Education Research: Trends of Neurology Clerkships in the United States Amidst a Global Pandemic.

Abstract

Background and objectives: To report a 2022 survey of US medical school neurology clerkship directors (CDs) and to compare the results with those of similar surveys conducted in 2005, 2012, and 2017.

Methods: An American Academy of Neurology (AAN) Consortium of Neurology Clerkship Directors (CNCD) workgroup developed the survey sent to all neurology CDs listed in the AAN CNCD database. Comparisons were made with 2005, 2012, and 2017 surveys.

Results: The response rate was 72 (47%) of 152 CDs. The number of respondents reporting a required neurology clerkship has not significantly changed over the past 17 years (93%, 93%, 94%, and 96% for 2005, 2012, 2017, and 2022, respectively, p = 0.848), but the timing of the clerkship has shifted. The proportion of clerkships that occur exclusively in students' third year has fluctuated around 50% since 2012 (56% in 2012, 51% in 2017, and 58% in 2022). Those taken only in the fourth year have decreased (from 45.6% in 2005, to 12% in 2012, 9% in 2017, and 3% in 2022 p < 0.001). Three-fourths of respondents (n = 54 of 72) report a 4-week clerkship duration, the same as past years (75% in 2017 and 75% in 2012). During the initial stages of the coronavirus disease 2019 (COVID-19) pandemic (March 2020-July 2021), students in the neurology clerkship spent an average of 6 hours in online learning compared with 3 hours currently (p < 0.001). Respondents received an average of 27% of a full-time equivalent protected time. 87% indicated that they are very or somewhat satisfied in their role, but most (60%, n = 38/63) indicated that they have experienced burnout at some point within their career as a neurology CD.

Discussion: Neurology clerkships remained resilient in the United States through the initial stages of the COVID-19 pandemic with demonstrated consistency in structure, curriculum, and administration. There has been a continued increase in the requirement of the clerkship as a 4-week clinical experience. The needs persist for more clerkship coordinator support and more protected time for neurology CDs. Despite high satisfaction, most of the respondents have experienced burnout for a variety of reasons, including lack of protected time and competing obligations.