Developing a Curriculum for Functional Neurological Disorder in Neurology Training
Sara Finkelstein1, Angela O'Neal4, Gaston Baslet5, Barbara Dworetzky6, Ellen Godena1, Julie Maggio2, Daniel Millstein1, Tracey Milligan7, David Perez3
1Neurology, 2Physical Therapy, 3Neurology & Psychiatry, Massachusetts General Hospital, 4Neurology, 5Psychiatry, Brigham and Women's Hospital, 6Brigham and Women's Hospital, 7Neurology, Westchester Medical Center Health Network, New York Medical College
Objective:
To put forward a case for why a functional neurological disorder (FND) curriculum is needed and to provide guidance on curricular content and teaching methods. 
Background:

FND is commonly encountered by neurologists, with a growing body of evidence-based treatments operationalized over the past two decades. There remains a large gap in neurology education regarding FND, with little to no formal teaching over the course of medical education, and many practicing neurologists do not feel as though they have good knowledge of FND.

Design/Methods:

We included multidisciplinary and interdisciplinary expert consensus from FND care providers across neurology, psychiatry, social work, physical therapy, and psychology to develop a framework for the development of an FND curriculum for neurology residents. 

Results:

Key curricular content regarding FND should include:

1) Medical knowledge regarding pathophysiology and neuropsychological etiological factors, diagnostic criteria, approach to adjunctive diagnostic testing, and principles underlying treatment modalities (rehabilitative and psychological therapies). 

2) Clinical skills including being able to perform a psychiatric and social history, specific exam maneuvers to determine rule-in diagnostic features, and formulation of a multidisciplinary treatment and longitudinal care plan.

3) Communication and collaboration skills including effectively conveying an FND diagnosis, educating the patient/family around diagnosis and management including addressing diagnostic doubt, and a thorough understanding of all care team member roles and ability to work together towards care optimization. 

Methods for teaching this curricular content should include didactic sessions, clinical exposure, and access to supplementary content resources for self-guided learning. Methods for evaluation of curricular content should be linked to Accreditation Council for Graduate Medical Education milestones and include written evaluation, direct clinical observation, and standardized skill assessment through use of standardized or simulated patients.   

Conclusions:
A dedicated FND curriculum to appropriately train residents is needed, and should aim to provide knowledge, clinical acumen, communication skills, and effective use of team-based collaboration.
10.1212/WNL.0000000000202098