Attitudes Toward Neuroimaging Education From Five Psychiatry Residencies: A Call for a Formal Neuroimaging Curriculum

Since the 1980s, developments in brain-imaging methods have advanced rapidly and are actively changing the knowledge base of psychiatry (1, 2). However, not much is known about neuroimaging education in psychiatric training.

We conducted a needs assessment to investigate the attitudes, self-perceived knowledge, and the need for a neuroimaging curriculum in a cohort of psychiatry residents at five university-based programs: University of Chicago (UChicago), University of Illinois at Chicago (UIC), University of Miami (UMiami), University of Maryland (UMaryland), and Drexel University (Drexel). This project was granted exempt status for multisite research by the UChicago Institutional Review Board, and an anonymous, voluntary, 20-item Web-based survey was used to collect data from December 2017 to January 2019.

Of 207 residents, 130 (63%) completed the survey. Response rates from each site were as follows: UChicago, 91%; UIC, 65%; UMiami, 67%; UMaryland, 51%; and Drexel, 55%. The sample of residents was as follows: PGY-1, 29%; PGY-2, 24%; PGY-3, 25%; and PGY-4, 23%.

The survey used a 5-point Likert scale system. A significant majority of respondents stated that they want to improve their knowledge of neuroimaging (85%), that neuroimaging education is important to psychiatric training (81%), and that there should be a formal neuroimaging curriculum during their training (78%). Only 8% reported that they are receiving adequate training in neuroimaging. About 10% reported being comfortable with their overall knowledge of radiological neuroanatomy. More specifically, only 11% reported being comfortable interpreting computerized tomography (CT) head images and only 6% at interpreting brain MRI images. We purposefully distinguished between reading the actual brain images and the summary reports, and we found that 52% reported feeling comfortable interpreting radiological impression/summary reports of either a CT head or brain MRI. Comfort with positron emission tomography/single-photon emission computed tomography (PET/SPECT) was especially low: only one trainee reported feeling capable of interpreting images, and merely 20% felt capable of interpreting a PET/SPECT report. Of concern, only 31% reported that they feel confident explaining neuroimaging topics to patients.

The good news is that this survey showed a very strong learner interest in a dedicated neuroimaging curriculum. The bad news is that it highlights the current state of neuroimaging education in psychiatry. Trainees’ overall self-assessment knowledge was low among all imaging modalities, but especially low for functional neuroimaging. Fortunately, trainees are overwhelmingly in favor of a curricular and cultural change in psychiatric imaging education, and they emphasized in the comments section of the survey that there is a large gap between perceived importance of these skills and the current status quo.

What should a targeted neuroimaging curriculum entail? At the bare minimum, it should emphasize that practicing psychiatrists should routinely look at the brain images themselves and become accustomed to identifying basic radiological neuroanatomy. Further skills should include the ability to recognize emergent imaging findings, describe abnormalities, and competently interpret neuroimaging of the brain.

This change should be fixed into the guidelines of psychiatric residency training. Currently, the Psychiatry Milestones Project (3) briefly mentions neuroimaging in the subcompetency of Clinical Neuroscience, and lists a level 4 milestone as being able to explain the significance of routine imaging and abnormalities to patient—a milestone that only 12 of 30 (40%) soon-to-be-graduating PGY-4s in our survey felt confident in accomplishing. Of note, this would not be considered acceptable practice for neurologists, who have an entire subcompetency within their residency training Neurology Milestones Project dedicated solely to the interpretation of neuroimaging (4).

In conclusion, future psychiatrists must have an understanding of neuroimaging techniques if they are to make neuroimaging-informed treatment decisions (5). The time is now to provide psychiatric residents with a formal curriculum in neuroimaging.