Neurology. Education最新文献

{"title":"For Whom the Note Scrolls: A Brief History of the Medical Record's Role in Education and the Risks It Faces in the Age of OpenNotes.","authors":"Adina Wise","doi":"10.1212/NE9.0000000000200147","DOIUrl":"10.1212/NE9.0000000000200147","url":null,"abstract":"<p><p>Dating back to ancient civilizations when records were carefully transcribed onto papyrus, clinical documentation has long served as a cornerstone of medical-and especially neurologic-education. From the case histories of Hippocrates to the diurnal patient logs used by trainees in the 18th and 19th centuries, clinical notes have an extended history as invaluable instruments of pedagogy, scholarly practice, and interprofessional communication. The novel paradigm introduced by Lawrence Weed in the 1950s, advocating for the problem-oriented medical record system, revolutionized the clinical note template and emphasized the need for physicians' carefully considered analyses of a patient's presentation to be clearly reflected in well-organized documentation. In the realm of medical records today, however, a profound shift is underway, largely propelled by the emergence of electronic medical records, the OpenNotes mandate of the federal 21st Century Cures Act, and, most recently, artificial intelligence (AI). Appropriately, patients now have full access to their medical records, but this raises critical questions. Should clinical notes now prioritize patient comprehension over their traditional role as educational instruments, <i>aide-mémoire</i>, and repositories of detailed assessments and insights? What role, if any, should AI have in the creation of physician notes and patient-facing clinical documents? These tensions underscore the delicate balance between transparency and the preservation of notes' clinical integrity and analytical depth. As we navigate the path forward, finding an equilibrium between openness and the continued utility of medical records as tools for education and professional communication will be imperative.</p>","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200147"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Research: Burnout and Perception of Value in a Cross-Section of Neurology Residency Program Directors.","authors":"Alissa S Higinbotham, James T Patrie, Katherine B Peters","doi":"10.1212/NE9.0000000000200144","DOIUrl":"10.1212/NE9.0000000000200144","url":null,"abstract":"<p><strong>Background and objectives: </strong>There are no dedicated studies specifically assessing burnout in neurology residency program directors (PDs). A study of residency and fellowship directors across specialties found neurology residency PDs had the highest work-related Copenhagen Burnout Inventory (CBI) score, which may reflect high-level burnout in neurology in general. Indeed, the American Academy of Neurology Burnout Task Force reported burnout in 60% of neurologists. The aims of this study are to determine the level of burnout in adult and pediatric neurology residency PDs, and to determine whether perception of value is related to burnout.</p><p><strong>Methods: </strong>In an IRB-approved study, 184 neurology residency PDs were emailed an anonymous survey consisting of the full CBI, demographic information, and 2 items addressing perception of value in the PD role: \"I feel valued by my department in my educational role,\" to which the participant could respond \"strongly disagree, disagree, agree, or strongly agree,\" and \"satisfaction with current percent effort for the educational role,\" to which the participant could respond \"very dissatisfied, dissatisfied, satisfied, or very satisfied.\" Data were analyzed through analysis of variance and ordinal logistic regression.</p><p><strong>Results: </strong>A total of 85 PDs (46%) responded to the survey. The average ± SEM personal, work-related, and patient-related CBI scores were 41.8 ± 2.2, 39.7 ± 2.2, and 32.4 ± 2.2, respectively. Higher personal and work-related CBI scores were associated with less positive perception of value (proportional odds ratio 1.03, 95% CI 1.01-1.06, <i>p</i> = 0.004 and proportional odds ratio 1.04; 95% CI 1.01-1.06, <i>p</i> = 0.003, respectively). Higher personal and work-related CBI scores were also associated with greater dissatisfaction with percent effort granted for the PD role. Level of burnout did not differ between adult and pediatric PDs. Burnout was not related to sex, years in practice, years as PD, academic rank, or percentage effort granted for the PD role.</p><p><strong>Discussion: </strong>Despite working in a field associated with high burnout, neurology residency PDs were found to have lower-level burnout than previously reported. Ninety-four percent of the PDs reported feeling valued in their role which was associated with lower-level personal and work-related burnout and may represent a key target for reflection and burnout intervention in the future.</p>","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200144"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing as a Physician: Visual Arts in Medical Education.","authors":"Emily Schwartz, Dominique Harz, Brooke DiGiovanni Evans","doi":"10.1212/NE9.0000000000200151","DOIUrl":"10.1212/NE9.0000000000200151","url":null,"abstract":"","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200151"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Writing: The Art of Slowing Down Thinking.","authors":"Roy E Strowd","doi":"10.1212/NE9.0000000000200155","DOIUrl":"10.1212/NE9.0000000000200155","url":null,"abstract":"","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200155"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Residency Recruitment: Impact on Equity.","authors":"Rachel Gottlieb-Smith, Kathryn Xixis, Jaclyn M Martindale, Jessica H R Goldstein, Justin Rosati","doi":"10.1212/NE9.0000000000200150","DOIUrl":"10.1212/NE9.0000000000200150","url":null,"abstract":"","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200150"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Research: The Current Landscape of Clinician Educator Tracks in Adult Neurology Residency Programs: A National Survey of Program Directors.","authors":"Nuri Jacoby, K H Vincent Lau, Maureen I Ekwebelem, Jeremy J Moeller, Daniel Shalev","doi":"10.1212/NE9.0000000000200142","DOIUrl":"10.1212/NE9.0000000000200142","url":null,"abstract":"<p><strong>Background and objectives: </strong>As the concept of a clinician-educator (CE) evolves and the multiple competencies of the role become better defined, there seems to be a growing need for targeted training for clinicians pursuing a career in medical education. This study aims to describe the current state of CE tracks in adult neurology residency programs and to identify the barriers to implementation, potential solutions, and program goals and outcomes.</p><p><strong>Methods: </strong>We characterized CE tracks using 2 methods. First, we reviewed the websites of all US adult neurology residency programs to determine the availability of a CE track and its characteristics. Second, we administered a 20-item survey to program directors (PDs) of all US neurology residency programs, with questions focused on track availability, characteristics, perceived benefits of CE tracks on resident career development, barriers to implementation, and ideas for national initiatives that may facilitate track development or improvement.</p><p><strong>Results: </strong>Fifty-eight of 177 (33%) PDs responded to the survey. Combining the results of the website reviews and surveys, we found that 34 of 179 (19%) programs have CE tracks. Seventy percent of PDs felt that CE tracks are very impactful or impactful for participating residents' careers, a perception more common among PDs of programs with tracks. The greatest perceived benefit was in preparing residents for educational leadership roles. The greatest barriers to implementation were a lack of teaching faculty, a lack of resources, and limited resident time. The highest ranked idea for a national initiative that can facilitate track development was live and recorded lectures on medical education topics.</p><p><strong>Discussion: </strong>Although most PDs surveyed agreed that CE tracks are impactful for preparing residents as teachers and education leaders, such tracks are available in only 19% of adult neurology residency programs. PDs report that the benefits of CE tracks extend beyond the participants, with implications for the health of the residency program and the neurology department. While some programs have significant barriers to implementation, national initiatives may help reduce the resource burden on individual programs. Future areas of study include assessing the development and outcomes of national initiatives and analyzing the outcomes associated with CE tracks.</p>","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200142"},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curriculum Innovations: Enhancing Skills in Serious Illness Communication in Neurology Residents Using Simulation: A Pilot Study.","authors":"Marcey Osgood, Brian Silver, Jennifer Reidy, Vandana Nagpal","doi":"10.1212/NE9.0000000000200140","DOIUrl":"10.1212/NE9.0000000000200140","url":null,"abstract":"<p><strong>Background and problem statement: </strong>Patients with acute ischemic stroke are faced with prognostic uncertainty, progressive decline, and early mortality. Many neurologists report a lack of education and experience in providing palliative care. We developed a simulation-based curriculum to improve residents' confidence and comfort with conducting late-stage goals of care (GOC) conversations.</p><p><strong>Objectives: </strong>To assess and improve neurology residents' self-reported confidence and comfort around GOC discussions, prognostication, and hospice; encourage neurology residents to conduct GOC conversations early in the illness; introduce neurology residents to a structured framework for conducting GOC conversations; facilitate the residents to build rapport and convey a mindful presence during GOC conversations; provide direct, real-time feedback and an opportunity for redo and practice; and identify gaps for education.</p><p><strong>Methods and curriculum description: </strong>The 3-hour experience included a didactic session followed by an interactive simulation and debriefing. The residents' objectives were to deliver difficult news, discuss prognosis, explore goals, navigate treatment options, and discuss end-of-life care including hospice. The faculty observed each interaction and called time-outs to allow the residents to self-assess and obtain feedback. Residents and faculty debriefed to identify take-home points and to reflect on their emotions, self-care, and sense of purpose in medicine.</p><p><strong>Results and assessment: </strong>Twenty-six neurology residents filled out an anonymous presurvey to self-assess their confidence and comfort surrounding GOC conversations. More than 50% of residents reported being confident in conducting GOC discussions, whereas only 42% reported adequate prior training. Postsession, more than 90% of residents reported that training was relevant, helpful, organized, and clear. Faculty identified that residents had difficulty addressing prognosis, assessing goals, planning treatment, and using silence, responding to emotion, and displaying empathy. Fifteen residents filled out a postsurvey that revealed improved comfort with delivering prognosis, discussing hospice, and initiating early GOC discussions.</p><p><strong>Discussion and lessons learned: </strong>Our project uniquely focuses on late-stage GOC conversations and builds on existing literature that supports a structured program with both didactic and simulation components to improve residents' abilities to effectively navigate GOC conversations with patients and families. Future work will focus on reinforcement and reassessment of communication skills.</p>","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200140"},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curriculum Innovation: A Standardized Experiential Simulation Curriculum Equips Residents to Face the Challenges of Chief Year.","authors":"Elina Zakin, Nada Abou-Fayssal, Aaron S Lord, Aaron Nelson, Sara K Rostanski, Cen Zhang, Sondra Zabar, Steven L Galetta, Arielle Kurzweil","doi":"10.1212/NE9.0000000000200138","DOIUrl":"10.1212/NE9.0000000000200138","url":null,"abstract":"<p><strong>Introduction and problem statement: </strong>A chief resident's role incorporates administrative, academic, and interpersonal responsibilities essential to managing a successful residency program. However, rising chief residents receive little formal exposure to leadership training.</p><p><strong>Objectives: </strong>To (1) define leadership styles; (2) understand the effect of cultural competence on leadership styles; (3) learn effective methods to advocate as the chief resident; (4) provide effective peer feedback; (5) provide effective supervisor feedback; (6) learn effective conflict management; (7) ensure psychological safety.</p><p><strong>Methods and curriculum description: </strong>We developed a 1-day curriculum combining didactics and simulation activities for our program's rising chief residents. Implementation of our curricular design included a morning session focusing on small groups and didactic-based lectures on specific topics pertinent to leadership, along with a debriefing of a psychometric evaluation tool administered before the curriculum day. The simulation activity consisted of 3 group objective structured clinical examination (G-OSCE) scenarios: (1) providing a struggling junior trainee with feedback; (2) debriefing an adverse clinical outcome as the team leader; (3) navigating a challenging situation with a supervising physician. Standardized participants were surveyed for specific objectives. Learners completed precurricular and postcurricular surveys on their familiarity and preparedness for their chief year.</p><p><strong>Results and assessment data: </strong>Comparison of preintervention (n = 16) and postintervention (n = 10) data shows improvements in familiarity with leadership models (<i>p</i> = 0.006), cultural competence in leadership (<i>p</i> = 0.027), and team organizational structure (<i>p</i> = 0.010) with notable improvement in report of advocating for the team to 100% of participants in the postcurricular survey. In addition, although not statistically significant, familiarity with specific strategies for feedback delivery improved (<i>p</i> = 0.053), as did learner comfort levels with feedback delivery (comparing 51% of learners were either very or somewhat comfortable precurriculum to 90% postcurriculum). This is further supported by standardized participant data after the G-OSCEs. Although familiarity with wellness resources did improve across learners (<i>p</i> = 0.421), learner-reported use of wellness resources was noted to be reduced after the curricular intervention and remains a result of further interest for exploration.</p><p><strong>Discussion and lessons learned: </strong>A 1-day leadership development curriculum combining didactics and simulation is an effective means of preparing rising chief residents to succeed in their transition to this leadership role.</p>","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200138"},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11419294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Makes a Great Peer Reviewer in Neurology Education?","authors":"Roy E Strowd","doi":"10.1212/NE9.0000000000200139","DOIUrl":"https://doi.org/10.1212/NE9.0000000000200139","url":null,"abstract":"","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 2","pages":"e200139"},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the Gender Gap in Residency Awards Using a Blinded Selection Process.","authors":"Clare M Lambert, Reshma Narula, Vanessa Cooper, Jeremy J Moeller","doi":"10.1212/NE9.0000000000200136","DOIUrl":"10.1212/NE9.0000000000200136","url":null,"abstract":"","PeriodicalId":520085,"journal":{"name":"Neurology. Education","volume":"3 3","pages":"e200136"},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}