Child Neurology Residency Research Articles

We Don't Talk About X(Twitter): A Cross-Sectional Analysis of Social Media Utilization Among Neurologists.

Medical professionals use social media for career development, education, clinical outreach, or advocacy. Prior studies estimate that 25% to 65% of health care providers use social media professionally; however, the number of users and platforms are rapidly changing. Therefore, as part of a broader study, we set out to assess platform preferences and social media usage among neurologists. This was a multisite cross-sectional analysis consisting of a REDCap survey of clinicians, residents, and medical students. Faculty, trainees, or clinical year medical students interested in child neurology or adult neurology residency or fellowship programs within the United States were eligible to participate. Recruitment methods were broad to encompass as diverse and extensive participation as possible. Results were analyzed using descriptive statistics. Data are presented according to the STROBE guidelines. Of the 226 neurology respondents, 55% (n = 124) were child neurology and 45% (n = 102) were adult neurology across all career stages, including students. Of the 70% who reported using social media in a professional capacity, the most commonly reported reasons were for networking and collaboration (n = 95, 60%), self-directed medical learning (n = 90, 57%), and brand building and reputation (n = 62, 39%). Twitter and Facebook were the most common and versatile platforms used by neurologists. Medical students had the highest documentation of social media scholarships on their curriculum vitae (37%, P = .016) and the most interest (33%, P = .016) in learning how to document social media scholarships if they were not already. Early faculty shared this interest more than residents, fellows, or mid-late career faculty. In all groups except for mid-late career faculty, a majority of respondents (>75%) showed interest in learning how to leverage social media for career development. Social media is used professionally by a majority of neurologists, most commonly for networking, self-directed learning, and building individual brands. Opportunities exist to better understand platform preferences and ways to optimize their use for various professional activities as well as to provide education on effective professional use of social media including documentation for promotion.

Expert Accuracy and Inter-rater Agreement of “Must-know” EEG Findings for Adult and Child Neurology Residents (P11-1.001)

Expert Accuracy and Inter-rater Agreement of “Must-know” EEG Findings for Adult and Child Neurology Residents (P11-1.001)

A Qualitative Analysis of Communication-focused Feedback Provided to Child Neurology Residents During an Objective Structured Clinical Exam (OSCE) (P4-7.003)

A Qualitative Analysis of Communication-focused Feedback Provided to Child Neurology Residents During an Objective Structured Clinical Exam (OSCE) (P4-7.003)

@NMatch2024: A Student-led Social Media-based Initiative to Guide Adult and Child Neurology Residency Applicants and Programs in a Digital Era (P5-7.005)

@NMatch2024: A Student-led Social Media-based Initiative to Guide Adult and Child Neurology Residency Applicants and Programs in a Digital Era (P5-7.005)

Education Research: Educating Child Neurology Residents About Psychogenic Nonepileptic Seizures

Background and Objectives Psychogenic nonepileptic seizures (PNES) are difficult to differentiate from epileptic seizures (ES) even for neurologists who see these conditions frequently. This difficulty is due to overlapping semiologic findings between the 2 diagnoses. Previous studies have shown that trainees, including neurology trainees, are not accurate in differentiating PNES from ES. Neurologists often find the communication of PNES difficult. Despite these challenges, most programs do not have formal curricula for teaching PNES, and there are no standards for residency curricula in this topic. The aim of this study was to understand the gaps in resident education on PNES. Methods This study was accomplished through a needs assessment of current pediatric neurology residents and residency program directors (PDs). Two unique surveys were distributed, 1 for child neurology trainees and 1 for PDs. Questions were designed to understand trainees' self-reported knowledge, confidence, current education received, and desired teaching. Similarly for PDs, questions were designed to assess the state of education on PNES at their programs, sufficiency of education, and their desire for standardized curriculum. Results Sixty-eight trainees and 21 PDs responded to the survey. Approximately one-quarter of trainees reported neutral to low levels of confidence and 38% reported neutral to low levels of knowledge in caring for patients with PNES. Trainees reported that directing patients with PNES to appropriate management was the most challenging aspect of care, followed by communicating the diagnosis, with 60% and 46% reporting difficulty, respectively. Only 21% of residents felt their current PNES education needs no improvement. One-fifth of PDs felt their current PNES education is not sufficient, and all reported they would incorporate a standardized curriculum. Trainees reported preferring to learn about this topic through lectures and simulation, while PDs preferred online modules and simulation. Discussion While residents and PDs report high confidence and knowledge in treating pediatric patients with PNES, respondents felt improvement is needed to their curricula regarding this topic. Multiple learning methods are preferred, with emphasis on communicating the diagnosis and management of patients once the diagnosis has been made. PDs desire a standardized curriculum and would incorporate one into their programs. Findings of this study could be used to create a national curriculum.

Expert accuracy and inter-rater agreement of "must-know" EEG findings for adult and child neurology residents.

We published a list of "must-know" routine EEG (rEEG) findings for trainees based on expert opinion. Here, we studied the accuracy and inter-rater agreement (IRA) of these "must-know" rEEG findings among international experts. A previously validated online rEEG examination was disseminated to EEG experts. It consisted of a survey and 30 multiple-choice questions predicated on the previously published "must-know" rEEG findings divided into four domains: normal, abnormal, normal variants, and artifacts. Questions contained de-identified 10-20-s epochs of EEG that were considered unequivocal examples by five EEG experts. The examination was completed by 258 international EEG experts. Overall mean accuracy and IRA (AC1) were 81% and substantial (0.632), respectively. The domain-specific mean accuracies and IRA were: 76%, moderate (0.558) (normal); 78%, moderate (0.575) (abnormal); 85%, substantial (0.678) (normal variants); 85%, substantial (0.740) (artifacts). Academic experts had a higher accuracy than private practice experts (82% vs. 77%; p = .035). Country-specific overall mean accuracies and IRA were: 92%, almost perfect (0.836) (U.S.); 86%, substantial (0.762) (Brazil); 79%, substantial (0.646) (Italy); and 72%, moderate (0.496) (India). In conclusion, collective expert accuracy and IRA of "must-know" rEEG findings are suboptimal and heterogeneous. We recommend the development and implementation of pragmatic, accessible, country-specific ways to measure and improve the expert accuracy and IRA.

Education Research: Competency-Based EEG Education: An Online Routine EEG Examination for Adult and Child Neurology Residents.

We recently published expert consensus-based curricular objectives for routine EEG (rEEG) interpretation for adult and child neurology residents. In this study, we used this curriculum framework to develop and validate an online, competency-based, formative and summative rEEG examination for neurology residents. We developed an online rEEG examination consisting of a brief survey and 30 multiple-choice questions covering EEG learning objectives for neurology residents in 4 domains: normal, abnormal, normal variants, and artifacts. Each question contained a deidentified EEG image, displayed in 2 montages (bipolar and average), reviewed and optimized by the authors to address the learning objectives. Respondents reported their level of confidence (LOC, 5-point Likert scale) with identifying 4 categories of EEG findings independently: states of wakefulness/sleep, sleep structures, normal variants, and artifacts. Accuracy and item discrimination were calculated for each question and LOC for each category. The test was disseminated by the International League Against Epilepsy and shared on social media. Of 2,080 responses, 922 were complete. Respondents comprised clinical neurophysiologists/experts (n = 41), EEG/epilepsy clinical fellows (n = 211), EEG technologists (n = 128), attending neurologists (n = 111), adult neurology residents (n = 227), child neurology residents (n = 108), medical students (n = 24), attending non-neurologists (n = 18), and others (n = 54). Mean overall scores (95% CI) were 82% (77-86) (clinical neurophysiologists), 81% (79-83) (clinical fellows), and 72% (70-73) (adult and child neurology residents). Experts were more confident than clinical fellows in all categories but sleep structures. Experts and clinical fellows were more confident than residents in all 4 categories. Among residents, accuracy and LOC increased as a function of prior EEG weeks of training. Accuracy improved from 67% (baseline/no prior EEG training) to 77% (>12 prior EEG weeks). More than 8 weeks of EEG training was needed to reach accuracy comparable with clinical neurophysiologists on this rEEG examination. Increase in LOC was slower and less robust than increase in accuracy. All but 3 questions had a high discrimination index (>0.25). This online, competency-based rEEG examination, mapped to a published EEG curriculum, has excellent psychometrics and differentiates experienced EEG readers from adult and child neurology residents. This online tool has the potential to improve resident EEG education worldwide.

Recognizing and Responding to the Needs of Future Child and Adult Neurology Care Through the Evolution of Residency Training.

Recent insights into the frequency of occurrence and the genetic and mechanistic basis of nervous system disease have demonstrated that neurologic disorders occur as a spectrum across all ages. To meet future needs of patients with neurologic disease of all ages and prepare for increasing implementaton of precision therapies, greater integration of child and adult neurology residency training is needed. ANN NEUROL 2023;94:1005-1007.

Education Research: Junior Neurology Residents Achieve Competency but Not Mastery After a Brief Acute Ischemic Stroke Simulation Course.

Simulation bootcamps are used to onboard neurology trainees. It is not known whether these bootcamps result in competency for acute ischemic stroke (AIS). For this prospective, single-center pre-post educational intervention study, the Angoff standard setting method was used to determine a Minimum Passing Score (MPS) and Mastery Score for 2 AIS simulations. Junior neurology residents completed precourse knowledge and confidence assessments and had traditional didactic teaching. A week later, each resident completed the first scored AIS simulation. Each resident then practiced stroke care in an unscored simulation. Two to 8 weeks later, each resident was evaluated in an unannounced AIS simulation (the post-test). Postgraduate year (PGY)-3 adult neurology senior residents also completed a knowledge and confidence assessment and were scored on just the AIS post-test case. Using independent and paired t tests, respectively, we compared the junior residents' retention test performance to their baseline assessment and to senior residents' performance. Thirteen junior residents (9 PGY-2 adult neurology residents and 4 PGY-3 child neurology residents) participated in the course. Only 3 junior residents (23%) initially achieved the MPS in the first AIS simulation. After the simulation course, 9 junior residents (69%) achieved the MPS threshold. Although none achieved mastery, junior residents' mean performance score in the simulation improved (mean score preintervention [SD] = 10.3 [2.8] vs mean score postintervention [SD] = 15.7 [2.6], p < 0.001) and their confidence increased (mean score preintervention [SD] = 3.3 [1.9] vs mean score postintervention [SD] = 4.9 [1.2], p < 0.001, d = 1.7). Eight PGY-3 adult neurology residents were scored on the AIS post-test. Five reached MPS (63%), and 1 demonstrated mastery. The simulation scores of the postcourse juniors and seniors were similar (junior resident mean score [SD] = 15.7 [2.6] vs senior resident mean score [SD] = 16.0 [2.5], p = 0.793). A brief AIS simulation course may improve junior residents' performance and confidence to a level comparable with senior residents, although not to mastery.

@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.

Child Neurology Residency Survey of Psychogenic Nonepileptic Seizure Education (P2-2.004)

<h3>Objective:</h3> To assess the learning needs of pediatric neurology resident trainees and program directors (PD) on the education of psychogenic nonepileptic seizures (PNES) during training. <h3>Background:</h3> PNES proves difficult to differentiate from epileptic seizures (ES) even for neurologists who see these conditions frequently, given overlapping semiologic findings between the two diagnoses. Previous studies have shown trainees, including neurology trainees, are not very accurate in differentiating PNES from ES. Neurologists often find the communication of PNES difficult. Despite these challenges, most programs do not have a formal curriculum for teaching PNES and there are no ABPN standards for residency curricula in this topic. <h3>Design/Methods:</h3> Two unique surveys were designed, one for child neurology trainees and one for PDs. Questions were designed to assess trainees’ abilities, current education received, and desired teaching. Similarly, PDs’ level of confidence in trainee management of PNES was assessed, as well as specific preferences for a standardized curriculum. <h3>Results:</h3> Sixty-five trainees out of approximately 202 and 21 PDs and associate PDs have responded to the survey. About one-third of trainees report neutral to low levels of confidence and 36.9% report neutral to low levels of knowledge in caring for PNES patients. Trainees reported that directing PNES patients to appropriate management was the most challenging aspect of care, followed by communicating the diagnosis, with 60.0% and 46.1% reporting difficulty, respectively. Trainees report preferring to learn about this topic through reading material and simulation. One-fifth of PDs feel their current PNES education is not sufficient and 52.4% of PDs would incorporate a standardized curriculum, with remaining PDs reporting willingness depending on the required time. <h3>Conclusions:</h3> Areas of needed training and desired teaching format were identified based on trainee responses. PDs desire a standardized curriculum and would incorporate one into their programs. Findings of this study will be utilized to create a national curriculum. <b>Disclosure:</b> The institution of Dr. Albert has received research support from Nationwide Children’s Hospital, Division of Neurology, Internal Research Grant. Dr. Freedman has nothing to disclose. Dr. Talai has nothing to disclose.

Development and Evaluation of a Child Neurology Resident Curriculum for Communication Around Serious Illness

Background: Communication around serious illness is a core competency for all residencies. One-fifth of neurology residencies have no curriculum. Published curricula use didactics or role-play to assess confidence performing this skill without evaluation in clinical settings. The SPIKES mnemonic (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary) outlines 6 evidence-based steps for communication around serious illness. It is unknown whether child neurology residents can incorporate SPIKES into communication around serious illness in clinical settings. Objective: To develop and evaluate a curriculum on communication around serious illness using SPIKES for child neurology residents that shows long-term skill retention in clinical settings at a single institution. Methods: In 2019, we created a pre-post survey and skills checklist based on SPIKES, with 20 total including 10 core skills. Faculty observed residents' (n = 7) communication with families and completed both preintervention and postintervention checklists for comparison. Residents underwent training in SPIKES during a 2-hour session using didactic and coached role-play. Results: All (n = 7) residents completed preintervention surveys, 4 of 6 completed postintervention. All (n = 6) participated in the training session. Following the training, 75% of residents reported improved confidence in use of SPIKES, though 50% were still unsure about appropriately responding to emotions. There was improvement in all SPIKES skills, with significant improvement in 6 of 20 skills up to 1 year following training. Conclusion: This is the first evaluation of the implementation of a communication around serious illness curriculum for child neurology residents. We identified improved comfort with SPIKES after training. Successful acquisition and utilization of this framework in our program suggests it could be incorporated into any residency program.

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

Virtual Radiology Fellowship Recruitment: Benefits, Limitations, and Future Directions

Virtual Radiology Fellowship Recruitment: Benefits, Limitations, and Future Directions

Trust but Verify: Misrepresentation of Publication Records Among Child Neurology Residency Applicants

IntroductionNumerous authors have reported that misrepresentation of publication records among residency applicants is not uncommon. We sought to determine the percentage of child neurology residency applicants who falsify information about publications in the documents submitted to the Electronic Residency Application Service. MethodsThe records of applicants to our residency program between 2014 and 2020 (898 individuals) were analyzed. Publications were verified by searching online databases and with a research librarian's assistance. Searches were conducted using all available information—author name, article title, and journal name—alone or in combination. Articles in inaccessible publications were disregarded. Misrepresentation was recorded when one the following was identified: listing a nonexistent article, promoting the applicant's name on the authors' list, misattributing authorship, and listing a publication as “in-press” yet never published. ResultsFrom the 7 residency match cycles reviewed, 514 applicants reported having had authored at least 1 publication. Of those, 47 (9.14%) listed 75 unquestionably misrepresented publications. In 33 instances, the paper did not exist, with some applicants going as far as submitting a nonexistent PubMed Identifier; in 21 instances, the author's name was promoted on the authors' list; in 15 instances, the applicant was not an author; and in 6 instances, the author reported the publication as “in-press,” but the work has never been published. ConclusionAs happens in other specialties, child neurology residency applicants sometimes submit fraudulent information about their publications. Program directors need to be aware of this possibility and carefully review the information provided by applicants.

Adult Neurology Rotations for Child Neurology Residents: Exploring the Resident Perspective

BackgroundIn 2014 the Accreditation Council for Graduate Medical Education modified adult training requirements for child neurology certification to reduce the number of hospital-based rotations and require inclusion of outpatient clinic and electives. We aimed to identify how these training requirements are being met and explored its impact on residents. MethodsA REDCap questionnaire surveying resident opinion on impact of adult training on resident education, professional development, and wellness was e-mailed to 79 program directors in the United States for distribution in 2020. Results were analyzed using descriptive statistics and t test calculations. Qualitative analysis of narrative responses involved theme identification. ResultsA total of 116 child neurology residents participated (30.2% PGY-3, 37.9% PGY-4, and 31.9% PGY-5 residents); 20.9% had all adult rotations during the PGY-3 year, and 79.1% had adult rotations spread throughout residency. Adult training had a small positive impact on resident autonomy and a negative impact on resident wellness regardless of training structure. However, residents with 12 months of adult training during PGY-3 year scored worse on burnout, mood changes, work-life balance, and social well-being (P < 0.05). Some themes identified included residents feeling unsafe due to lack of supervision, that education was not prioritized, and that adult patient care lacked relevance to long-term career goals. ConclusionsAdult neurology training was found to negatively affect child neurology resident wellness, with a larger negative impact when adult training was completed in 12 months during PGY-3 year. Other identified areas where change could be implemented include improving feelings of resident safety and prioritizing quality and relevance of education.

Gaps in Neurogenetics Education During Child Neurology Residency: Results of a National Survey.

The practice of child neurology has changed significantly in the past two decades as we have integrated genetic testing into our standard of care to achieve precise diagnoses and to guide management of many childhood neurological conditions. Despite this paradigm shift, there appears to be a gap in both clinical exposure to neurogenetic disorders and education provided to residents in ordering and interpreting genetic testing. We therefore conducted a national survey for child neurology trainees in all programs across the United States to delineate their perception of the adequacy of current training and didactics in genetic/neurogenetic disorders. The results revealed knowledge gaps related to ordering and interpreting genetic testing, managing acute metabolic emergencies, and identifying resources for referral of patients to clinical trials. Responders considered their current curriculum in neurogenetics to be insufficient and voted favorably for an educational platform using recorded lectures and interactive sessions.

Adult Neurology Rotations for Child Neurology Residents: A Survey of Program Directors.

We aimed to identify how child neurology and neurodevelopmental disabilities residency program directors (PDs) implemented revised Accreditation Council for Graduate Medical Education requirements for adult neurology training for child neurology residents. Before 2014, the American Board of Psychiatry and Neurology certification for child neurology required an adult year, with no specified rotation requirements. At that point, programs scheduled a median of 10 months of adult neurology rotations during the third postgraduate year (PGY-3). In 2014, the adult neurology requirements were modified to include 6 months of hospital-based, 3 months of outpatient, and 3 months of other elective (may include neurophysiology, neuropathology, and/or neuroradiology) rotations. However, the effects of these changes on child neurology residency training nationally have not been characterized. A 16-item online survey was emailed to 79 PDs in the United States in September 2020. Survey responses were collected from September to October 2020. Descriptive statistics were calculated, and associations with departmental affiliation (pediatrics/neurology), graduate medical education (GME) funding source, and program size were compared using nonparametric tests. The response rate was 72% (53 pediatric neurology, 3 neurodevelopmental disabilities). The median adult months per year of training were as follows: 9 PGY-3, 2 PGY-4, and 1 PGY-5. Nearly all had both hospital inpatient and consult rotations with night and/or weekend shifts; 57% included neurocritical care and 36% epilepsy monitoring units. 48% of programs scheduled night and weekend shifts (including 25% that scheduled 24-hour calls) for residents on outpatient and elective rotations. Few programs required adult neurophysiology (20%), neuropathology (32%), or neuroradiology (25%). Programs with children's hospital GME funding (for either 2 or 3 years) tended to be larger (p = 0.008). Otherwise, departmental affiliation, funding source, and program size were not associated with rotation timing. Most child neurology residency programs still consolidate adult training in the PGY-3 year and often schedule additional hospital shifts during outpatient and elective months. However, there is a small shift toward adult neurology rotations occurring in the PGY-4 and PGY-5. Departmental affiliation, funding source, and program size do not consistently affect training practices. Few programs mandate adult neurophysiology, neuropathology, or neuroradiology rotations.

@NMatch2022: The Expansion of a Student-Led Social Media-Based Initiative that supports Neurology and Child Neurology Residency Applicants (P1-1.Virtual)

@NMatch2022: The Expansion of a Student-Led Social Media-Based Initiative that supports Neurology and Child Neurology Residency Applicants (P1-1.Virtual)