Combined neuropsychiatry residencies include the ACGME-specified training in general psychiatry and general neurology. Programs differ as to the amount of integrated neuropsychiatric training, though many include dedicated neuropsychiatry clinics and conferences. Fellowship curricula vary according to the patient population or research focus.
The ANPA Education Committee and the BNS have developed a recommended core curriculum applicable to both neuropsychiatry and behavioral neurology fellowships (available online at http://imaging.cmpmedica.com/CME/pt/content/neurocurr.pdf).
The ANPA Education Committee also maintains an online annotated bibliography of core references in neuropsychiatry under the editorship of Deborah Black, M.D., of the University of Toronto.Funding Issues
Given the high-profile advances in neuroscience research of the past few decades and the rapid evolution of available treatments, it might seem surprising at first glance that there are relatively few trainees in combined residencies or fellowship programs in this area. In part, the limited number of trainees is related to the limited number of practicing neuropsychiatrists in the country, resulting in little medical student contact. However, the realities of graduate medical education funding are another important factor. Medicare Part A, which pays for inpatient care for Medicare subscribers, funds hospitals to pay for the salaries and indirect educational expenses for residents in the majority of residency training programs in the United States. Part A funds can only be used for ACGME-accredited residency training and only provide the resident's salary until the time of initial board eligibility. Hospitals are reimbursed only 50% of their direct resident expenses after the fourth year of training, causing hospitals or departments to have to pay the balance of the fifth- and sixth-year salaries themselves. Because they are not eligible for Medicare funding, neuropsychiatry and behavioral neurology fellowship programs tend to rely on research dollars, clinical contracts and departmental funds for support of fellowship expenses, and discontinuities in the funding stream from year to year are not uncommon.General Psychiatry Training
Since 1987, the ACGME and the ABPN have required a minimum of two months of neurology training as part of psychiatry residency training. As of July, they also require one month of psychiatry training as part of neurology residency training. The neurology rotation for psychiatry trainees is supposed to provide sufficient didactic and clinical experience for residents to develop expertise in the diagnosis of neurological problems that might occur in psychiatric practice and require differential diagnosis from primary psychiatric conditions. The ANPA Education Committee has developed a set of more specific neuropsychiatry training objectives for psychiatry residents, the outline of which is listed in Table 4. A referenced version of these objectives with enabling objectives for each topic has been published elsewhere (Benjamin and Mah, 2002). Not all general psychiatry or neurology programs have access to neuropsychiatric faculty, so there is wide variability in resident exposure to neuropsychiatric thinking. Although there are now close to 100 textbooks and 25 journals in neuropsychiatry and related areas, there is still a need for curriculum materials designed to make the neuropsychiatric paradigm accessible to general psychiatry and neurology programs without neuropsychiatric faculty.Conclusion
Rapid advances in the neuropsychiatric sciences make this an exciting time to practice neuropsychiatry. A wealth of textbooks and journals have emerged in the past 20 years, along with a professional organization providing research forums, continuing education, training resources and opportunities for clinicians and researchers to interact with colleagues from related disciplines. The fields of neuropsychiatry and behavioral neurology are on a path toward eventual accreditation of training programs and certification of practitioners. The timing is excellent for a renaissance of neuropsychiatry training, despite the fact that funding issues, availability of faculty and absence of a formal board-certification process have restrained growth in neuropsychiatric training for the time being.