Adult Neurology Residency Research Articles

Simulation-based Assessment of Brain Death Determination for ACGME Milestones of Adult Neurology Residents (P8-2.004)

<h3>Objective:</h3> Determining the utility of simulation-based training in assessment of the ACGME milestone for brain death determination in adult Neurology residents. <h3>Background:</h3> Recent updates to the ACGME milestones require proficiency in brain death determination. Because brain death occurs rarely, there is limited opportunity to observe and perform a brain death exam during residency. Simulation-based training is a useful tool for teaching management of infrequently encountered scenarios such as brain death. Prior studies have shown simulation improves practitioner knowledge base and comfort level with diagnosing brain death. No studies have demonstrated its utility as an assessment tool. <h3>Design/Methods:</h3> We created a simulation using a SimMan 3G manikin for brain death determination. Using the American Academy of Neurology guidelines, we created a validated checklist scoring four categories: pre-requisites and confounders, neurologic examination, apnea test, and determination of the need for ancillary testing. Adult neurology residents completed a survey before participating in the simulation. After the simulation, residents participated in a group debriefing and completed a post-simulation survey identical to the pre-simulation survey. The ACGME milestone for determination of brain death was assessed based on participants’ scores on the simulation. <h3>Results:</h3> All UF neurology residents performed the brain death determination simulation and were objectively scored on the ACGME milestone. Residents reported improved comfort level with determining brain death and scored higher on knowledge-based questions after the simulation and debriefing session. <h3>Conclusions:</h3> We successfully created a simulation designed to assess residents’ progress on the ACGME milestones in determining death by neurologic criteria. Variations of these scenarios exposed residents to commonly-encountered confounders, barriers to completing the exam, and situations where interventions may be required to continue testing safely. Additionally, residents reported increased comfort level and scored higher on knowledge-based questions after the simulation and debriefing. <b>Disclosure:</b> Dr. Wasserstrom has nothing to disclose. Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health. The institution of an immediate family member of Dr. Wilson has received research support from NIH. An immediate family member of Dr. Wilson has received intellectual property interests from a discovery or technology relating to health care. Dr. Wilson has received publishing royalties from a publication relating to health care. Dr. Ford has nothing to disclose.

@NMatch2023: A Student-Led Social Media-Based Initiative to Guide Adult and Child Neurology Residency Applicants and Programs in a Digital Era (P10-2.002)

<h3>Objective:</h3> To describe the expansion of the @NeurologyMatch2023 project in supporting medical students applying to Adult and Child Neurology Residency programs in the United States. To offer recommendations for the online presence of Neurology Programs to encourage engagement with applicants. <h3>Background:</h3> The COVID-19 pandemic has left a lasting impact on the residency application process. Virtual interviews offer a viable alternative to traditional in-person interviews, and residency programs rely on a strong online presence for applicant engagement. @NeurologyMatch is a student-operated, social media initiative to promote networking, education, and information-sharing within the online neurology community. @NMatch2023 has continued to expand and improve this resource for both neurology applicants and residency programs. <h3>Design/Methods:</h3> <h3>Timeline:</h3> <b>May:</b> @NMatch2023 leaders transitioned, Feedback Survey released <b>June:</b> Match Motivation Mondays launched <b>July:</b> Mentorship program launched <b>August:</b> Program calendar and features launched <b>September:</b> NMatch Panel with the PDs <b>October:</b> Data collection <h3>Results:</h3> <h3>Frequent ERAS Questions (n=189):</h3> The most commonly asked questions were about USMLE scores (36.3%), preliminary vs. advanced positions (18.1%) and personal statements (13.7%). <h3>Twitter Analytics:</h3> Since the transition of leadership in May 2022, we had an average of 114 tweets; 140,000 impressions; 49,200 profile visits; 440 mentions; and 295 followers per month. <h3>Instagram Analytics:</h3> Compared to May 2022, our analytics demonstrate a 174% increase in accounts, with 4,443 accounts in the last 90 day period. There was an increase in account engagement by 155%, with a total number of 730. <h3>Conclusions:</h3> Since May 2022, @NMatch2023 experienced a substantial increase in follower activity on Instagram and consistent Twitter engagement. From the applicant perspective, NMatch is a resource to see program highlights and compare programs. From the perspective of Neurology residency programs, NMatch serves as a tool to determine what is important for applicants in choosing a program as well as suggest information their program makes available for student review prior to applying. <b>Disclosure:</b> Miss Goel has nothing to disclose. Miss Pertsovskaya has nothing to disclose. Ms. Mendez Colmenares has nothing to disclose. Melanie Orr has nothing to disclose. Ms. Naveed has nothing to disclose. Mr. Yarlagadda has nothing to disclose. Mr. Emmanuel has nothing to disclose.

Tackling resident burn-out through enhancing the work environment amidst the COVID-19 pandemic (P7-7.002)

<h3>Objective:</h3> To investigate different ways of improving neurology resident wellbeing through enhancing the daily work environment. <h3>Background:</h3> Resident physician burnout has been shown to affect the quality of clinical care provided. Burnout may also lead to major depression and increases risk for suicide amongst physicians. Resident burnout rates were higher during the COVID-19 pandemic. At our academic institution, there is 5 adult neurology residents and 1 pediatric neurology resident per year. We implemented multiple changes to improve the residents’ work environment and therefore alleviate some of the burnout associated with long work hours and isolation during the COVID-19 pandemic. <h3>Design/Methods:</h3> Quality improvement project. Different changes were implemented then residents were surveyed to measure satisfaction. All questions were measured across a 3-point scale, “yes”, “no”, “maybe”. Analyses were reported as frequencies. <h3>Results:</h3> 13 out of 18 residents answered the survey. 100% thought that having a residency wellness chief helped improve wellness overall. 62% reported they worked 70 hours per week. More than 50% felt that getting out on time is the most important thing to their quality of life. 30% of residents thought that feeling heard is most important to them. 92% of residents thought that having snacks and drinks available in the work room was valuable to them. 92% of residents agreed that having a futon in the team room allowed residents to rest during night call amidst the pandemic when there were concerns over sharing call rooms. 62% of residents agreed that we should plan quarterly social events. <h3>Conclusions:</h3> Implementing simple measures like appointing a resident wellness, making snacks available in the work room and adding a futon made our residents feel appreciated. These small changes were effective in alleviating some of the stress associated with working during the pandemic. <b>Disclosure:</b> Dr. Ouf has nothing to disclose. Dr. Shaikh has nothing to disclose.

Assessing the Impact of a Multi-Modal Neuro-Ophthalmology Educational Workshop on Resident Confidence in the Neuro-Ophthalmology Examination (P1-2.005)

<h3>Objective:</h3> To identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Background:</h3> The Neuro-Ophthalmology examination is essential for neurological localization. However, increased workloads and limited exposure make it challenging for residents to become proficient. This study aims to identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Design/Methods:</h3> This is a single-center, mixed methods, quantitative-qualitative (convergent parallel design) survey-based study evaluating resident confidence in neuro-ophthalmological examination. The utility of a didactic-based and hands-on Neuro-Ophthalmology workshop covering evaluation of visual fields, extraocular movements (EOM), and fundoscopic exam was assessed. A survey composed of Likert scales (1=strongly agree, 5=strongly disagree) and open-ended questions for qualitative feedback was administered before and after the workshop. Descriptive data and paired comparisons (Wilcoxon signed-rank test) are reported. <h3>Results:</h3> 16 adult and pediatric neurology residents (81% adult, median post-graduate training-year 3, [range 1–4]) participated in the 2-hour workshop. Pre-workshop surveys revealed that residents were least confident in disc edema assessment (median rating 4 [range 2–5]) and reported an unmet need for teaching and feedback about examination techniques (median rating 4 [range 2–5]). Post-workshop surveys demonstrated a significant improvement (p&lt;0.05) in overall confidence in exam skills, specifically when identifying relative-afferent pupillary defects and pathognomonic characteristics of ophthalmological disorders. Fundoscopic exam confidence did not improve significantly, but results were limited given early termination of breakout sessions. Videos of EOM abnormalities and immediate feedback from instructors were reported as most helpful. Residents suggested increasing workshop length for future sessions. <h3>Conclusions:</h3> A combined didactic-based and hands-on Neuro-Ophthalmology workshop is helpful in identifying gaps in Neuro-Ophthalmology training and increasing resident confidence. Additional instruction in visual acuity and fundoscopic assessments may be beneficial in future workshops. We aim to utilize our findings to create an optimized Neuro-Ophthalmology curriculum with future application to other aspects of resident training. <b>Disclosure:</b> Dr. Kang has nothing to disclose. Dr. Flowers has received intellectual property interests from a discovery or technology relating to health care. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Lavin has nothing to disclose. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Shah has received publishing royalties from a publication relating to health care.

Simulation training in Neuropalliative Care (P8-6.002)

<h3>Objective:</h3> The purpose of our study is to evaluate if a simulation in neuropalliative care is a useful training method for neurology residents. <h3>Background:</h3> Education in palliative care is lacking in neurology training. The majority of neurology residency programs do not have a formal way to train and assess residents in this domain. <h3>Design/Methods:</h3> The simulation targeted adult and pediatric Neurology residents ranging from PGY2-PGY4. The Serious Illness Conversation Guide (SICG) was used as a framework. Residents first received a didactic reviewing the SICG, followed by two simulations with standardized patients (SPs). The first simulation focused on giving bad news in the outpatient setting. The second focused on shared decision making in the inpatient setting. Residents filled out surveys assessing their comfort levels before and after the simulations, as well as 3 months later to determine how it influenced their practice. <h3>Results:</h3> Twenty-one residents participated in the simulation. Survey responses were received from 100% of participants. After the simulation, respondents who felt comfortable giving bad news increased by 11% for the inpatient setting and by 19% for the outpatient setting. There was a trend towards improved comfort in assessing illness understanding, managing uncertainty in prognosis, making a recommendation based on patient goals, and discussing hospice options. Overall, 91% thought the simulation accurately represented real life and 100% felt that the simulation would influence their future practice. At 3 months after the simulation, 85% of trainees reported using the SICG in palliative care conversations. <h3>Conclusions:</h3> Simulation training with SPs is a valuable way to train neurology residents in neuropalliative care discussions. Future simulations can tailor specific scenarios to resident level of training. <b>Disclosure:</b> Dr. Lalla has nothing to disclose. Ms. Dobie has nothing to disclose. The institution of Dr. Bissonnette has received research support from Michael J Fox Foundation. The institution of Dr. Bissonnette has received research support from Cogan Family Foundation. Dr. Lau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint. The institution of Dr. Lau has received research support from Amyloidosis Foundation. Dr. Tulsky has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for American Board of Internal Medicine. Dr. Kaku has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Fatcliffe Harten Galamaga LLP.

Improving Knowledge and Diagnostic Comfort Levels through Brain Death Simulation Education (P9-2.003)

<h3>Objective:</h3> Enhance neurology resident comfort in diagnosing brain death through simulation education. <h3>Background:</h3> Uniform experience in diagnosing brain death is not guaranteed in residency training. Previous literature describes simulation training as a supplement to brain death education by demonstrating improvement in knowledge and confidence with clinical examination and apnea testing performance as well as diagnosis disclosure. To address educational gaps, we implemented brain death simulation education for senior neurology residents to standardize training and improve knowledge and comfort. <h3>Design/Methods:</h3> 19 adult neurology residents (PGY3 and 4s) participated. Residents were provided educational materials and asked to complete a pre-test, which included 20 knowledge-based and 15 comfort-based questions (scale 1 to 5, 1= very uncomfortable, 5= very comfortable) on key aspects of diagnosing brain death. A neurointensivist mentored each session and covered all phases of brain death testing: pre-requisites, physical examination, apnea testing, ancillary testing, and communication of findings. Following a debrief session, residents were instructed to complete a post-test (identical to pre-test). <h3>Results:</h3> Knowledge scores improved from 9.6/12 to 10.8/12 for 95% of participants (n=18). Average comfort score improvement was statistically significant (p&lt;0.05) for ensuring all pre-requisites for brain death testing are met (3.5/5 to 4.3/5), identifying/correcting confounding factors (3.3/5 to 4.2/5), brain death physical examination 3.4/5 to 4.5/5), apnea testing (2.5/5 to 4.1/5), and determining need for ancillary testing (3.1/5 to 3.9/5). There was non-significant improvement in determining eligibility for testing (3.7/5 to 4.1/5, p = 0.21) and communication of findings (3.2/5 to 3.6/5, p = 0.23). <h3>Conclusions:</h3> Simulation education is a powerful tool for building skills in the determination of death by neurologic criteria during neurology residency. It not only improves resident knowledge but also comfort across the core competencies of diagnosing brain death. <b>Disclosure:</b> Dr. Barnes has nothing to disclose. Dr. Moeller has received publishing royalties from a publication relating to health care. The institution of Dr. Gilmore has received research support from NIH. Dr. Beekman has nothing to disclose.

The Impact of Establishing a Diversity, Equity, and Inclusion Committee in a Single US Adult Neurology Residency Program (P5-9.005)

The Impact of Establishing a Diversity, Equity, and Inclusion Committee in a Single US Adult Neurology Residency Program (P5-9.005)

Global neurology: It's time to take notice.

Global neurology: It's time to take notice.

A half‐century check‐up for child neurology training

A half‐century check‐up for child neurology training

Competency-based EEG education: a list of "must-know" EEG findings for adult and child neurology residents

Competency-based EEG education: a list of "must-know" EEG findings for adult and child neurology residents

Stroke Neurointervention: A Novel Educational Pathway to Improve Neurology Resident Training in Neurointervention and Regional Access to Thrombectomy

Large vessel occlusions account for ≈30% of acute ischemic stroke. Mechanical thrombectomy is a highly beneficial treatment for large vessel occlusion strokes in appropriately selected patients. However, there is significant geographic variability in regional access to this important therapy, and broadening coverage by using non‐neuroscience specialties places patients at risk for suboptimal cerebrovascular care. An alternative solution is to train more neurologists to perform this procedure and consolidate expertise in vascular neurology. However, neurology residents have minimal exposure to the angiography suite and are disadvantaged in this regard when it comes to preparedness for fellowship training. We detail a novel training pathway incorporating neuroendovascular training into the adult neurology residency and an option to continue hybridized stroke–neurointervention training in a vascular neurology fellowship. Here, we present the development of the training curriculum, early trainee experience, and challenges to widespread implementation. The stroke–neurointervention training pathway was created with the intention of improving access to this important therapy by enfolding early training into neurology residency.

Leadership and Professional Development Innovation in a Military Adult Neurology Residency Program to Enhance Medical Readiness (P10-6.002)

Leadership and Professional Development Innovation in a Military Adult Neurology Residency Program to Enhance Medical Readiness (P10-6.002)

Trends in Diversity at a Single US Adult Neurology Residency Program (P18-13.002)

Trends in Diversity at a Single US Adult Neurology Residency Program (P18-13.002)

Retrospective Study of an Adult Neurology Residency’s Implementation of an Academic Half Day Curriculum (P9-6.005)

Retrospective Study of an Adult Neurology Residency’s Implementation of an Academic Half Day Curriculum (P9-6.005)

Multicentre collection of uniform data on patients hospitalised for transient ischaemic attack or stroke in the Philippines: the Philippine Neurological Association One Database-Stroke (PNA1DB-Stroke) protocol

IntroductionFor scientific advances to translate into improved patient outcomes, systems of care must be in place to facilitate delivery of care. There is scarce information on quality of care and...

The Neurology Fellowship Application Conundrum: Finding Common Ground.

For many neurologic subspecialties, the fellowship application process begins early in the first half of the second year of neurology-specific training (PGY3 for adult neurology residents and PGY4 for child neurology residents). In 2019, the American Academy of Neurology (AAN) published a position statement recommending communication between fellowship candidates and training programs begin no sooner than March 1 of the penultimate year of training and that programs offer fellowship positions no sooner than August 1 of the final year of training. A few pilot subspecialties adopted this timeline for 2021 recruitment for positions beginning in 2022. All United States-based AAN-affiliated neurology and child neurology residents who recently completed the fellowship application process received a survey about their fellowship application experience. Of the 291 residents who responded to the survey, 96% agree that applications should not be submitted before March 1 of the penultimate year of training and 72% believe that August 1 of the final year is a reasonable time to begin offering positions. Nearly half (49%) of residents believe that there is too little time for subspecialty/clinical exposure before applying for fellowship and 88% feel the current process and timeline are stressful. Residents who applied to programs in pilot subspecialties report more time to choose, less stress, and a lower number of time-pressured offers. A large majority of residents (89%) prefer to submit a single application through a centralized system. The survey results suggest that residents who just completed the fellowship application process agree with the AAN recommended timeline for all subspecialties and that all neurology subspecialties should consider adopting a fellowship match. Programs can help facilitate a better fellowship application experience by providing earlier exposure to a broad range of neurologic subspecialties and ensure that residents are given opportunities to attend national meetings and participate in appropriately scoped scholarly endeavors.

Short-term effectiveness of a condensed series of standard EEG lectures for adult neurology residents.

To investigate (i) the short-term effectiveness of a series of traditional didactic EEG lectures for an adult neurology resident cohort and (ii) whether the educational benefit of such lectures correlates with residents' prior formal EEG exposure. We evaluated the short-term effectiveness of traditional lectures by testing residents' EEG knowledge before and after a series of four EEG lectures given by epilepsy attending physicians. The EEG test consisted of both normal (27) and abnormal (10) EEG questions. Only residents who performed the test before (pre-test) and after (post-test) and attended at least two lectures were included. Residents were divided based on whether they had at least one EEG rotation during or prior to the study (Group A) or not (Group B). Twelve residents met the inclusion criteria: two PGY1 (one-year postgraduate), four PGY2, one PGY3, and five PGY4 residents. One of these residents did not complete the abnormal EEG section of the tests. The time interval between both tests ranged from 40 to 75 days. The overall score (mean±SEM) for the normal (n=12) EEG section was 47±6.1% (pre-test) and 58±5.5% (post-test) (p=0.0168). The overall score for the abnormal (n=11) EEG section was 48±7.2% (pre-test) and 62±8.6% (post-test) (p=0.0396). Group A (n=6) pre- and post-test scores were 53±6.7% and 72±4.6%, respectively (p=0.0008). Group B (n=5) pre- and post-test scores were 42±11.4% and 48±11.7%, respectively (p=0.3777). A condensed series of four EEG lectures given by epilepsy attending physicians generated a statistically significant increase in EEG knowledge among adult neurology residents who already had some degree of formal in-residency EEG exposure. Standard EEG lectures may be an invaluable tool in resident EEG education. It would be advisable to ensure that residents undergo hands-on EEG exposure through formal rotations either prior to or during standard lectures in order to generate maximal educational benefits via this teaching avenue.

Abstract TP78: Team-based Resident Training For Stroke Code Simulations Decreases Variations In Thrombolytic Door To Needle Times

Introduction: Stroke code simulation training is effective at reducing door to needle times (DTNT) for tPA administration. We aimed to evaluate the effect on DTNT from simulation training specifically for Neurology residents. Method: Stroke code simulation was implemented at our comprehensive stroke center in July 2017, targeting PGY2 adult neurology residents and PGY3 pediatric neurology residents who were first responders at stroke codes during off-hours. Training was completed at the beginning of the residents’ respective training years. An interrupted time series analysis of DTNT for tPA before and after the implementation of simulation training from July 2016 to July 2019 was performed. Demographics, tPA metrics, and safety and hospital metrics were compared pre and post intervention among the residents. No other quality improvement projects targeting DTNT were implemented during this time. Results: Between July 2016 and July 2019, 305 patients received thrombolysis from a resident first responder - 118 (39%) of whom were treated pre-simulation and 187 (61.3%) treated during the simulation period. There was no significant difference in patient baseline characteristics between the two groups (Table 1). Median DTNT was 49.5 (IQR 40-71) min during the pre-simulation period and 48 (IQR 37-60) min during the post-simulation period (p= 0.04). Compared to pre-simulation, there were no months in which the median DTNT exceeded 60 min post-simulation. IQR for the DTNT appeared both clinically and statistically different. Pre and post simulation, there was no difference in incidence of symptomatic intracranial hemorrhage nor in 90-day outcomes. Conclusion: In our analysis of the effect of stroke code simulation training among neurology residents, improvement in DTNT after simulation training appears more driven by improvement in the variation in times rather than a clinically significant decrease in median times.

EEG education in Brazil: a national survey of adult neurology residents.

In light of the established challenges of resident EEG education worldwide, we sought to better understand the current state of neurology resident EEG education in Brazil. To define Brazilian EEG practices including in-residency requirements for EEG training and competency. We assessed the perspectives of adult residents (PGY1-3) on EEG education and their level of confidence interpreting EEG with a 24-question online survey. We analyzed 102 responses from 52 Brazilian neurology residency programs distributed in 14 states. There were 18 PGY1s, 45 PGY2s, and 39 PGY3s. Ninety-six percent of participants reported that learning how to read EEG during residency was very or extremely important. The most commonly reported barriers to EEG education were insufficient EEG exposure (70%) and ineffective didactics (46%). Residents believed that standard EEG lectures were the most efficient EEG teaching method followed by interpreting EEG with attendings' supervision. Roughly half of residents (45%) reported not being able to read EEG even with supervision, and approximately 70% of all participants did not feel confident writing an EEG report independently. Despite the well-established residency EEG education requirements recommended by the Brazilian Academy of Neurology (ABN), there seems to be a significant lack of comfort interpreting EEG among Brazilian adult neurology residents. We encourage Brazilian neurology residency leadership to re-evaluate the current EEG education system in order to ensure that residency programs are following EEG education requirements and to assess whether EEG benchmarks require modifications.

Grand rounds education in neurology, with a focus on headache medicine.

To quantify the proportion of headache-related grand rounds in academic neurology programs and to compare this with adult neurology residency director views on the need for an increase in headache-related grand rounds. Although headache are among the most prevalent and most burdensome neurologic conditions, headache medicine is often considered underrepresented in neurology departments. Additionally, prior studies have shown that many neurology residency directors feel that training programs do not include an adequate amount of exposure to headache clinics or headache-related didactics. One important aspect of didactic education in neurology departments is adult neurology grand rounds. Previous publications have evaluated neither the proportion of headache-related grand rounds in academic neurology departments nor the residency program directors' views on appropriate amount of headache-related grand rounds. Our study has attempted to quantify this information to elucidate opportunities to improve practice educational gaps. In this cross-sectional study, we surveyed adult neurology residency directors (from the Accreditation Council for Graduate Medical Education [ACGME] listing of academic adult neurology residency programs) between October 2018 and September 2019. In addition, we used two methods to obtain the proportion of headache-related grand rounds in neurology: (1) emailing residency directors a questionnaire asking for a list of prior grand rounds topics and (2) an online search for each academic neurology program. First, for our grand rounds analysis, headache medicine consisted of 3.7% of the lectures in 2017-2018 and 6.3% of the lectures in 2018-2019 (average of each institution; 17 institutions and 411 total lectures in 2017-2018, 21 institutions and 463 total lectures in 2018-2019). The most common number of lectures on headache medicine for each grand rounds series was zero (for 7 of 17 grand rounds series in 2017-2018 and 7 of 21 in 2018-2019), followed closely by one lecture (for 6 of 17 grand rounds series in 2017-2018 and 6 of 21 in 2018-2019). Second, for our survey, the response rate was 19.3% (29/150). No residency director thought their institution had too many grand rounds dedicated to headache medicine, and 62.1% (18/29) thought they had an adequate amount of headache grand rounds. Within the survey responders, 75.9% (22/29) of adult neurology residency programs have a board-certified headache specialist at their institution. Although most adult neurology residency directors believe that headache is adequately represented in adult neurology grand rounds, headache medicine makes up 4%-6% of all neurology grand rounds. Compared with other neurology subspecialties and the other core ACGME milestones, headache makes up the fewest grand rounds lectures that were assessed in this study.