American Academy Of Neurology Members Research Articles

Question of the Day: A Learning Success (S10.001)

<h3>Objective:</h3> To demonstrate the successful implementation of the American Academy of Neurology (AAN) Question of the Day (QOD) mobile application and its value to AAN members. <h3>Background:</h3> QOD, launched in 2020, provides daily board exam–style multiple-choice questions in two tracks: one for practicing neurologists and one for medical students. Questions for neurologists follow a yearly curriculum based on the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification (MOC) content outline. Topics include a wide variety of neurology subspecialties. Each question is accompanied by a detailed rationale and current references, many of which are hyperlinked to peer-reviewed resources. Users can earn up to 29 self-assessment continuing medical education (SA-CME) per year, which is 2 SA-CME per 25 QOD questions. The ABPN has approved QOD as part of a comprehensive lifelong learning program. <h3>Design/Methods:</h3> Data collected from QOD since April 2021 include activity by AAN member type, total active daily users, number of CME earned, and program evaluation data. <h3>Results:</h3> Total users per year were 5.6K, 9.5K, and 11K for 2020, 2021, and 2022, respectively, with practicing neurologists (25%) and junior (59%) AAN members the most engaged, and with participation from 123 countries. Average daily users increased from 1.4K in 2021 to 1.5K in 2022, with weekly (2.7K) and monthly (4.3K) usage comparable in 2021 and 2022. In total, 8.7K hours of SA-CME have been claimed in 2022 compared with 5.8K in 2021. Satisfaction has remained high since launch and is currently 99%. Users report that the questions are useful, fair, balanced, and of high quality. <h3>Conclusions:</h3> Since its introduction in 2020, QOD has become a very popular, effective continuing education program for AAN members. There has been substantial growth of new users each year while maintaining a strong contingency of daily users. <b>Disclosure:</b> Dr. Seachrist has received personal compensation for serving as an employee of American Academy of Neurology. The institution of Dr. Seachrist has received research support from Bristol Myers Squibb. Dr. Seachrist has a non-compensated relationship as a Topic Group Member with American Academy of Neurology that is relevant to AAN interests or activities. Ms. Shindoll has nothing to disclose. The institution of Dr. Pawar has received research support from ACGME "Back to Bedside" Grant support. Dr. London has nothing to disclose. Dr. Khan has nothing to disclose. The institution of Dr. Kraakevik has received research support from Parkinson Foundation. Dr. Graber has a non-compensated relationship as a Editorial Board member with Neuro-Oncology: Practice, published by Oxford that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Journal of Pain and Symptom Management that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Certification Exam Committee Member with United Council of Neurogical Subspecialties that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Question of the Day ’app’ committee with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Practical Neurology (BMC) that is relevant to AAN interests or activities. Dr. Gliksman has nothing to disclose.

Gender Disparities in the Career of Neurology Researchers.

To assess gender disparities in neurology researcher careers in the United States. A 34-question survey was distributed to 4,644 US-based American Academy of Neurology members who self-identified as researchers in 2020 addressing the following domains: research and funding, scholarly activities, coronavirus disease 2019 (COVID-19) effect, and local institutional climate. A total of 700 (15%) individuals completed the survey (women, n = 231; men, n = 426), with 71% White and >80% conducting research. Women respondents were significantly younger than men, more likely to be assistant professors (32% vs 21%), and less likely to be full professors (18% vs 39%). Compared with men, women received equivalent grants and research support and had comparable or additional formal research training and mentorship. Women had less middle author publications (mean 5.8 [SD 9.2] vs mean 8.2 [SD 11.8], p = 0.03) compared with men but similar first or last author publications (mean 4.3[5.4] vs 6.1 [9.8], p = 0.05). A lower proportion of women presented research at grand rounds or at a national/international conference compared with men (58% vs 69%, p = 0.01). Women spent more time in nonprofessional responsibilities, were less satisfied with their work-life balance, and were less likely to agree with statements addressing equity/diversity and institutional climate. Respondents shared their concerns regarding how the pandemic was affecting neurology research careers, with a higher proportion of women reporting that family responsibilities affected research activities and lead to delayed submission of non-COVID-19-related manuscripts. Our survey of US-based neurology researchers demonstrated continued gender-based disparities in academic rank, manuscript authorship, and invited speaking engagements, although funding opportunities and access to additional training were equivalent. Women were less likely than men to agree that neurology departments support diversity and equity and that the institutional climate was inclusive and transparent. The pandemic had affected both genders in research, but areas were different for women related to family responsibilities. This article also highlights additional areas of research and areas for intervention to improve and reduce gender disparities among neurology researchers.

COVID-19 Exposure During Neurology Practice: Results of American Academy of Neurology Survey.

To determine the exposure risk for coronavirus 2019 (COVID-19) during neurology practice. Neurological manifestations of COVID-19 are increasingly being recognized mandating high level of participation by neurologists. An American Academy of Neurology survey inquiring about various aspects of COVID-19 exposure was sent to a random sample of 800 active American Academy of Neurology members who work in the United States. Use of second tier protection (1 or more including sterile gloves, surgical gown, protective goggles/face shield but not N95 mask) or maximum protection (N95 mask in addition to second tier protection) during clinical encounter with suspected/confirmed COVID-19 patients was inquired. Of the 81 respondents, 38% indicated exposure to COVID-19 at work, 1% at home, and none outside of work/home. Of the 28 respondents who did experience at least 1 symptom of COVID-19, tiredness (32%) or diarrhea (8%) were reported. One respondent tested positive out of 12 (17%) of respondents who were tested for COVID-19 within the last 2 weeks. One respondent received health care at an emergency department/urgent care or was hospitalized related to COVID-19. When seeing patients, maximum protection personal protective equipment was used either always or most of the times by 16% of respondents in outpatient setting and 56% of respondents in inpatient settings, respectively. The data could enhance our knowledge of the factors that contribute to COVID-19 exposure during neurology practice in United States, and inform education and advocacy efforts to neurology providers, trainees, and patients in this unprecedented pandemic.

Use of Social Media in Health Care-Opportunities, Challenges, and Ethical Considerations: A Position Statement of the American Academy of Neurology.

The American Academy of Neurology (AAN) Code of Professional Conduct (CPC)1 formalizes the standards of professional behavior for AAN members. The CPC provides the ethical principles and professional standards that neurologists and other neuroscience professionals should or must observe in their clinical and scientific activities. While ethical principles do not change with time, developments in technology and social structure may lead to a change in how these principles are applied. One such technological development is social media—a class of communication tools that has rapidly grown in number and popularity in recent years. The AAN developed this position statement to review in-depth how social media use has transformed clinical practice, with a particular focus on neurologic practice, and, by exploring the relevant principles in the CPC,1 to provide an ethical framework for neurology professionals and trainees to consider when engaging in social media. This statement complements the CPC; it is not a replacement for the AAN Web site's Code of Conduct, Privacy Policy, or Terms of Service.

American Academy of Neurology Code of Professional Conduct.

The American Academy of Neurology (AAN) developed the Code of Professional Conduct to formalize the standards of professional behavior for AAN members to help them in their pursuit of providing the highest quality of patient-centered neurologic care. The goal of this code is to establish the professional standards that AAN members must or should observe in their clinical, academic, scientific, and personal activities.

American Academy of Neurology members' preparedness to treat sexual and gender minorities.

To measure the attitudes and knowledge of American Academy of Neurology (AAN) member neurologists in caring for sexual and gender minority (SGM) patients (e.g., those who identify in the lesbian, gay, bisexual, transgender, queer, or questioning [LGBTQ+] spectrum) to inform future educational offerings. A questionnaire was created in an iterative process by the LGBTQ+ Survey Task Force, consisting of 21 questions examining self-reported knowledge, attitudes, and clinical preparedness in caring for SGM patients. Participants responded to each statement with a 5-point Likert scale ("strongly disagree" to "strongly agree"). The survey was distributed via electronic and conventional mail to a random, representative sample of 1,000 AAN members. The response rate was 13.5% (n = 135). Most respondents (60%-66%) were aware of local and national barriers that inhibit SGM individuals from using health care services; the majority (73%-91%) felt comfortable assessing SGM patients. Over half believed sexual orientation (SO) and gender identity (GI) to be social determinants of health (61% and 57%, respectively). Yet a third would not tailor neurologic care based on a patient's SGM identity, and 43% believed that SO/GI has no bearing on the management of neurologic illness. Most neurologists surveyed were aware of overarching barriers to care experienced by SGM individuals; however, a minority of respondents recognized the intersection of SGM identity with neurologic health. Our results highlight awareness gaps that could be addressed via targeted educational opportunities, ensuring that neurologists provide high-quality neurologic care to patients of all sexual orientations and gender identities.

The state of clinical research in neurology.

To study and provide an update on the state of clinical research in neurology in the United States. US American Academy of Neurology members and chairs of departments of neurology were surveyed regarding clinical research in 2016. NIH data on the neuroscience pipeline and extramural grant funding were also collected. The response rate was 32% (n = 254) for nonchair researchers and 58% (n = 67) for department chairs. Researcher respondents were on average 50 years old, 66% were men, and 81% were actively conducting clinical research, with phase II/III clinical trials and outcome measure studies being the most common type of research conducted. Time to conduct research, recruitment, and administrative burden were the major barriers reported. According to department chairs, funding and training opportunities in patient-oriented research have increased over the last 10 years. Overall, applicants to neuroscience-specific NIH institutes for extramural funding have decreased over the same time period. The state of clinical research in neurology has remained relatively stable over the last 10 years, but neurologists still have barriers in conducting clinical research. There has been an interval decrease in neuroscience applicants for NIH funding, which raises concerns about the pipeline and future of clinical research in neurology. These results will serve as a reference for the development of solutions to these issues.

The evaluation of small fiber neuropathy: a survey of American Academy of Neurology members (P4.140)

The evaluation of small fiber neuropathy: a survey of American Academy of Neurology members (P4.140)

Education Research: Neurology resident education: Trending skills, confidence, and professional preparation.

To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training.

Sports neurology topics in neurologic practice: A survey of AAN members.

We sought to assess neurologists' interest in sports neurology and learn about their experience in treating sports-related neurologic conditions. A survey was sent to a random sample of American Academy of Neurology members. A majority of members (77%) see at least some patients with sports-related neurologic issues. Concussion is the most common sports-related condition neurologists treat. More than half of survey participants (63%) did not receive any formal or informal training in sports neurology. At least two-thirds of respondents think it is very important to address the following issues: developing evidence-based return-to-play guidelines, identifying risk factors for long-term cognitive-behavioral sequelae, and developing objective diagnostic criteria for concussion. Our findings provide an up-to-date view of the subspecialty of sports neurology and identify areas for future research.

The American Academy of Neurology's Top Five Choosing Wisely recommendations

Objective: To discuss the American Academy of Neurology (AAN)9s Top Five Recommendations in the Choosing Wisely campaign promoting high-value neurologic medicine and physician–patient communication. The AAN published its Top Five Recommendations in February 2013 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports . Methods: A Choosing Wisely Working Group of 10 AAN members was formed to oversee the process and craft the evidence-based recommendations. AAN members were solicited for recommendations, the recommendations were sent out for external review, and the Working Group members (article authors) used a modified Delphi process to select their Top Five Recommendations. Results and recommendations: The Working Group submitted 5 neurologic recommendations to the AAN Practice Committee and Board of Directors; all 5 were approved by both entities in September 2012. Recommendation 1: Don9t perform EEGs for headaches. Recommendation 2: Don9t perform imaging of the carotid arteries for simple syncope without other neurologic symptoms. Recommendation 3: Don9t use opioids or butalbital for treatment of migraine, except as a last resort. Recommendation 4: Don9t prescribe interferon-β or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis. Recommendation 5: Don9t recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (

New antiepileptic drug safety information is not transmitted systematically and accepted by U.S. neurologists

We surveyed U.S. neurologists in order to evaluate their knowledge of, and sources for, recent FDA safety warnings regarding antiepileptic drugs (AEDs) and whether they incorporate this information into their practices. Survey respondents (N=505) were predominantly board-certified American Academy of Neurology members. Approximately 20% of respondent neurologists were not aware of warnings about four drug safety risks: suicidality with newer AEDs, increased birth defect risks from in utero divalproex exposure, impaired cognitive development from in utero divalproex exposure, and the requirement of haplotype screening in patients of Asian descent starting carbamazepine. Most respondents were aware of a recommendation for haplotype screening, yet did not routinely perform the safety screening, and 18 reported patients that had hypersensitivity reactions to carbamazepine. Respondents learned about drug safety risks from varied sources; only notifications from specialty organizations were associated with accurate knowledge of drug safety warnings. Most surveyed neurologists would prefer implementing “a formal warning process via specialty organizations” with e-mails of updated product insert warnings.

The American Academy of Neurology's Top Five Choosing Wisely recommendations

To discuss the American Academy of Neurology (AAN)'s Top Five Recommendations in the Choosing Wisely campaign promoting high-value neurologic medicine and physician-patient communication. The AAN published its Top Five Recommendations in February 2013 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports. A Choosing Wisely Working Group of 10 AAN members was formed to oversee the process and craft the evidence-based recommendations. AAN members were solicited for recommendations, the recommendations were sent out for external review, and the Working Group members (article authors) used a modified Delphi process to select their Top Five Recommendations. The Working Group submitted 5 neurologic recommendations to the AAN Practice Committee and Board of Directors; all 5 were approved by both entities in September 2012. Recommendation 1: Don't perform EEGs for headaches. Recommendation 2: Don't perform imaging of the carotid arteries for simple syncope without other neurologic symptoms. Recommendation 3: Don't use opioids or butalbital for treatment of migraine, except as a last resort. Recommendation 4: Don't prescribe interferon-β or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis. Recommendation 5: Don't recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (<3%).

Blurring of local and remote practice models threatens IOM's future

In this issue of Neurology ® , Nuwer et al.1 present the results of a recent survey of American Academy of Neurology members concerning practice patterns for intraoperative neurophysiologic monitoring (IOM). The study confirms the continued growth of IOM but also sheds light on striking differences between 2 practice models—“local” monitoring and the “remote” telemetry. For historical reasons, a single Current Procedural Terminology (CPT) code has applied to both models, generating considerable ambiguity and resulting in lack of transparency, particularly to third-party payers, which now presents a serious challenge to the field and to neurologists providing IOM services. On November 1, 2012, with the issuance of the Centers for Medicare & Medicaid Services's (CMS's) Final Rule for Medicaid physician payments,2 this challenge became a crisis that threatens to limit IOM services available to Medicare patients.

The practice of neurology, 2000–2010

To present an analysis of American Academy of Neurology (AAN) membership demographics and practice trends over the past decade. Data from the 2009 AAN Census and 2010 Practice Profile Form (PPF) surveys were compared to results from 2004 and 2000 surveys. The Census was sent to all AAN members, and the PPF was sent to a random sample of US practicing neurologists. Since 2000, AAN membership increased by 31%, and the number of US neurologist-members increased by 14%. Mean age of US neurologists increased from 48.6 to 53.3 years, and 23.9% of neurologists are women. There was a 15% increase in the proportion of neurologists relative to the US population, from 3.41 neurologists per 100,000 population in 2000 to 3.92 neurologists in 2009. In 2009, 24.1% of US neurologists were in solo practice, 27.8% were in a neurology group, and 35.6% were in multispecialty/university settings, with little change in practice arrangements over time. The top 5 practice interest areas were unchanged since 2004 as were the number of hours devoted to patient care (42.3) or total work hours per week (57.1). Little change was observed in performed procedures, except increased use of botulinum toxin and nerve blocks and a decline in lumbar punctures. Neurologists rely more on physician assistants to see follow-up and new patients independently (p < 0.001). Despite advances in neurologic diagnosis and therapy, there has been little change in practice characteristics of US neurologists.

Upholding professionalism

To review the disciplinary process by which the American Academy of Neurology (AAN) enforces its formalized standards of professional conduct. We reviewed the AAN's Disciplinary Action Policy. We tracked the elapsed time from receipt to final decision of all allegations ("complaints") of improper conduct by AAN members submitted from 2004 to 2009. We placed each complaint into 1 of 4 categories: allegations of 1) improper expert witness testimony; 2) substandard care; 3) unprofessional conduct; 4) or both 2 and 3. We noted the type of complainant (AAN member or nonmember) and the final outcome for each complaint. The AAN's disciplinary process is a 5-step procedure with multiple reviewing bodies. From 2004 to 2009, the AAN received 3-16 complaints per year (total 58), with 16 filed each year in 2008 and 2009. Thirty-one complaints (53%) were submitted by nonmembers and 27 (47%) by members. Disciplinary action was recommended for 6 complaints (10.3%) with action taken in 3 (5.1%) and the member resigning in lieu of action in 3 (5.1%). The average number of days from receipt of complaint to final decision was 537, with an average of 890 days from 2004 to 2006, decreased to 184 days from 2007 to 2009. Recent revisions to the disciplinary process have increased efficiency and enhanced procedural safeguards. The AAN determined a mean of 12 months, from receipt of complaint to final decision rendered, is an appropriate benchmark when handling complaints. The AAN's disciplinary process upholds standards of professional conduct for AAN members and protects members from unsubstantiated complaints.

AAN guidelines

American Academy of Neurology (AAN) members assign high value to clinical practice guidelines. In a 2006 needs assessment survey, 82% of members rated guidelines as “important” or “very important.”1 Moreover, a 2009 survey of a representative sample of AAN members found that 75% used 1–6 AAN guidelines in the past year.2 However, the AAN has received feedback suggesting that guidelines without high-level recommendations (i.e., Level A or B) should not be published because they do not guide practice. Indeed, to account for lower levels of evidence, many specialty medical societies “fill in the gaps” with consensus and expert opinion–based recommendations. The AAN has decided not to incorporate consensus so as not to substitute the judgment of its members with the judgment of an expert panel, and maintains strict adherence to its evidence-based process. This decision was made with full knowledge that it may result in guidelines that are not as prescriptive for practice as many would find desirable. Such policy acknowledges that there are some questions that evidence-based medicine is ill-suited to answer and some important questions for which high-quality research is lacking. Nonetheless, the AAN′s guideline development subcommittees (Quality Standards Subcommittee [QSS] and Therapeutics and Technology Assessment Subcommittee [TTA]) believe that AAN guidelines are valuable tools regardless of the level of recommendation they contain. Our reasons for this belief follow. First, development of these documents involves performing a literature review for all evidence related to an answerable clinical question and grading it according to the AAN′s classification scheme.3 In view of the volume of literature available, a comprehensive but focused distillation of the evidence itself provides …

International science at the annual meeting of the American Academy of Neurology

The annual meeting of the American Academy of Neurology (AAN) is a major venue for presentation of the latest disease-related clinical and basic neurologic research and is attended by a large number of neurologists from countries outside the United States and Canada. One-third of annual meeting attendees and abstract submissions are international in origin, with wide variations between countries and world regions, and this proportion has remained stable for the past 5 years. By comparison, international neurologists constitute 12% (n = 2,485) of AAN membership, and international membership has declined slightly over the past 5 years compared to a 15% increase from the United States and Canada. The scientific topics covered by international abstracts are similar to those from the United States and Canada. Abstract acceptance rates are 15% lower for international submissions than for those from the United States and Canada although variations between countries are seen. Three times more European neurologists attend the annual meeting than are AAN members whereas Asian neurologists are more likely to be AAN members than to attend the annual meeting. The AAN is working to understand and address the issues that affect international physicians' decisions to participate in the annual meeting.

International science at the annual meeting of the American Academy of Neurology

The annual meeting of the American Academy of Neurology (AAN) is a major venue for presentation of the latest disease-related clinical and basic neurologic research and is attended by a large number of neurologists from countries outside the United States and Canada. One-third of annual meeting attendees and abstract submissions are international in origin, with wide variations between countries and world regions, and this proportion has remained stable for the past 5 years. By comparison, international neurologists constitute 12% (n = 2,485) of AAN membership, and international membership has declined slightly over the past 5 years compared to a 15% increase from the United States and Canada. The scientific topics covered by international abstracts are similar to those from the United States and Canada. Abstract acceptance rates are 15% lower for international submissions than for those from the United States and Canada although variations between countries are seen. Three times more European neurologists attend the annual meeting than are AAN members whereas Asian neurologists are more likely to be AAN members than to attend the annual meeting. The AAN is working to understand and address the issues that affect international physicians' decisions to participate in the annual meeting.

End-of-life care: a survey of US neurologists' attitudes, behavior, and knowledge.

The American Academy of Neurology (AAN) surveyed the attitudes, behavior, and knowledge of its members regarding care at the end of life. Three groups of AAN members were surveyed: neuro-oncologists, ALS specialists, and a representative sample of US neurologists. The survey presented two clinical scenarios involving end-of-life care. Neurologists were asked a series of questions to assess their knowledge of existing medical, ethical, and legal guidelines; their willingness to participate in physician-assisted suicide (PAS) or carry out voluntary euthanasia (VE); and their general attitudes regarding end-of-life care. Neurologists support a patient's right to refuse life-sustaining treatment, but many believe that they are killing their patients in supporting such refusals. Thirty-seven percent think it is illegal to administer analgesics in doses that risk respiratory depression to the point of death. Forty percent believe they should obtain legal counsel when considering stopping life-sustaining treatment. One half believe that PAS should be made explicitly legal by statute for terminally ill patients. Under current law, 13% would participate in PAS and 4% would carry out VE; if those procedures were legalized, 44% would participate in PAS and 28% in VE. Approximately one third believe that physicians have the same ethical duty to honor a terminally ill patient's request for PAS as they do to honor a such a patient's refusal of life-sustaining therapy. There is a gap between established medical, legal, and ethical guidelines for the care of dying patients and the beliefs and practices of many neurologists, suggesting a need for graduate and postgraduate education programs in the principles and practices of palliative care medicine. Many neurologists would participate in PAS and carry out VE if legalized.