The study, led by Adela-Georgiana Buciuc of the University of Miami Health System and Jackson Health System, together with Heidi Linden Kiziah and Zelde Espinel, set out to measure a problem that medical educators have flagged repeatedly over the past decade but rarely quantified at the earliest stage of psychiatric training. The researchers administered a voluntary, anonymous 19-item questionnaire to 43 junior psychiatry residents at a single academic institution. Twenty-nine residents completed the survey, a response rate of 67 percent, including nine first-year residents, twelve second-year residents, and eight third-year residents. The instrument, adapted from a needs assessment previously developed by Medina and colleagues, asked residents to rate their confidence across twelve clinical neuroimaging tasks and to describe their attitudes toward imaging in psychiatric practice, using a five-point Likert scale ranging from strongly disagree to strongly agree. The study was approved as exempt by the participating institution’s Institutional Review Board, and participation was fully anonymous.

The headline numbers are sobering. Baseline self-efficacy averaged just 2.18 out of 5.0 across all cohorts, well below the midpoint of the scale. Confidence was lowest for the modalities and skills that sit furthest from routine psychiatric work: residents reported the least confidence in interpreting positron emission tomography and single-photon emission computed tomography reports, with a mean score of 1.69, followed by recognizing functional neuroanatomy at 1.83 and independently interpreting brain magnetic resonance imaging studies at 1.86. These are not exotic skills. Functional neuroanatomy underpins nearly every conversation psychiatrists have about mood, psychosis, and cognition, and brain MRI is ordered routinely in the workup of first-episode psychosis and suspected dementia. The fact that trainees feel barely equipped to engage with these reports suggests a widening gap between what modern psychiatric practice demands and what residency curricula deliver.

Perhaps the most consequential finding is what the data reveal about the trajectory of learning over time. A one-way analysis of variance found no statistically significant difference in self-efficacy across training years: first-year residents averaged 2.00, second-years 2.35, and third-years 2.10, with F(2,26) equal to 0.83 and a p-value of 0.45. In other words, confidence did not grow with seniority. Three years of clinical rotations, call nights, and informal exposure to radiology reports produced no measurable gains in how equipped residents felt to interpret neuroimaging. The authors interpret this null result as evidence that unstructured clinical exposure alone is insufficient to build this competency, a conclusion with significant implications for how residency programs allocate teaching time.

Residents themselves appear acutely aware of the problem. Satisfaction with current neuroimaging knowledge was lowest among first-year residents, with a mean of just 1.22 out of 5.0, and levels of neurophobia, the well-documented anxiety that medical trainees experience when confronted with neurology and neuroscience content, remained elevated across all three training levels, with an overall mean of 2.86. Neurophobia is not a trivial phenomenon. Decades of medical education research have linked it to avoidance of neuroscience-heavy specialties and to superficial learning strategies that prioritize memorization over mechanistic understanding. The finding that imaging-related anxiety does not attenuate with seniority in the absence of deliberate instruction suggests that the problem is self-perpetuating: trainees who feel incompetent avoid the material, and avoidance prevents the competence from ever developing.

What makes the study particularly striking is the contrast between competence and motivation. While self-efficacy languished at 2.18 out of 5.0, composite attitude scores averaged 3.69, with broad agreement among respondents that a dedicated neuroimaging curriculum should be part of residency education. Residents, in short, want to develop this competency but do not feel equipped to do so. The authors argue that this dissociation indicates the barrier is primarily institutional rather than attitudinal. This distinction matters for program directors and educators, because interventions aimed at motivating learners are likely to miss the mark when the learners are already motivated. What is missing instead is structured instruction: dedicated didactic time, supervised reading of actual scans, and a curriculum that builds functional neuroanatomy and imaging interpretation progressively across the years of training.

The new data also sharpen a question left open by earlier work. Medina and colleagues, in a 2020 needs assessment published in the same journal, identified neuroimaging education as a meaningful gap in psychiatry training and called for a dedicated curriculum, but surveyed residents across all postgraduate years without specifying when such instruction should begin. The Miami findings indicate that the gap is already established at the very start of residency and does not narrow with seniority, providing a rationale for introducing neuroimaging instruction early rather than deferring it to elective or advanced years. Calls for structured neuroimaging and clinical neuroscience curricula have recurred throughout the past decade, including recent contributions in Neuropsychopharmacology and the Harvard Review of Psychiatry, yet the gap persists. The authors argue that the field now needs to move from repeated documentation of the problem toward actual implementation.

The study is not without limitations, and the authors are candid about them. The sample comes from a single institution, and 29 respondents is a modest number that limits statistical power and generalizability. The cross-sectional design captures a snapshot rather than a trajectory, so the flat self-efficacy curve across training years is inferred from comparing different cohorts rather than following the same individuals over time. Self-reported self-efficacy is also an imperfect proxy for actual interpretive skill, and a resident who underestimates their abilities is not the same as one who misreads a scan. Multisite studies that pair self-efficacy measures with objective assessments of interpretation would substantially strengthen the evidence base. Still, the consistency of the findings with a decade of prior literature lends them credibility, and the pattern of low confidence, high motivation, and no growth over time is difficult to explain away as an artifact of one institution’s culture.

Informed by these findings, the authors’ institution has already developed and implemented a structured, longitudinal neuroimaging curriculum, the design and evaluation of which will be reported separately. The study’s broader message extends beyond psychiatry. As imaging, genetics, and computational neuroscience reshape the biological understanding of mental illness, the psychiatrists who treat patients will need to engage with these tools confidently, not as spectators to a radiology report but as informed interpreters who can integrate imaging findings into clinical reasoning. The Miami data suggest that this engagement will not happen by osmosis. If neurophobia takes hold early and clinical exposure alone fails to build competence, then deliberate, early, and sustained instruction is not an educational luxury but a necessity. The residents, it turns out, are already asking for it.

Subject of Research: Neuroimaging self-efficacy and neurophobia among junior psychiatry residents

Article Title: Neuroimaging Self-Efficacy and Neurophobia Among Junior Psychiatry Residents: A Cross-Sectional Needs Assessment

Article References: Buciuc, A.-G., Kiziah, H. L., & Espinel, Z. (2026). Neuroimaging Self-Efficacy and Neurophobia Among Junior Psychiatry Residents: A Cross-Sectional Needs Assessment. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02442-5

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02442-5

Keywords: neuroimaging, psychiatry residency, neurophobia, self-efficacy, medical education, MRI, PET/SPECT, clinical neuroscience, curriculum design, residency training, functional neuroanatomy, needs assessment