavior. These technologies and the findings from them complement the clinical interview and examination and extend the core knowledge base and clinical skills that define modern neuropsychiatry and behavioral neurology. A principal goal of this integrative approach is to transcend the mind-brain duality reflected in the separation of psychiatry and neurology. Given the breadth of the clinical problems encountered by behavioral neurologists and neuropsychiatrists, expertise in pharmacological, behavioral, psychosocial, and environmental interventions is required to address comprehensively the needs of patients with these conditions and their families.
Goals and Major Objectives:
- To develop clinical expertise in the care of patients with cognitive, emotional, and/or behavioral problems related to neurological illness, including understanding of diagnostic skills, neurologic and mental status examinations, cognitive testing, electrophysiological testing, neuroimaging, differential diagnosis, crisis intervention, application of time-limited psychotherapy, and referral for rehabilitative therapies.
- To gain a broad knowledge in the field through extensive exposure to the core literature in neuropsychiatry, neuropsychology, and behavioral neurology. The neuroanatomy and neurochemistry of cognition, emotion, and behavior are emphasized.
- To develop an understanding of the principles and practice of neuropsychopharmacology, with special emphasis on psychostimulants, cholinesterase inhibitors, NMDA receptor antagonists, anticonvulsants, atypical antipsychotics, antidepressants, and emerging neuropharmacologic agents, as well as the interactions of such agents with other medications.
This is fostered through participation in a structured educational curriculum that complements clinical and self-study experiences including clinical rounds, case conferences, individual supervision, and other courses or seminars relevant to training in behavioral neurology and neuropsychiatry. To develop an understanding of research and research methodology in behavioral neurology and neuropsychiatry.
Educational Objectives as Related to Program Activities
I. Patient Care
A. The fellow will demonstrate the ability to perform and document a comprehensive neuropsychiatric history and examination in adult and child/adolescent patients to include:
1. Complete present and past psychiatric and neurologic history
2. Social history
3. Family history
4. Substance use history
5. Medical history and review of systems
6. Physical and neurological examination
7. Comprehensive mental status examination, including assessment of cognitive functions
8. Based on a comprehensive neuropsychiatric assessment as previously described, the fellow will demonstrate the ability to develop and document the following:
a) Complete DSM-5/ICD differential diagnosis
b) Evaluation plan, including appropriate laboratory, imaging, and neuropsychological examinations
c) Comprehensive treatment plan addressing biological, psychological, and social domains
B. The fellow will demonstrate the ability to comprehensively assess, discuss, and document the patient’s potential for self-harm or harm to others and will intervene as appropriate. This will include:
1. Assessment of risk based on known risk factors
2. Knowledge of involuntary treatment standards and procedures
3. Effectively intervening to minimize risk
C. The fellow will establish a patient-physician relationship. This will specifically include:
1. Establishing and maintaining a therapeutic alliance with patients
2. Establishing and maintaining treatment goals
a) Interacting in a direct and nonthreatening manner
b) Responding to the patient and give feedback and advice
when appropriate
c) Understanding the patient as a unique individual within his/her family,
sociocultural, and community structure
Patient care competency will be evaluated/measured by:
- Patient Care Evaluation Form to be filled out by attending
- Global quarterly rating by attending
II. Medical Knowledge
- The fellow will demonstrate knowledge of the major neurobehavioral and neuropsychiatric
disordersbased on the scientific literature and standards of practice. This knowledge will include:
1. Epidemiology of the disorders
2. Etiology of the disorder, including medical, genetic, and social factors
3. Phenomenology of the disorder
4. DSM-5 and other diagnostic criteria
5. Effective treatment strategies
6. Course and prognosis
B. The fellow will demonstrate knowledge of neuropsychotropic medications including antidepressants, antipsychotics, antiepileptics, anxiolytics, mood stabilizers, hypnotics, and stimulants. In addition, the fellow will demonstrate knowledge of the cognitive and psychiatric side effects of non-psychiatric medications including steroids, antihypertensives, antiarrhythmics, antibiotics, antifungals, and cancer chemotherapeutic agents. For neuropsychotropic medications, this knowledge shall include:
1. Pharmacological action
2. Clinical indications
3. Side effects
4. Drug interactions
5. Toxicity
6. Appropriate prescribing practices
C. The fellow will demonstrate knowledge of the neuropsychiatric issues regarding substances of abuse. This knowledge includes:
1. Pharmacologic action
2. Signs and symptoms of toxicity and their management
3. Signs and symptoms of withdrawal and their management
4. Manifestations and management of the chronic effects of substance
use disorders
5. Epidemiology and social factors
D. The fellow will demonstrate knowledge of brain-behavior relationships underlying normal functioning and neuropsychiatric conditions. This knowledge includes the brain-behavior relations pertaining to:
1. Attention and concentration
2. Memory
3. Abstract thinking
4. Volition
5. Mood and affect
6. Language and speech
7. Calculation
8. Visuospatial skills
9. Motor regulation
10. Self-monitoring
11. Social skills
E. The fellow will demonstrate relevant knowledge about psychiatric and behavioral
manifestations of neurological and medical diseases, and the management of neuropsychiatric
disorders in a medical setting.
F. The fellow will attend didactic courses and seminars including:
1. Behavioral Neuroanatomy
2. Cognitive and Behavioral Neurology
3. Neuroanatomy Review Series
4. Applied Neurobehavior Seminar Series
5. Behavioral Neuroscience Seminar
6. Functional MRI Seminar
7. Neuropsychiatry/Behavioral Neurology Literature Seminar
8. Neurology and Psychiatry Grand Rounds
Medical knowledge competency will be evaluated/measured by:
- Quarterly global and monthly rotation-specific written evaluations by attendings and supervisors.
III. Practice-Based Learning and Improvement
Neuropsychiatrists/behavioral neurologists must recognize and accept limitations in their knowledge and clinical skills, and practice lifelong learning.
A. The fellow will acquire appropriate skills in obtaining up-to-date information from the scientific and practice literature and other sources to assist in patient care. This shall include, but is not limited to, the competent use of:
1. Medical libraries
2. Information technology, including Internet-based searches and literature databases
(e.g., Medline)
3. Drug information databases
B. The fellow shall evaluate caseload and practice experience systematically. This may include:
1. Maintaining patient logs
2. Reviewing patient records and outcomes
3. Obtaining appropriate supervision
4. Maintaining a system for examining errors in practice and initiating improvements to eliminate errors.
- The fellow shall demonstrate the ability to critically evaluate the scientific literature. This may include:
- Using knowledge of common methodologies employed in psychiatric research to evaluate studies, particularly drug treatment trials
- Conducting and presenting reviews of current research in such formats as journal clubs, grand rounds, or original publications
- Researching and summarizing a particular problem that derives from the fellow’s caseload
- The fellow shall be able to:
- Review and critically assess scientific literature to determine how quality of care can be
improved in one’s practice and to assess the applicability of research findings to patients,
taking into account their sociodemographic and clinical characteristics.
- Develop and pursue effective remediation strategies that are based on critical review of
scientific literature Practice-based learning and improvement will be evaluated/measured by:
- Portfolio
- Critical Review Form 10
- Application of research and statistics (portfolio)
- Use of information technology (portfolio)
IV. Interpersonal and Communication Skills
A. The Fellow shall demonstrate the following abilities:
1. To listen to and understand patients and to attend to their nonverbal communication
2. To communicate effectively with patients using verbal and nonverbal skills as appropriate
3. To develop and maintain a therapeutic alliance with patients by instilling feelings of trust, honesty,
openness, rapport, and comfort in the relationship with physicians
4. To partner with patients to develop an agreed upon healthcare management plan
5. To transmit information to patients in a clear and meaningful fashion
6. To understand the impact of physicians’ own feelings and behavior so that it does not interfere with appropriate treatment
7. To communicate effectively and work collaboratively with allied healthcare professionals and with other professionals involved in the lives of patients and families
8. To educate patients, their families, and professionals about medical, psychosocial, and behavioral issues
B. The Fellow shall demonstrate the ability to obtain, interpret, and evaluate consultations from other medical specialties. This shall include:
1. Knowing when to solicit consultation and having sensitivity to assess the need for consultation
2. Formulating and clearly communicating the consultation question
3. Discussing the consultation findings with the consultant
4. Discussing the consultation findings with the patient and family
C. The Fellow shall serve as an effective consultant to other medical specialists, mental health professionals, and community agencies by demonstrating the abilities to:
1. Communicate effectively with the requesting party to refine the consultation question
2. Maintain the role of consultant
3. Communicate clear and specific recommendations
4. Respect the knowledge and expertise of the requesting professionals
D. The Fellow shall demonstrate the ability to communicate effectively with patients and their families by:
1. Gearing all communication to the educational and intellectual levels of patients and their families
2. Demonstrating sociocultural sensitivity to patients and their families
3. Providing explanations of psychiatric and neurological disorders and treatment that are jargon-free and geared to the educational/intellectual levels of patients and their families
4. Providing preventive education that is understandable and practical
5. Respecting the patients' cultural, ethnic, religious, and economic backgrounds
6. Developing and enhancing rapport and a working alliance with patients and their families
7. Ensuring that the patient and/or family have understood the communication 11
- The fellow shall maintain up-to-date medical records and write legible clear prescriptions. These records must capture essential information while simultaneously respecting patient privacy, and they must be useful to health professionals outside psychiatry and neurology.
F. Trainees shall demonstrate the ability to effectively lead a multidisciplinary treatment team, including being able to:
1. Listen effectively
2. Elicit needed information from team members
3. Integrate information from different disciplines
4. Manage conflict
5. Clearly communicate an integrated treatment plan
G. The fellow shall demonstrate the ability to communicate effectively with patients and their families while respecting confidentiality. Such communication may include:
1. The results of the assessment
2. Use of informed consent when considering investigative procedures
3. Genetic counseling and palliative care when appropriate
4. Consideration and compassion for the patient in providing accurate medical information and prognosis
5. The risks and benefits of the proposed treatment plan, including possible side-effects of medications and/or complications of non-pharmacologic treatments
6. Alternatives (if any) to the proposed treatment plan
7. Appropriate education concerning the disorder, its prognosis, and prevention strategies Interpersonal and communication skills will be evaluated/measured by:
- Patient Care Evaluation Form
- Global Quarterly or Specific Rotation rating by attending
Interpersonal and communication skills will be emphasized throughout the rotations, and will be assessed by means of quarterly evaluations filled out by attending physicians, residents, and nursing and ancillary staff.