Play-Doh and 3-D apps bring neuroscience into psychiatry training
Jennifer Stockwell brain image and photo
“Hello, my name is Josh Gordon from Columbia University, and I’m going to show you how to build your brain out of Play-Doh,” said Gordon, M.D., Ph.D. Two hundred psychiatry residency program directors from across the country watched Gordon on a video on their laptops, tablets, and other personal devices at the 2014 BRAIN Conference—the one-day, neuroscience-focused pre-meeting to the American Association of Directors of Psychiatric Residency Training conference in March in Tucson, Ariz. Gordon made the instructional video after the conference workshops were beta-tested ahead of time in New York. “Josh is something of a Play-Doh savant,” said David A. Ross, Ph.D. ’04, M.D. ’05, assistant professor of psychiatry, who helped plan the event. While many beta testers struggled to assemble the building blocks of the brain, Gordon was sculpting NMDA receptors, critical cellular structures for learning and memory. “It was stunning,” said Ross. At the conference, the residency program directors molded their own Play-Doh brains, following along as Gordon explained that the wad of yellow Play-Doh on their screens was the brain stem—a conduit through the spinal cord between the brain and the rest of the body. Layer by layer, from the multicolored blobs of nontoxic modeling material, a 3-D model of the brain emerged.
Neuroscience can be overwhelming, said Ross, one of three psychiatry educators spearheading the National Neuroscience Curriculum Initiative (NNCI), which aims to provide universities with the tools to teach neuroscience effectively. The NNCI provides a framework for neuroscience education, relying on expert neuroscientists and educators to generate content. The Play-Doh brain, the first module of the initiative, is a kinesthetic learning exercise that serves as an introduction to the complex organ. “We’re going to start with something simple and fun,” said Ross. “Let’s play.”
The NNCI was created in response to the rising demand for better neuroscience education in psychiatry. Historically, a deep divide has existed be-tween neuroscience’s biological approach to the mind and the more traditional—and humanistic—psychiatric perspective. In the past, neurobiological findings have not readily translated into patient care, but technological advances over the last two decades have the potential to revolutionize both our understanding of psychiatric illness and the development of new treatments. Advances in neuroimaging allow physicians to see healthy and abnormal brains in action, and advances in genetics have allowed researchers to identify rare genetic variants that contribute to such neuropsychiatric disorders as Tourette syndrome.
Surveys conducted at Stanford and Georgetown found that psychiatry residents overwhelmingly agreed that they needed better training to translate those advances into clinical practice. Still, only a handful of universities, Yale among them, have comprehensive neuroscience education programs.
One of the barriers to incorporating neuroscience into psychiatric training is the difficulty in teaching the subject effectively. Graduate medical education traditionally follows a lecture-intense format—a limited approach, according to Ross. “The literature on adult learning is that less than 5 percent of what’s presented in a lecture setting is retained, and even that, I think, is wonderfully generous,” he said. “There would be a tragic irony if we, as the psychiatrists and neuroscientists who are studying how adults learn, failed to take that into account in the way we’re teaching our trainees.”
Melissa P. Arbuckle, M.D., Ph.D., associate professor of clinical psychiatry and the associate director of resident education at the Columbia University College of Physicians and Surgeons, and chair of the 2014 BRAIN conference, teamed up with Ross and Michael J. Travis, M.D., associate professor of psychiatry at the University of Pittsburgh and director of Residency Training at Western Psychiatric Institute and Clinic at the University of Pittsburgh, to develop the BRAIN conference program—“Neuroscience: Why, What, and How to Teach It”—around novel ideas for ways to teach neuroscience. They dropped the traditional keynote lectures, opting for a workshop-driven day filled with new experiential learning approaches to neuroscience that other program directors could test at the conference and then incorporate into their own programs.
It worked. In the weeks immediately following the conference, the NNCI organizers began receiving positive feedback from programs around the country that had already implemented the Play-Doh exercise. Other modules developed for the brain meeting included an integrative case conference, which explores a case from biological, psychological, and social perspectives; a translational neuroscience module, in which participants look at cutting-edge clinical neuroscience research and discuss how those advances could reshape psychiatry; and a module called Talking Pathways to Patients, in which participants role-play physician-patient interactions using a laminated card with images from the 3-D brain app to explain to a patient the neural systems underlying a disorder.
“Building on this success, we wanted to formalize a structure for continuing this work on a broader scale,” said Ross. He and colleagues built a website to house the modules and their content, where programs across the country or the globe could access the materials and implement them into their own neuroscience programs. “They’re thinking past their own institutions,” said Joyce Y. Chung, M.D., the program director of the National Institute of Mental Health (NIMH) clinical research training program, who saw the potential of the initiative at the BRAIN conference and advised the group on their NIMH grant application. “When I saw what they had done without funding, I could only imagine what they could do with funding,” said Chung. In June of this year the group received a supplementary education grant of about $450,000.
The team created teaching guides for each module so that anyone without a background in neuroscience can feel comfortable teaching it.
Programs at Yale, Columbia, and Pittsburgh, which provide the framework for the NNCI, are at the leading edge of trends in psychiatry training. “At present, these advances in neuroscience education are a matter of passion for those involved,” wrote Mayada Akil, M.D., professor of psychiatry and vice chair for education at Georgetown, and her co-authors in an April 2014 commentary in Academic Psychiatry. “We hope that in five to 10 years they will become a matter of course.”