Post by Former NIMH Director Thomas Insel: Training for the Future
A lot has been written about the gap between modern neuroscience and contemporary psychiatry, sometimes caricatured as mindless neuroscience versus brainless psychiatry. Patients and families will need the field to overcome this gap if the power of modern neuroscience is to improve outcomes for people with autism or other serious mental illnesses.
How do we bridge this gap? To some extent, this problem is resolving itself. Every year more neuroscientists choose to train in psychiatry. The psychiatric residency program at Yale received applications from 60 M.D.-Ph.D. students this year, for only 16 positions. Other psychiatry programs also reported a spike in the number of Ph.D. neuroscientists who applied for post-graduate training after completing medical school.
Until recently these young physician-scientists often discovered that their residency training was completely disconnected from their rigorous scientific background. Psychiatry training comprised required instruction on psychodynamic theory, psychopharmacology, and psychotherapy but little that linked to their interests in brain circuits or brain function. Faculty taught largely what they were taught twenty years ago. There were exceptions—NIMH supports several residency programs to offer research tracks for a few residents to pursue science during their clinical training years—but for most young psychiatrists, training in 2015 is hardly different from training in 1995.
A small band of psychiatrists who are involved in residency training, led by David Ross at Yale, Melissa Arbuckle at Columbia, and Michael Travis at Pittsburgh, set out to change this with the creation of the National Neuroscience Curriculum Initiative (NNCI). This online set of teaching modules is grounded in principles of adult learning and innovative teaching methods. Take a look at http://www.nncionline.org. You can see the case conferences, experiential learning modules, and a course on neuroscience in the media that the NNCI uses as a toolkit to help residents navigate the new world of brain science.
Why would residents want to know about modern clinical neuroscience? After all, there are very few useful neuroscience-based diagnostic tests or treatments. What Dr. Ross and his colleagues discovered was a hunger for the information from modern brain science. At the annual meeting of residency training directors, the NNCI workshop has been a standing room only event for the past two years. Over 200 individuals from around the country have signed up to be part of the NNCI “learning collaborative,” a group that helps test and develop teaching materials, and more than 25 residency programs have incorporated NNCI material into their training.
It’s true that most of the neuroscience and genomics findings are not yet actionable for psychiatry. No one doubts that the brain is the organ of affect and behavior, but no one can point to a biomarker that is essential for clinical practice. In the short-run, we may do much more to bend the curve on suicide mortality by changing public policy (such as through restricting access to means) rather than finding a biomarker for suicidality. But in the long-run, and we need a long-run strategy, policy will hit a wall and we will need better diagnostics and therapeutics. That is where this new initiative can make a difference. The research of 2015 suggests that the clinician of 2025 and certainly the clinician of 2035 will need to know about cortical dynamics, neural networks, and genomic variation. Those entering the field today will need to know how to think about the brain and how to critique brain science. By changing the training of the next generation, we not only prepare for the future, we create it.