Neurology: Education最新文献

{"title":"An Issue on Innovation: What Makes Curricula Innovative and New Approaches to Neurology Education","authors":"R. Strowd","doi":"10.1212/ne9.0000000000200062","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200062","url":null,"abstract":"","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"130 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114087212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviews in Medical Education: Advances in Simulation to Address New Challenges in Neurology","authors":"Catherine Albin, J. Greene, Sara C. LaHue, P. Kandiah, Arielle M. Kurzweil, Yara Mikhaeil-Demo, Nicholas A. Morris","doi":"10.1212/ne9.0000000000200042","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200042","url":null,"abstract":"Simulation is an engaging modality of medical education that leverages adult learning theory. Since its inception, educators have used simulation to train clinicians in bedside procedures and neurologic emergencies, as well as in communication, teamwork, and leadership skills. Many applications of simulation in neurology are yet to be fully adopted or explored. However, challenges to traditional educational paradigms, such as the shift to competency-based assessments and the need for remote or hybrid platforms, have created an impetus for neurologists to embrace simulation. In this article, we explore how simulation might be adapted to meet these current challenges in neurologic education by reviewing the existing literature in simulation from the field of neurology and beyond. We discuss how simulation can engage neurology trainees who seek interactive, contextualized, on-demand education. We consider how educators can incorporate simulation for competency-based evaluations and procedural training. We foresee a growing role of simulation initiatives that assess bias and promote equity. We also provide tangible solutions that make simulation an educational tool that is within reach for any educator in both high-resource and low-resource settings.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122522635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurology APP Residency Training Programs","authors":"J. Morgenlander","doi":"10.1212/ne9.0000000000200039","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200039","url":null,"abstract":"","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122026048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping Review: Innovations in Clinical Neurology Education","authors":"W. D. Zimmerman, Melissa B. Pergakis, Emily F Gorman, Melissa Motta, Peter Jin, R. Salas, Nicholas A. Morris","doi":"10.1212/ne9.0000000000200048","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200048","url":null,"abstract":"Advances in adult learning theory and instructional technologies provide opportunities to improve neurology knowledge acquisition. This scoping review aimed to survey the emerging landscape of educational innovation in clinical neurology. With the assistance of a research librarian, we conducted a literature search on November 4, 2021, using the following databases: PubMed, Embase, Scopus, Cochrane Library, Education Resources Information Center, and PsycINFO. We included studies of innovative teaching methods for medical students through attending physician-level learners and excluded interventions for undergraduate students and established methods of teaching, as well as those published before 2010. Two authors independently reviewed all abstracts and full-text articles to determine inclusion. In the case of disagreement, a third author acted as arbiter. Study evaluation consisted of grading level of outcomes using the Kirkpatrick model, assessing for the presence of key components of education innovation literature, and applying an author-driven global innovation rating. Among 3,830 identified publications, 350 (175 full texts and 175 abstracts) studies were selected for analysis. Only 13 studies were included from 2010 to 2011, with 98 from 2020 to 2021. The most common innovations were simulation (142), eLearning, including web-based software and video-based learning (78), 3-dimensional modeling/printing (34), virtual/augmented reality (26) podcasts/smartphone applications/social media (24), team-based learning (17), flipped classroom (17), problem-based learning (10), and gamification (9). Ninety-eight (28.0%) articles included a study design with a comparison group, but only 23 of those randomized learners to an intervention. Most studies relied on Kirkpatrick Level 1 and 2 outcomes—the perceptions of training by learners and acquisition of knowledge. The sustainability of the innovation, transferability of the innovation to a new context, and the explanation of the novel nature of the innovations were some of the least represented features. We rated most innovations as only slightly innovative. There has been an explosion of reports on educational methods in clinical neurology over the last decade, especially in simulation and eLearning. Unfortunately, most reports lack adequate assessment of the validity and effect of the respective innovation's merits, as well as details regarding sustainability and transferability to new contexts.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"14 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115607901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curriculum Innovations: Improving Residents' Knowledge and Interest in Outpatient Neurology Through an Interactive Patient-Centered Didactic Series","authors":"C. Doughty, Galina Gheihman, T. Milligan, Tracey A. Cho","doi":"10.1212/ne9.0000000000200043","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200043","url":null,"abstract":"Neurology residency training is inpatient focused, underemphasizing outpatient disorders. We implemented a novel didactic series of facilitated discussions between a patient and their outpatient neurologist to expose residents to outpatient topics and management skills.(1) Improve residents' understanding of the roles and responsibilities of the neurologist in the outpatient setting; (2) share with residents the patient's perspective of living with chronic neurologic disease; and (3) improve residents' understanding of what effective shared decision making entails.Residents in an academic neurology program participated. Six bimonthly, 1-hour sessions were piloted in person in 2016; participants were surveyed after each session to refine the format. The formal program (6 sessions) was held virtually in 2020–2021. Each session focused on 1 disorder. The format was conversational and moderated by a course director. Discussion points were preplanned and focused on patients' experiences living with chronic neurologic disease and shared decision making. Residents, participating faculty, and patients were surveyed at the conclusion of the 2020–2021 series to evaluate its effectiveness.Fifty-five survey responses were completed by residents during the pilot. Only 12 residents (22%) indicated that they longitudinally followed more than 1 patient with the condition represented in the session. Qualitative comments from residents and faculty (n = 5) identified that hearing the patient perspective was the most valuable component of the series. Twenty-one of 54 residents evaluated the final program. A majority of residents, 100% of faculty (n = 6), and 100% of patients (n = 6) felt that the program's 3 learning objectives were met. Forty-eight percent of residents reported increased interest in outpatient careers. Faculty agreed that the session format was as effective as traditional lecture, without added preparation burden. Patients felt that sharing their experiences would help physicians better understand their illness and improve care for future patients; all would participate again.Our series effectively educated residents about underrepresented outpatient topics. Hearing patients' perspectives was instrumental in achieving our learning objectives. Key factors for successful implementation included a faculty moderator, preplanned questions, and teaching slides to emphasize key learning points. Future work should evaluate whether residents' increased knowledge and interest translates into sustained behavior change and more residents selecting outpatient careers.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115144447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Research: Appraisal of Outpatient Clinical Experience During Neurology Residency","authors":"Aman Dabir, Vincent Arnone, Beebarg Raza, U. Najib, G. Pawar","doi":"10.1212/ne9.0000000000200046","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200046","url":null,"abstract":"Outpatient clinical experience is a key component of neurology residency. Understanding the educational environment for residents in the outpatient setting can inform educators to maximize teaching and learning opportunities, enhance resident exposure to subspecialty diagnoses and management, and deliver quality care. We studied the continuity clinic experience of 5 neurology residents over the course of their residency to determine the breadth of their ambulatory experience.We used administrative health data from new and return patient visits scheduled with 5 neurology residents of the same class over 3 years of continuity clinic. International classification of disease codes pertaining to neurologic diagnoses and symptoms associated with these visits were analyzed. Frequency and proportions of the most commonly evaluated diagnoses and symptoms were tabulated. These were compared with previously published data about resident experience during training. We also analyzed resident experience over time.Five neurology residents evaluated 948 patients (mean 189.6; range 180–202; 59.2% female) during 2,699 clinic visits (mean 539.8; range 510–576) over 3 years in their continuity clinics. There were 6,555 international classification of disease codes associated with these visits (2,948 [44.9%] neurologic diagnoses, 2,249 [34.3%] neurologic symptoms, and 1,358 [20.8%] comorbidities). The most common neurologic diagnoses were as follows: headache disorders (24.5%), neuromuscular disorders (17.3%), movement disorders (12.1%), cerebrovascular disorders (11.5%), and epilepsy (7.5%). The most common neurologic symptoms evaluated by residents were as follows: seizure-like events (16.5%), sensory symptoms (12.4%), pain (10.3%), headache (9.7%), and motor symptoms (8.1%).The clinical experience of residents in the continuity clinic was diverse, but it was skewed toward headache, neuromuscular, and movement disorders, which constituted 54% of the workload. When compared with previous studies, the range of resident's outpatient clinical experience differed from that of inpatient experience. Based on the results of this study, we made changes to our outpatient curriculum by adding 2-month–long rotations in subspecialty clinics from postgraduate year 2 to 4 with the aim of boosting resident exposure to neurologic disorders in the outpatient setting.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"52 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133807462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Research: Neurology Residents Report Improved Skills After Initiation of a Lumbar Puncture Clinic","authors":"Anna C. Pfalzer, Heather Koons, Christopher Lee, L. M. Acosta","doi":"10.1212/ne9.0000000000200040","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200040","url":null,"abstract":"Neurology residents have limited opportunities to perform lumbar punctures (LPs). We hypothesized that establishing a clinic for residents to perform LPs would increase success rates, improve resident comfort with LPs, reduce the need for assistance by attending physicians, and improve patient care.The Vanderbilt University Medical Center neurology residency began a resident LP clinic and measured residents' input and clinical data to see whether the clinic affected resident LP skills. Before and after the launch of LP clinic, neurology residents were invited to complete online surveys at the end of the academic year and during their LP clinic rotation. Completion of the surveys was voluntary and considered consent. The surveys assessed LP attitudes and experience (e.g., confidence with LPs and number performed) and LP clinic procedural data (e.g., LP success rate). Attitudes were measured by assessing confidence; experience by quantifying the number of LPs performed; procedural success was measured by the number of LPs with successful CSF acquisition. Differences in resident attitude and LP outcomes were analyzed using Spearman correlations and logistic regressions.Prior to the launch, 15/25 (60% response) residents responded to the clinic survey. After the launch, 6/21 (29%) responded to the first-year follow-up survey and 12/21 (57%) to the second-year follow-up survey. Resident confidence and the number of LPs performed were unchanged. Success rate reported by individual residents increased 15% (p= 0.04), which did not correlate with the overall LP clinic success rate. In the first year of the clinic, 83% of postgraduate year (PGY)3s needed an attending's assistance compared with 29% of PGY4s. In the second year, 44% of PGY3s and 32% of PGY4s needed an attending's assistance.This structured clinic provided an opportunity for informal resident-to-resident teaching, which may have reduced the need for attending assistance.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121540836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Research: The Inappropriate Consult","authors":"Charles Sanky, Caroline Gentile, Jennifer Ren, Eric M Bortnick, S. Krieger","doi":"10.1212/ne9.0000000000200044","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200044","url":null,"abstract":"As resident physicians specialize, they lose familiarity with knowledge central to other fields. This can yield what we term the dual fallacies: (1) the sense that their own expertise is common knowledge, and (2) unfamiliar clinical situations seem beyond their scope. In graduate medical education, these dual fallacies may engender the perception of inappropriate consults among specialties. This project evaluated biases in residents' perceptions of expected knowledge and inappropriate consults to improve interdisciplinary education among neurology residents (neurologists) and internal medicine residents (internists). Secondarily, we evaluated whether these biases were mitigated after implementing an educational intervention.Resident neurologists and internists at a large, urban, academic medical center answered board-style questions reflecting neurology and medicine consultation scenarios. They then rated the extent to which each scenario reflected common knowledge to both specialties and whether a consult was warranted. After revising the internal medicine residency curriculum to include a neurology rotation, another cohort of residents was surveyed and participated in semistructured interviews. Paired samplettests and qualitative data analysis were performed.Neurologists and internists participated in phase 1 (n = 23) and phase 2 (n = 42) of the study. Residents from both fields answered more questions correctly from their own specialty than the other in phase 1 (p< 0.05) and phase 2 (p< 0.001). Neurologists and internists in both cohorts thought that each other should know more neurology answers than they actually did (p< 0.05). Neurologists were less likely to agree than internists that medicine questions deserved a consult (p= 0.014). Interviews revealed themes regarding perceived consult appropriateness, affected by educational, communication, clinical, and administrative factors. In addition, residents agreed that appropriate consults must pose a specific question and occur only after an initial investigation was performed, but that this rarely happens.Our findings support that discordant expectations of expertise contribute to a perception of inappropriate consults among neurologists. Nonclinical factors, from cognitive biases to contextual considerations, inform clinical consultation and interdisciplinary patient care. Implementing rotations on other services alone is insufficient to eradicate discordant expectations; however, we propose additional interventions that may prove valuable in medical education.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122215112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Research: Predictors of Resident Physician Comfort With Individuals With Intellectual and Developmental Disabilities","authors":"Hannah Shapiro, Julia Frueh, Madeline Chiujdea, S. Sillau, J. Sanders","doi":"10.1212/ne9.0000000000200045","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200045","url":null,"abstract":"Individuals with intellectual and/or developmental disabilities (IDD) experience worse health outcomes compared with peers without a disability partly due to difficulties accessing age-appropriate health care. Provider discomfort with interacting and caring for individuals with IDD is a primary barrier to accessing care. The objectives of this study were to describe resident physicians' education, experiences, and comfort levels regarding individuals with IDD and to identify predictors of higher comfort levels with this patient population.In this cross-sectional study, we surveyed medical trainees in 7 residency programs in Boston, Massachusetts on their education, experiences, and comfort levels regarding individuals with IDD. The comfort level was assessed directly on a 6-point Likert scale. The relationship between comfort regarding people with IDD and several candidate explanatory variables was explored with Spearman and partial Spearman correlations (rs).The estimated survey response rate was 49%. Of 423 resident physicians included in the study, 96% reported they had treated a patient with IDD, while only 25% reported having formal education on caring for this population. On a scale of 1–6, with higher numbers corresponding to greater comfort, the mean comfort level treating individuals with IDD was 3.73 (CI 3.61–3.85). In bivariant analyses, the amount of prior experience with people with IDD had a moderate, positive correlation with increased comfort levels treating individuals with IDD (rs= 0.42,p< 0.01). The following characteristics had a weak, positive correlation with increased comfort levels: training in a pediatric-focused residency specialty (rs= 0.18,p< 0.01), number of hours of formal education on caring for people with IDD (rs= 0.15,p< 0.01), and age (rs= 0.12,p= 0.03). Only the amount of prior experience with this patient population remained positively correlated with higher comfort levels when the other variables were controlled for (rs= 0.38,p< 0.01).Prior experience with individuals with IDD predicted higher comfort levels with this population. This study supports the need for increased opportunities for medical trainees to engage with people with IDD to improve resident physicians' comfort caring for this patient population.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122148862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curriculum Innovations: Enhancing Medical Student Neuroscience Training With a Team-Based Learning Curriculum","authors":"Christopher G. Tarolli, R. Józefowicz","doi":"10.1212/ne9.0000000000200037","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200037","url":null,"abstract":"Neurophobia, the fear of, discomfort with, and dislike of clinical neurology, is frequently due to poor experiences in preclinical neuroscience education among medical providers. We developed, implemented, and assessed a curricular innovation using clinician-educators and team-based learning (TBL) with the goals to demonstrate clinical relevance in neuropathology, enhance student engagement in neuropathology education, and promote direct application of knowledge.We identified an underperforming neuropathology curriculum within the second-year medical student neuroscience course at the University of Rochester School of Medicine and Dentistry and implemented a traditional TBL curriculum to deliver this content. In addition, we transitioned to primarily clinician-led lectures in the neuropathology curriculum. We assessed student opinions of the curricular changes though end-of-course feedback, the implementation of a novel survey, and semistructured interviews with students. We assessed outcomes on the course final examination and overall course performance, comparing student performance in the preimplementation phase (year 2020–2021) with that in the postimplementation phase (year 2021–2022) using a 2-samplettest.Student opinions of the curricular changes were positive on the end-of-course evaluation (79.4% rated TBL as good or excellent) and novel survey (89%–96% of students rated the portions of the curriculum positively). Themes identified in free text responses and through qualitative interviews included an appreciation of the streamlined course content and a sense that the various sessions within the neuropathology curriculum effectively reinforced learning. Student performance on the final examination was similar in the preimplementation vs postimplementation phases (81.2% correct vs 80.3% correct;p= 0.37). Performance on the neuropathology subsection of the final examination was also similar among the 2 cohorts (82.6% correct vs 83.9% correct;p= 0.36).We demonstrate the feasibility and utility of a transition to primarily neurologist and neurosurgeon-led lectures and the implementation of a TBL curriculum within a neuroscience course. While we report data from implementation at a single center, these results have potential relevance to other courses, given our demonstration that TBL is a useful method to deliver neuroscience learning, nonpathologist lecturers can effectively provide neuropathology education, and a small number of educational faculty can be engaged to deliver this material.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130500082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}