Adult Neurology Research Articles

Beyond Limits: Unmasking Potential Through Movement Discovery.

Beth E. Fisher, PT, PhD, FAPTA, is a physical therapist, educator, and scholar whose clinical career has been shaped by numerous observations and experiences of patients' remarkable potential to recover ideal movement capability. Currently, Dr Fisher is a Professor of Clinical Physical Therapy in the Division of Biokinesiology and Physical Therapy at the University of Southern California. She is Director of the Neuroplasticity and Imaging Laboratory, primarily using transcranial magnetic stimulation to investigate brain-behavior relationships during motor skill learning and motor control in both individuals without disabilities and individuals with neurologic disorders. Dr Fisher previously worked at Rancho Los Amigos Medical Center on the Adult Neurology and Brain Injury Services. During her years as a clinician and rehabilitation specialist, it was her greatest ambition to be a part of developing physical therapist interventions that would maximize neural and behavioral recovery in individuals with pathological conditions affecting the nervous system. Toward this goal, she has continued to consult and teach nationally and internationally on current concepts for the treatment of adults with neurological disorders. It has been her consistent clinical observation not only that patients are limited by impairments that result from their injury, but that movement abnormalities are in part the result of a patient's automatic, implicit tendency to "respond" to those impairments via compensation.

Increasing Resident Satisfaction with Continuity Clinic in Adult Neurology and Internal Medicine Residency Programs through Block Scheduling (588)

Increasing Resident Satisfaction with Continuity Clinic in Adult Neurology and Internal Medicine Residency Programs through Block Scheduling (588)

Treatment of generalized convulsive status epilepticus: An international survey in the East Mediterranean Countries

PurposeThree Chapters of the Commission of the East Mediterranean Affairs (CEMA) of the ILAE conducted a survey to assess the availability of drugs used for the treatment of generalized convulsive status epilepticus (GCSE) across the CEMA countries and to evaluate the treatment choices of adult and pediatric neurologists for the treatment of this condition. MethodThe web-based survey consisted of two similar vignettes of GCSE in a child and an adult. The questions evaluated the sequential drugs of choice based on drug availability and with the assumption that all drugs were at the disposition of the neurologists. The neurologists were also asked about the timing of introduction of anesthetic drugs and how they monitor patients in drug induced coma. ResultsOur data showed that the availability of drugs differ substantially across CEMA countries. A benzodiazepine and phenytoin/phenobarbital were the initial drugs of choice for the majority of adults and pediatric neurologists. In cases of refractory status, most neurologists would use a third agent before proceeding to treatment with an anesthetic agent. Although the vast majority would prefer to monitor patients in drug-induced coma with continuous EEG, only 38% are using this modality because of its unavailability at their institutions. ConclusionsOur data emphasize that an algorithm for the treatment of GCSE in the CEMA countries should be flexible and should propose different treatment options at each step of the protocol that are based on the best available data while taking into consideration the drug availability across the CEMA countries.

Attitudes towards genetic testing and information: does parenthood shape the views?

This study examines how parents of pediatric patients might differ in their views and attitudes towards genetic technology and information when compared to adult patients. There is surprisingly little evidence on how parents compare to other parts of population in their attitudes. Previous empirical studies often relate health-related preferences and attitudes to factors such as age, education, and income instead of parental status, thus evading comparison of parents to others as health-related decision makers. Findings related to the parental status can be useful when implementing genetic technology in clinical practice. We conducted a survey of views on genetic technology and information for groups of adult neurology patients (n = 68) and parents of pediatric neurology patients (n = 31) to shed some light on this issue. In addition to our own survey instrument, we conducted other surveys to gain insight on psychosocial factors that might affect these attitudes. The results suggest that parents are more concerned about their children’s genetic risk factors when compared to the attitudes of adult patients about their own risk. For both groups, negative emotional state was associated with more concerns towards genetic information. Our study provides insights on how parental views might affect the acceptance of genetic technology and information.

Focal Cerebral Arteriopathy in Young Adult Patients With Stroke.

Background and Purpose- Focal cerebral arteriopathy is monophasic inflammatory stenosis of the distal internal carotid artery or the proximal segment of the middle cerebral artery. It is one of the most common causes of acute arterial ischemic stroke in young children but is a less familiar entity for adult neurologists. Methods- We retrospectively reviewed stroke service radiology records at a tertiary referral center from January 2013 to December 2014. Focal cerebral arteriopathy was defined as nonprogressive unifocal and unilateral stenosis/irregularity of the distal internal carotid artery or its proximal branches. Only patients aged 16 to 55 years with stroke were included. Results- There were 5 cases of focal cerebral arteriopathy: 2 males and 3 females. Three cases were from the cohort of 123 acute presentations of young stroke, and 2 cases were outpatient referrals. The mean age (range) was 43 (32-55) years. The majority presented with recurrent transient ischemic attacks/minor strokes within a single vascular territory over days to weeks. All cases had characteristic radiological features. Interval imaging demonstrated resolution in 1 case and improvement in 3 cases. Functional outcome was excellent with discharge modified Rankin Scale score ranging from 0 to 1. Recurrence occurred in 1 case. Conclusions- Focal cerebral arteriopathy is a rare cause of arterial ischemic stroke in young adults. Follow-up intracranial imaging is essential to differentiate from progressive arteriopathies. Evidence-based treatment warrants further investigation. Prognosis is favorable.

Contribution of a synchronic teleneurology program to decrease the patient number waiting for a first consultation and their waiting time in Chile

BackroundThere is a shortage of medical specialists in Chile, including neurologists; currently, there are 56,614 patients waiting for a first adult Neurology appointment in the country. The Teleneurology Program at the Hospital Las Higueras de Talcahuano (HHT) was implemented in 2015 to help reduce both the number of patients waiting for a first consultation and their waiting times.MethodsThis retrospective study analyzed a cohort of 8269 patients referred to the HHT Neurology clinic between 2013 and 2018, from primary, secondary, and tertiary health centers. Cox regression analyses were performed to determine the factors influencing each outcome (number of patients waiting for a consultation and waiting time), such as age, gender, referral health establishment and the type of consultation (whether in situ at the HHT or by synchronic telepresence through the Teleneurology Program).ResultsOut of the 8269 patients included in the study, 1743 consulted the neurologist through the Teleneurology Program, while 6526 received a consultation in situ at the HHT. Since its implementation (2015) until the end of 2018, the Teleneurology program contributed to decrease the number of patients waiting for their first appointment from 3084 to 298. Waiting time for the first consultation was 60% shorter for patients enrolled in the Teleneurology program than those with consultation in situ at HHT (6.23 ± 6.82 and 10.47 ± 8.70 months, respectively). Similar differences were observed when sorting patient data according to the referral health center. Cox regression analysis showed that patients waiting for a traditional in situ first adult Neurology consultation at the HHT had a higher risk (OR = 6.74) of waiting 90% longer than patients enrolled in the Teleneurology Program, without significant differences due to gender or age.ConclusionsData from this study show a significant contribution of the Teleneurology Program at the HHT to decrease the number of patients waiting for a first consultation with a neurologist, as well as shorter waiting times, when derived from primary and secondary health centers.

Transition of patients with childhood onset epilepsy: Perspectives from pediatric and adult neurologists

Transition from pediatric to adult care systems is a major challenge in the management of adolescents with epilepsy. The comparison of pediatric and adult physicians' points of view on this issue is scarcely described. The aim of this study was to understand pediatric and adult neurologists' experience and opinions on transition in epilepsy in France. We investigate the age at which they usually transfer patients, their opinion on the factors that positively or negatively impact transition, on the help provided during this transition period, and their propositions to improve this process. We prepared a targeted questionnaire with two versions, one adapted for neurologists and the other for child neurologists. The questionnaires were diffused through the Reference Centre for Rare Epilepsies, the French Chapter of the League Against Epilepsy, the French Association for Office-based Neurologists, and the French Pediatric Neurology Society. A total of sixty-eight physicians involved mostly in epilepsy care answered this questionnaire: 39 child neurologists and 29 neurologists. Questionnaires were filled at 96.8%. Twenty-six child neurologists followed patients aged over 18 years (70%), and 18 neurologists followed patients under the age of 12 years (66.6%). Cognitive impairment in childhood led significantly to a later transfer to adult care. The major factors believed to delay the transfer were attachment between child neurologists and families as reported in 96.3% by neurologists and in 81.1% by child neurologists, p = 0.07 and lack of adaptation of adult neurology facilities to adolescents especially with intellectual disability (59.3% neurologists, 75.7% child neurologists, p = 0.16). Factors that helped a transfer around 18–19 years were mainly pharmacoresistant epilepsy (71% for neurologists vs. 19% for child neurologists, p < 105) and pregnancy (72% for child neurologists versus 50% for neurologists, p = 0.08). Factors that negatively impacted transition were the lack of information about daily life in adulthood (driving license, contraception, sexuality, carrier guidance, etc.), the weak transition preparation in pediatric system, the lack of knowledge of pediatric epilepsy syndromes, and the lack of global support for patients with intellectual disability and multidisciplinary care needs in adult system. Both groups proposed joint clinics (>65% of providers) and development of care networks between pediatric and adult care for patients with epilepsy (>55%) to improve transition as well as introducing courses on transition. Few physicians were aware of transition and transfer recommendations.Although child and adult neurologists still have some preconceived beliefs, they were able to identify the strengths and weaknesses of both care systems paving the way for proposals to improve transition and transfer of patients with epilepsy from pediatric to adult care.

Clinician awareness of brain computer interfaces: a Canadian national survey

BackgroundIndividuals with severe neurological disabilities but preserved cognition, including children, are often precluded from connecting with their environments. Brain computer interfaces (BCI) are a potential solution where advancing technologies create new clinical opportunities. We evaluated clinician awareness as a modifiable barrier to progress and identified eligible populations.MethodsWe executed a national, population-based, cross-sectional survey of physician specialists caring for persons with severe disability. An evidence- and experience-based survey had three themes: clinician BCI knowledge, eligible populations, and potential impact. A BCI knowledge index was created and scored. Canadian adult and pediatric neurologists, physiatrists and a subset of developmental pediatricians were contacted. Secure, web-based software administered the survey via email with online data collection.ResultsOf 922 valid emails (664 neurologists, 253 physiatrists), 137 (15%) responded. One third estimated that ≥10% of their patients had severe neurological disability with cognitive capacity. BCI knowledge scores were low with > 40% identifying as less than “vaguely aware” and only 15% as “somewhat familiar” or better. Knowledge did not differ across specialties. Only 6 physicians (4%) had patients using BCI. Communication and wheelchair control rated highest for potentially improving quality of life. Most (81%) felt BCI had high potential to improve quality of life. Estimates suggested that > 13,000 Canadians (36 M population) might benefit from BCI technologies.ConclusionsDespite high potential and thousands of patients who might benefit, BCI awareness among clinicians caring for disabled persons is poor. Further, functional priorities for BCI applications may differ between medical professionals and potential BCI users, perhaps reflecting that clinicians possess a less accurate understanding of the desires and needs of potential end-users. Improving knowledge and engaging both clinicians and patients could facilitate BCI program development to improve patient outcomes.

Extent of and influences on knowledge of Alzheimer's disease among undergraduate medical students.

Background:Alzheimer's disease (AD) is a major health problem, which is of increasing concern because of rising yearly incidence and estimated cost. Early diagnosis and treatment is essential to manage AD effectively and improve the outcomes. Inadequate knowledge can delay the diagnosis. General practitioners should play a more effective role in the identification and diagnosis of AD, and medical education is key to solving this issue.Objectives:This study aimed to assess the knowledge of undergraduate medical students and to identify the factors that influenced their knowledge.Methods:This study used a quantitative cross-sectional evaluation of 327 Saudi Arabian medical students from the first and final years in Riyadh, Saudi Arabia, who participated in an online survey via email between March and May 2018. Knowledge of AD was assessed using the 12-item AD Knowledge Test for Health Professionals from the University of Alabama at Birmingham (UAB ADKT). General linear models were used to identify the most significant influence on AD knowledge scores.Results:Only 10.73% of first-year and 33.33% of final-year students scored ≥ 50% on the UAB ADKT. Students pursuing specialties related to AD (adult neurology, geriatrics, or psychiatry) and students aged ≥ 27 years had higher scores (P < 0.05).Conclusion:Undergraduate medical students lacked proper knowledge of AD, suggesting that improvements in education programs can help. Future studies are needed to assess the quality and effectiveness of AD education in the curriculum of Saudi medical schools.

Faculty Videos of Resilience Narratives at Two Institutions

Burnout and mental health issues among residents are associated with adverse health consequences and suboptimal job performance, e.g. increased medical error. Given role models as key to cultivating resilience, we created faculty resilience narrative videos within resilience skill training programs, hypothesizing such videos would provide new perspectives/insights on resiliency and humanize attendings in a useful way. Child and adult neurology residents at two institutions positively rated the impact of these faculty videos. Such videos are an innovative and practical way to: 1) provide exemplar role models for learning about coping with physician challenges and gaining insights on resilience; 2) access stories of triumph over challenge for inspiration; and 3) work to achieve local culture change by reducing stigma and increase empathy/connection during training. Successful implementation of this video innovation provides good rationale for further evaluation of impact on local culture, faculty experience, and resident attitudes and behavior.

Knowledge and awareness among patients with epilepsy observed at Jordan University Hospital

The objective of this study was to assess the level of knowledge and awareness about epilepsy among patients with epilepsy (PWE) and to determine the correlation with sociodemographic and disease-related factors. A prospective cross-sectional study was set, and it included PWE attending the adult neurology clinic at Jordan University Hospital (JUH), Amman, Jordan. A structured questionnaire was utilized, which consisted of 3 parts: sociodemographic factors, disease characteristics, and an epilepsy knowledge scale — the Epilepsy Knowledge Profile—General (E.K.P-G) scale. There was a total of 108 patients, 43 males and 65 females with an age range from 16 to 63 years. The average score of the subjects in the E.K.P-G scale was 16.4/34 (48%). Twenty out of the 34 questions were answered correctly by less than 50% of the respondents. There was an overall poor understanding of the etiology of epilepsy. A higher E.K.P-G score was significantly correlated with higher levels of education, higher household income, controlled seizures for more than 2 years, and living in urban areas. On the other hand, there was no significant correlation between the level of knowledge and age, gender, marital status, occupational status, type of seizure, duration of epilepsy, source of information, number of antiepileptic drugs (AEDs), and family history of epilepsy. In conclusion, the study showed a significant lack of knowledge about epilepsy among PWE at JUH. A public educational program is necessary in Jordan to educate PWE about their disorder.

NeuroSeq: A Prospective Trial to Evaluate the Diagnostic Yield of Whole Genome Sequencing (WGS) in Adult Neurology

NeuroSeq: A Prospective Trial to Evaluate the Diagnostic Yield of Whole Genome Sequencing (WGS) in Adult Neurology

Clinical neuro-oncology for the neurologist

Neuro-oncologic patients are routinely encountered in clinical practice. Neuro-oncology is a rapidly evolving field, so understanding the most classic paradigms and contemporary advances will optimize patient care. We discuss the recent reclassification of tumors via molecular characteristics as it applies to direct clinical practice and review the contemporary standard of care for infiltrating gliomas, meningiomas, brain metastases, and CNS lymphoma. We provide a straightforward primer on neuro-oncology with a focus on the brain tumors most commonly encountered by the adult neurologist and a clear emphasis on clinically relevant points including those which have recently become incorporated into our standard management. We cite key reviews to allow interested readers an opportunity to gain a more comprehensive understanding of specific topics.

Validation of claims-based diagnoses of adult and pediatric neuromyelitis optica spectrum disorder and variations in diagnostic evaluation and treatment initiation

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disease in need of more studies to determine effective treatment regimens. The rarity of the disorder, however, makes large randomized-controlled trials challenging. Validation of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for NMO could facilitate the use of large healthcare claims data for future research. We aimed 1) to determine the positive predictive value (PPV) of the ICD-9-CM code for NMO as well as evaluate case-finding algorithms for the identification of patients with NMO/NMOSD and 2) to compare the evaluation of and treatment for pediatric versus adult patients. MethodsThis was a multicenter retrospective cohort study of patients with ≥ 1 ICD-9 code for NMO seen at 3 pediatric and 2 adult United States medical centers from 2001–2016. Using a standardized data entry form, pediatric and adult neurologists and rheumatologists reviewed patients’ medical records to determine whether patients fulfilled the 2006 criteria for NMO and/or the 2015 criteria for NMOSD in order to determine the positive predictive value (PPV) for the ICD-9-CM code. Demographic and clinical information was abstracted from patient medical records to ascertain variables then evaluated in case-based finding algorithms for further identification of patients with true NMO/NMOSD. We also evaluated differences in clinical characteristics between pediatric and adult patients using chi-squared or Fisher's exact tests, as appropriate, to assess for treatment variation. ResultsA single code for NMO had a PPV of 47% across all sites, with significant site variation (0–77%). The best case-finding algorithm included at least 5 codes as well as a documented hospitalization (PPV = =90% for children and PPV = 92% for adults). Children were more likely to be evaluated by a rheumatologist or ophthalmologist, undergo magnetic resonance imaging of the orbits, and receive immunosuppressive and biologic agents than their adult counterparts. Rituximab was administered similarly among the two groups. ConclusionThe ICD-9 code for neuromyelitis optica (NMO) is inaccurate for identification of NMO/NMOSD. Using case-finding algorithms increases the PPV. The initial diagnostic evaluation and treatment of NMOSD differs significantly between children and adults.

Editors' note: Neurology residency training in 2017: A survey of preparation, perspectives, and plans

In their survey of graduating adult and child neurology residents from 2017, Mahajan and colleagues reported on the subjective lack of preparation of graduating trainees as they take on fellowship or junior faculty roles. Among these findings, although more respondents in 2017 felt prepared to address managerial tasks (e.g., billing and malpractice) than in previous years, fewer than 40% felt knowledgeable about billing, coding, contract negotiations, malpractice insurance, or RVUs. Furthermore, among the adult neurology respondents, 54% felt that the fellowship application process began too early, with 46% feeling as if their limited outpatient exposure negatively affected the fellowship decision-making process. In response, Drs. Ratliff and Shanker reference similar pressures placed on orthopedic surgery residents as they embark on their own journeys into fellowship. Because 87% of neurology residents prefer fellowship applications to start in the second half of the PGY3 year or even later, it would be better to delay the application process until this time in order for residents to make the most informed decision about their future careers. As Dr. Mahajan points out, the process of mandating a single “match day” is challenging because of the differences in neurology fellowship offerings. Nonetheless, some date late in the PGY3 year could be suggested by our organizations as the earliest date a program director can make an offer. This may allow for more outpatient exposure, so our trainees can make a more informed career decision. In their survey of graduating adult and child neurology residents from 2017, Mahajan and colleagues reported on the subjective lack of preparation of graduating trainees as they take on fellowship or junior faculty roles. Among these findings, although more respondents in 2017 felt prepared to address managerial tasks (e.g., billing and malpractice) than in previous years, fewer than 40% felt knowledgeable about billing, coding, contract negotiations, malpractice insurance, or RVUs. Furthermore, among the adult neurology respondents, 54% felt that the fellowship application process began too early, with 46% feeling as if their limited outpatient exposure negatively affected the fellowship decision-making process. In response, Drs. Ratliff and Shanker reference similar pressures placed on orthopedic surgery residents as they embark on their own journeys into fellowship. Because 87% of neurology residents prefer fellowship applications to start in the second half of the PGY3 year or even later, it would be better to delay the application process until this time in order for residents to make the most informed decision about their future careers. As Dr. Mahajan points out, the process of mandating a single “match day” is challenging because of the differences in neurology fellowship offerings. Nonetheless, some date late in the PGY3 year could be suggested by our organizations as the earliest date a program director can make an offer. This may allow for more outpatient exposure, so our trainees can make a more informed career decision.

Editors' note: Surgery and risk of Guillain-Barré syndrome: A French nationwide epidemiologic study

In their retrospective, nationwide, case-crossover study of more than 8,000 cases of Guillain-Barre syndrome (GBS) (2009–2014), Rudant et al. reported on the association between surgery and postoperative risk of GBS. The authors found a significant 53% higher odds of postoperative GBS in the 60 days following any surgery (adjusted OR 1.53, 95% CI 1.25–1.88), although this may be driven in part by orthopedic and gastrointestinal surgeries. Also interesting was the observation that (generally) longer procedures were associated with a greater probability of postoperative GBS (OR 2.22, 95% CI 1.48–3.34 for surgeries lasting ≥120 minutes vs no surgery). Although the mechanism by which surgery mediates this risk remains unclear, Dr. Steiner suggests that the type of anesthesia (epidural vs general) may play a role. Citing earlier literature, Dr. Steiner notes that a substantial proportion of patients had undergone epidural anesthesia before the onset of GBS. Dr. Steiner suggests that local damage from the anesthetic agent or reagent may have contributed to nerve root injury and/or inflammation. Unfortunately, anesthetic technique is not documented in the claims data of the present investigation. Therefore, the investigators are unable to comment on whether epidural anesthesia may have played a role in the development of GBS in their nationwide data set. In their survey of graduating adult and child neurology residents from 2017, Mahajan and colleagues reported on the subjective lack of preparation of graduating trainees as they take on fellowship or junior faculty roles. Among these findings, although more respondents in 2017 felt prepared to address managerial tasks (e.g., billing and malpractice) than in previous years, fewer than 40% felt knowledgeable about billing, coding, contract negotiations, malpractice insurance, or RVUs. Furthermore, among the adult neurology respondents, 54% felt that the fellowship application process began too early, with 46% feeling as if their limited outpatient exposure negatively affected the fellowship decision-making process. In response, Drs. Ratliff and Shanker reference similar pressures placed on orthopedic surgery residents as they embark on their own journeys into fellowship. Because 87% of neurology residents prefer fellowship applications to start in the second half of the PGY3 year or even later, it would be better to delay the application process until this time in order for residents to make the most informed decision about their future careers. As Dr. Mahajan points out, the process of mandating a single “match day” is challenging because of the differences in neurology fellowship offerings. Nonetheless, some date late in the PGY3 year could be suggested by our organizations as the earliest date a program director can make an offer. This may allow for more outpatient exposure, so our trainees can make a more informed career decision.

Objective Structured Clinical Exams (OSCE) are a feasible method of teaching how to discuss a nonepileptic seizure diagnosis

ObjectivePresenting the diagnosis of psychogenic nonepileptic seizures (PNES) can be a difficult task, but disclosing this information effectively is important to optimize patient outcomes. We sought to develop a standardized method to teach neurology residents how to introduce the diagnosis of PNES via an objective structured clinical examination (OSCE) with a standardized patient (SP). MethodsIn conjunction with the New York University School of Medicine Simulation Center (NYSIM), we designed an OSCE in which a resident had to inform a SP of her diagnosis of PNES and discuss a treatment plan. The SP was provided with details to gradually disclose depending on what the resident said about the history of her episodes, triggers for her episodes and her history of sexual abuse. Each encounter was observed by an attending physician who provided real-time feedback to the resident after the session. Additionally, the SP completed an objective written checklist of items the resident should have covered in the session and gave them verbal feedback. ResultsTwenty-six adult neurology (n = 22), child neurology (n = 3), and neuropsychiatry (n = 1) residents participated in this OSCE in 2018 and 2019, with full data available for 25 participants. Residents reported the OSCE was very useful (mean Likert score of 4.9/5). They felt moderately prepared (mean Likert score 3.8/5) and rated their performance as a mean of 3.3/5. On the SP's checklist, most residents were rated as Well Done in the domains of information gathering, relationship development, and education and counseling. Only in the domain of psychosocial assessment were most residents rated as Not Done (only 7/25 inquired about past trauma as a risk factor for PNES). SignificanceThe OSCEs are a feasible and useful way to teach neurology residents about discussing PNES, as they allow for provision of real-time practice and feedback in a safe environment without real patients.

Molecular genetic studies in adult and paediatric neurology in Iraq: A review of 5-year joint collaboration, new experience and new challenges

Molecular genetic studies in adult and paediatric neurology in Iraq: A review of 5-year joint collaboration, new experience and new challenges

Pediatric and adult neurologist perspectives on the challenges of sustaining a transfer clinic.

We present a novel epilepsy fellow-driven transfer clinic model and discuss the challenges experienced in finding sustainability; this is timely as many pioneering transition clinics are dissolving across North America. The goal of this clinic was to improve patient care and satisfaction, as measured by a post-visit telephone survey. Unfortunately, our transfer clinic model proved unsustainable due to several factors, broadly categorized as (1) cultural-societal differences between the pediatric and adult health care environments, (2) staffing issues, (3) lack of an established standardized process for transfer of care, and (4) financial and administrative barriers. We suggest potential solutions to these challenges, but the fate of transition and transfer of care clinics may ultimately depend on implementation of practice, policy, and/or financial guidelines.

21. ESTABLISHING THE RESIDENT ACADEMIC PROJECT TO INCREASE SCHOLASTIC ACTIVITY AMONG PEDIATRIC RESIDENTS

Introduction Participation in scholarly activity is a critical element of clinicians’ training. Required research projects are becoming increasingly more common among medical schools and residency programs. The University of California, San Diego (UCSD) pediatric residency program aims to increase research participation among its residents by launching and evaluating a new Resident Academic Project (RAP Project). Methods The RAP Project will be initiated starting with the UCSD pediatric residency class of 2021. The RAP Project is introduced during the fall of their first year. In the spring of their first year, residents will attend an afternoon-long research session that will connect them to potential mentors within each available research area (basic science, clinical, quality improvement (QI), education, and advocacy/global health research). Residents will select a project chair and two committee members and, with the help of their chosen mentor, develop a research proposal. Proposals will be approved by each trainee's research committee as well as the RAP oversight board by the beginning of their second year of residency. Residents will complete their project within the two months prior to graduation, submitting a yearly update at the end of their second year. Residents will present their work at an annual research day at the end of residency. Conclusions A pediatric and adult neurology residency program found that requiring residents to participate in mentored projects aimed at producing peer-reviewed publications or conference presentations increased research productivity among residents as well as expanded its pool of research mentors. 1 We will use baseline data from previous residency classes to determine if the Resident Academic Project increases scholastic activity (peer-reviewed publications, conference participation, ongoing projects) among UCSD pediatric residents and if it increases residents’ satisfaction with their research opportunities during training. We will also create a database of research opportunities, funding sources, and mentors to continue to make the scholastic experience among pediatric residents more robust.