Bringing neuroscience to teaching rounds: Refreshing our clinical pidgin.

Abstract

Torous et al. offer a compelling proposal to ‘‘encourage all psychiatrists and psychiatry residents to engage in discussions around localizing suspected abnormally functioning brain circuits.’’ This timely paper offers a practical approach and echoes concerns (Bullmore et al., 2009; Kontos et al., 2006) about the pedagogical fallout of the current state of psychiatric practice. To put it more bluntly – are current workplaces inadequate learning environments for future psychiatrists? Will they transmit a style of practice that excludes emerging knowledge about the neurobiology of mental illness? Torous et al. offer several clinical examples, and are speaking as physicians, educators and scientists who are engaged in the real world of practice. The proposal thus evokes a familiar and central scene at the clinical coalface: the trainee and supervisor leaning in to their interaction with the patient. This is a triad in which the rubber of all our curricular aspirations meets the proverbial road of the clinical encounter where, for better and worse, habits of practice (and learning) are acquired. As with many practical initiatives, the authors acknowledge that there is much work to be done, e.g. to develop curricular resources, train faculty and address the limits of our knowledge. The effort itself, however, fits well within a long-standing pluralist tradition in medicine. Psychiatry has been a leading exemplar of such pluralism and can indeed welcome and integrate ‘Cognitive-Affective Neuroscience’ and ‘Neuropsychiatry’. Swales provided an illuminating and entertaining history of three old, and often battling, ‘cultures’ in medicine (Swales, 2000). While cutting-edge physiological theory (e.g. bleeding to target inflammation from excessive blood volume) had to sometimes yield to empirical evidence (patients with typhoid did not fare