Neurology Resident Diagnostic Accuracy in Critical Care Scenarios: Analysis of the Close-the-Loop Resident Clinical Acumen Project

Abstract

Objective: To evaluate junior neurology resident diagnostic accuracy among patients requiring intensive care unit (ICU) management, to help guide educational initiatives for resident assessment of high-acuity cases. Background: Neurology residents are frequently among the first to evaluate neurologic deficits, including in severely ill, complex patients. One of the most essential goals of training is to identify, triage and manage neurologic emergencies. Design/Methods: Through the Close the Loop Project at Mount Sinai, we recorded residents’ initial diagnostic impression in cases presenting in morning report from July 2010 to June 2016. We compared residents’ initial impression to the final diagnosis and characterized diagnostic errors. In this set of analyses, we stratified diagnostic accuracy according to disposition, critical care needs, and high-acuity diagnoses. Significance was determined using analysis of variance models. Results: 1301 cases were included, with a previously reported overall accuracy of 64.0%. Patient disposition was significantly associated with resident accuracy (p Conclusions: This analysis of our clinical acumen assessment database suggests that junior neurology resident accuracy varies with level of care required, with lower diagnostic accuracy in cases initially requiring critical care and urgent neurosurgical intervention. Our analyses explore the nature of diagnostic patterns among these patients, which can help guide educational/supervision approaches for these high-acuity clinical situations. Disclosure: Dr. Santos has nothing to disclose. Dr. Schorr has nothing to disclose. Dr. Brandstadter has nothing to disclose. Dr. Krieger has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, EMD Serono, Genentech, Genzyme, Mallinckrodt, MedDay, Novartis, Teva, and TG Therapeutics.