Neurology Fellowship Research Articles

Telestroke Training: Considerations for Expansion of Vascular Neurology Program Requirements.

Telemedicine for stroke (Telestroke) has been a key component to efficient, widespread acute stroke care for many years. The expansion of reimbursement through the Furthering Access to Stroke Telemedicine Act and rapid deployment of telemedicine resources during the COVID-19 public health emergency have further expanded remote care, with practitioners of varying educational backgrounds, and experience providing acute stroke care via telemedicine (Telestroke). Some Telestroke practitioners have not had fellowship-level vascular neurology training and many are without training specific to virtual modalities. While many vascular neurology fellowship programs incorporate Telestroke training into the curriculum, components of this curriculum are not consistent, extent of involvement is variable, and not all fellows receive hands-on training in remote care. Furthermore, the extent of training and evaluation of Telestroke in American Board of Psychiatry and Neurology training requirements and Accreditation Council for Graduate Medical Education assessments for vascular neurology fellowship are not standardized. We suggest that Telestroke be formally incorporated into vascular neurology fellowship curricula and provide considerations for key components of this training and metrics for evaluation.

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.

Comprehensive portrait of stroke fellowship training in Brazil: A national survey study

Background and objectivesThe field of vascular neurology has undergone significant advances over the last decade, and care has become more complex. However, vascular neurology training programs remain underdeveloped in many countries, despite stroke impact on health care. There are efforts towards building a nationally regulated curricula in some countries. Still, comprehensive planning and implementation of these programs may be needed on a global scale, especially in countries where stroke treatment is not fully implemented. We aim to comprehensively analyze vascular neurology trainees’ profiles in Brazil to describe training program contents from trainees and program directors’ perspectives. MethodsWe performed an observational, cross-sectional, web-based survey study to describe trainee and program-specific characteristics at vascular neurology fellowship training programs in Brazil. The study was conducted from June to September 2023 using a secure web-based survey sent to active fellows and program directors from all known vascular neurology fellowship programs in the country. All respondents were required to provide informed consent. ResultsWe obtained a 100 % response rate of a total of 12 programs distributed in 7 federal states. Notably, 57 % of the 28 surveyed fellows were women, 60 % were aged 25-30, and 70 % self-identified as White. All fellows had prior neurology training, and 60 % engaged in the program just following residency. Exposure to various training experiences was favorable, except for simulation-based learning and telestroke training. Program directors perceived exposure to be sufficient for most components but similarly found deficiencies in telestroke and simulation-based learning. Scientific productivity was low, with about two-thirds of fellows having no publications or abstracts. Most fellows (92.6 %) reported performing non-fellowship medical activities to supplement their incomes. DiscussionIn conclusion, the number of vascular neurology training programs and trainees in Brazil is currently insufficient and exhibits an uneven geographic distribution. Despite this, the clinical training provided is extensive, and there is generally some funding available for fellows. These insights highlight the need for strategic improvements in Brazil's stroke education and could inform similar developments in other nations.

Abstract TP116: Impacts of Formal Clinical Trial Didactic Training for Vascular Neurology Fellows

Introduction: A key barrier to stroke clinical trial recruitment is the lack of experienced investigators at the site level. However, there are currently no standards for training Vascular Neurology Fellows in clinical trial recruitment. We studied the impact of a formal clinical trial didactic curriculum on stroke fellows. Methods: Our institution initiated clinical trial training for Vascular Neurology Fellows in 2016 with the curriculum expanding year upon year (Figure 1a). We reviewed all clinical trial enrollments from 2015-2022 and determined the number completed by stroke fellows. The proportion of fellow enrollments was analyzed using the Mann-Kendall test. We surveyed past fellows to obtain their feedback on the clinical trial training curriculum and determine whether they were actively participating in clinical trials or planned to do so in the future. Results: Fourteen of sixteen (87.5%) past fellows completed the survey. Figure 1b shows fellow enrollment and total enrollments by academic year. The Mann-Kendall test demonstrated a trend for an increasing proportion of fellow enrollments during the study period (p=0.08). Seven past fellows (50%) are currently enrolling in clinical trials; four of whom (57.1%) enrolled greater than or equal to three subjects during fellowship. Thirteen (92.8%) intend to enroll in clinical trials in the future. Past fellows stated that the most valuable aspect of their clinical trial training was learning how an enrollment works and obtaining an informed consent. Conclusion: Our results show that a clinical trial didactic curriculum during Vascular Neurology Fellowship might increase clinical trial recruitment by fellows. Furthermore, engagement in clinical trial training and recruitment during fellowship was suggestive of continued engagement in future practice.

Evaluation of Vascular Neurology Fellowship Websites in the U.S.

Due to the limitations of the Coronavirus disease pandemic, medical applicants have relied on remote means of information, such as a program's website, to decide where to apply. However, studies have shown that many residency and fellowship websites lack information. Vascular neurology fellowship websites have not yet been studied. This study evaluates the availability and accessibility of information on vascular neurology fellowship websites. From 2021 to 2022, a total of 109 U.S. vascular neurology fellowship programs from the Fellowship and Residency Electronic Interactive Database were investigated to determine whether they had websites. Each website was evaluated on the immediate availability of 34 different criteria, which were deemed important by past studies. These criteria were reviewed under four categories: program overview, application information, fellow life, and curriculum. The comprehensiveness of the information among these different categories were analyzed. Programs were grouped by geographic region and electronic residency application service (ERAS)-participation status and comparisons were made within these groups. There were 107 programs with websites (98%). ERAS-participating programs fulfilled more criteria on average than non-participating programs (P = 0.004). All websites provided information on general descriptions of their programs, but information on board exam pass rates, fellow testimonials, history of the fellowship program, responsibility progression, family and social events, parking availability, and application deadline were provided by less than 25% of websites. This study found that there was a large lack of information on vascular neurology fellowship websites, which could be improved to attract more applicants.

Emerging Subspecialties in Neurology: Women's Neurology.

The influence of sex and gender on neurologic disease has become increasingly recognized in science and medicine. This is evident across a woman's lifespan especially during periods of hormonal transitions. Leaders in neurology have advocated for the importance of sex and gender-enriched clinical care, education, and research. The scope of women's neurology spans across a woman's life including puberty, adolescence, peripartum care, menopause, and aging. Women's neurology is a new subspecialty that aligns with a specific patient population and intersects with established neurology subspecialties and other specialties such as obstetrics, maternal fetal medicine, endocrinology, and psychiatry. Its establishment and collaboration with existing and emerging fields enables a more comprehensive approach to neurologic illness through the lens of sex and gender. Women's neurology is rapidly evolving through increased focus at academic centers, including expanded women's neurology curricula, dedicated women's neurology fellowship programs, improved understanding of sex and gender issues in neurosciences, and expansion of therapeutic options. Herein, we describe the history of the women's neurology field, emerging need for women's neurology specialists, information about training and career opportunities, and future directions.

Abstract 226: Canadian Experience Facilitating a Hands‐on Neurointerventional Workshop for Neurology Trainees

Introduction Neurointerventional radiology is a growing field that has seen innumerable advances in recent years. Unlike the US, which has a sizeable presence of interventional neurologists[1], Canada has disproportionately fewer neurologists in the field of neurointervention. One of the barriers to neurology trainees entering the field of neurointerventional radiology is a lack of exposure during their training. To address this barrier, we conducted the first hands‐on neurointervention workshop focusing on neurology trainees during a Canadian national conference. Though this workshop was open to trainees from neurology, neuroradiology, and neurosurgery, it was conducted in association with the Canadian Stroke Consortium and therefore marketed towards neurology trainees. This pilot hands‐on workshop was the first of its kind in Canada targeting neurology trainees. Methods A 2‐hour workshop was conducted in June, 2023 during a Canadian national conference. The workshop included 3 stations: basic equipment orientation, overview of endovascular techniques for ischemic stroke, and an intracranial aneurysm treatment model treatment station. Participants had an opportunity to rotate through each station at least once. Each station was facilitated by a neurointerventionalist or fellow who demonstrated the techniques and devices to participants. Participants practiced handling wires and catheters, deploying stent‐retrievers, and deploying coils in an aneurysm model, among other essential neurointerventional skills. Participants were asked to voluntarily provide feedback via electronic survey. An electronic survey was emailed to participants, on a voluntary basis; responses were anonymized. Survey results were collected and analyzed using Google Forms. Results Twelve workshop participants consented to participate in the survey and seven completed the entire survey. Respondents were from multiple Canadian neurology residency programs, medical schools, and vascular neurology fellowship programs. Prior to the workshop, most respondents (71.4%) had little‐to‐no knowledge about interventional techniques. Only one respondent answered that their training program provides hands‐on neurointervention experience. Most respondents found the station on endovascular techniques for ischemic stroke to be the most helpful. Prior to the workshop, many respondents had not considered pursuing neurointerventional radiology training. At least one participant responded that they would more favorably consider pursuing neurointerventional radiology following the workshop. Conclusion Increasing neurology trainee exposure to neurointerventional radiology is essential for expanding the number of neurologists entering this field. Events at national and international conferences that provide hands‐on experience are one way to increase exposure. This workshop provided practical experience, particularly in endovascular therapy techniques. All participants had little to no exposure to neurointervention and all favorably rated the workshop. Based on this pilot project, further efforts are needed to incorporate neurointerventional radiology training into Canadian neurology training programs.

Online Core Curriculum and Mastery (OCCAM): A Behavioral Neurology & Neuropsychiatry (BNNP) Curricular Needs Assessment.

Behavioral neurology & neuropsychiatry (BNNP) fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS). Programs cover the UCNS-recommended topics differently. A curriculum accessible to all fellowships would standardize education and identify gaps in topics that are less well covered across programs. The purpose of the present needs assessment was to inform the development of the Online Core Curriculum and Mastery: BNNP (OCCAM-BNNP), a website for all UCNS-accredited BNNP programs. Program directors and fellows were surveyed to learn how well topics are covered and identify educational gaps, or specific topics on the UCNS website that are less well represented among programs. Thirty-seven fellowship program directors listed on the UCNS website were invited to take the survey and forward it to both current fellows (graduating in 2021) and recent graduates (graduated from 2015 to 2020). There were 29 responses from 37 programs. Of the 34 topics that respondents rated on a 1-5 Likert scale (from "not covered" to "completely covered"), 15 of 34 (44%) were identified as having >40% of responses as mostly "not covered," "incompletely covered," or "partially covered." Ninety-seven percent of respondents affirmed that it would be useful to have a free web-based resource for BNNP education. Slightly under one-half of all BNNP topics were not well covered. A survey was undertaken to identify and fill the educational gaps indicated by fellowship directors and fellows, and the OCCAM-BNNP website was developed as a repository for relevant content, providing a resource that many BNNP clinicians would find useful.

Emerging Subspecialties in Neurology: Interventional Neurology: A Starter Guide for Neurology Residents.

Interventional neurology is a subspecialty at the cross-section of neurology, neurosurgery, and neuroradiology that uses image-guided endovascular catheter techniques to diagnose and treat neurovascular disorders. Although interventional neurology techniques have existed for decades, recent landmark trials in stroke thrombectomy have catalyzed dramatic changes to the interventional neurology field, and there is rising neurology interest and representation. Unlike other neurology subspecialties, however, interventional neurology training and fellowship applications are not standardized. Thus, it can be difficult for neurology trainees to navigate this rapidly changing and multidisciplinary field. This article seeks to provide neurology residents and residency program directors with a brief overview of the modern interventional neurology field, the current fellowship application process, and tips on how neurologists can best prepare for a career in interventional neurology. To this end, we conducted a nationwide survey of interventional neurology fellowship program directors regarding training neurologists. We distill survey responses into concrete, actionable items for neurology trainees.

Education Research: Diversity in Neurology Graduate Medical Education Leadership.

To describe the current landscape of gender and racial diversity among adult neurology residency and fellowship program directors (PDs). Diversity in medicine affects the quality of care provided to a diverse patient population. There are efforts in nearly every field of medicine to increase the diversity of the physician workforce. While there has been improvement in some of the known disparities in medicine such as gender disparities, these disparities have persisted in more senior academic positions in medicine. A data set was generated by the Association of American Medical Colleges for the purpose of this study using a variety of sources. The data included deidentified, person-level variables, including self-reported gender, race, or ethnicity, and the type of program for all PDs of Accreditation Council for Graduate Medical Education-accredited residencies and fellowships. This retrospective descriptive survey study sought to (1) describe the current gender and race climate of neurology PDs and (2) identify groups that may be disproportionally underrepresented in these positions compared with those in other specialties and levels of medical training. Descriptive statistics and tests of nonrandom association were performed to address the objectives. We found that 56.7% of residency PDs and 58% of fellowship PDs are male. The male to female ratio of PDs was similar to current neurology residents who are 53.4% male. There were significantly more female medical students (51.5%) compared with all other categories of academic rank other than neurology residency PDs (41.1%). Only 4.3% of residency PDs were Black and only 3.7% were Hispanic. There were no Black fellowship PDs, and 5.1% were Hispanic. There were significantly more non-White medical students and trainees compared with each PD group. The breakdown of gender and ethnic diversity of neurology PDs was similar to that of PDs from all residencies and fellowships. While there are many barriers to achieving diversity in medicine, program leadership in graduate medical education may be one of them. This report describes the current landscape of diversity among PDs of residency and fellowship programs in the United States. This study shows one snapshot in time, which can be used as a baseline during this era of change.

Trends in Demographics of Neurology House Staff in the United States (P6-2.005)

<h3>Objective:</h3> To examine the demographic characteristics of neurology residents and fellows. <h3>Background:</h3> The lack of an adequate number of neurologists is a worldwide problem. In addition to the growing demand, inadequate diversity in the neurology healthcare workforce still exists. <h3>Design/Methods:</h3> This cross-sectional study used data from the ACGME, AAMC, and the United States Census Bureau. Trends (from 2007 to 2018) in demographic characteristics were assessed using the slope and the associated p-value of a simple linear regression model, with the year as the independent variable. <h3>Results:</h3> From 2007 through 2018, the percentage of US medical school graduates in neurology residency decreased from 58% to 55% (slope = −0.25; p = 0.0004), while the percentage of international medical graduates (IMGs) decreased from 36% to 32% (slope = −0.29; p = 0.0141) and doctor of osteopathy (DO) graduates increased from 6% to 13% (slope = 0.58; p &lt; 0.0001). Although the percentage of female neurology residents increased from 39.5% in 2007 to 43.1% in 2018 (slope = 0.03; p = 0.8659), female physicians were underrepresented in vascular neurology fellowship (34% in 2018). Collectively, the percentage of underrepresented minorities in neurology residencies was low and increased only slightly over time (from 8% in 2011 to 9% in 2018; slope = 0.17; p = 0.0788). In 2018, the proportion of underrepresented minorities was smaller in neurology fellowships (5.5% neurophysiology, 12.5% epilepsy, 10.4% neuromuscular, and 12.4% vascular) compared to the population as a whole (31.3%). <h3>Conclusions:</h3> IMGs still play an important role in filling a significant portion of the neurology residencies and fellowships. DO graduates have slowly increased in neurology residencies and fellowships. Members of several racial/ethnic minority groups and women are underrepresented in neurology house staff and efforts need to be taken to increase diversity. <b>Disclosure:</b> Dr. Dhasakeerthi has nothing to disclose. Dr. Gil Tommee has nothing to disclose. Dr. Thatikala has nothing to disclose. Dr. Nalleballe has nothing to disclose. Dr. Onteddu has nothing to disclose.

Assessing preparedness for Alzheimer disease-modifying therapies in Australasian health care systems.

Assessing preparedness for Alzheimer disease-modifying therapies in Australasian health care systems.

Investigation on Gender Differences in Leadership of Stroke-Related Clinical Trials.

Gender disparities among principal investigators of clinical trials (CT) can have implications regarding the areas of investigation, methods, conduct, trial enrollment, and interpretation of results. An estimation of the gender gap in the leadership of stroke-related CTs from North America has to date not been undertaken. We extracted information about stroke-related CTs between 2011 and 2020 from www. gov and PubMed. We examined the gender distribution according to the academic credentials and the trial type. The gender of PIs and authors was determined using gender package in R, which identifies gender using historical data from the United States. Additionally, we obtained information from Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education data resource books on the gender composition of full-time neurology faculty, neurology residents and vascular neurology fellows. In these analyses of 821 CTs registered on Clinicaltrials.gov and 110 trials published on PubMed, we found that gender disparity among the PIs, first and last authors have persisted over the last decade without any significant trend toward parity (P>0.05). On examining the gender distribution according to academic credentials and trial type, we found that men were over-represented in the sub-group of PIs with an MD degree (78.11% versus 21.87%; P<0.01) and those leading acute stroke trials (86.04% versus 13.89%; P<0.01). We also found that a lower proportion of women neurology residents pursued a vascular neurology fellowship during this period (33.5% versus 42.5%; P<0.05). Our results show that the favorable trend toward gender parity seen in Neurology faculty over the last decade has not translated to the same in the leadership of CTs. Our findings merit further investigation and a re-examination of efforts toward inclusion of women as leaders of stroke-related CTs.

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.

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.

Trends in Racial and Ethnic Diversity in Vascular Neurology Fellowships From 2006 to 2018: A Cross-Sectional Analysis.

Workforce diversity in vascular neurology is a crucial component of reducing disparities in stroke care and outcomes. The objective of this study is to describe trends in the racial and ethnic diversity of neurology residents pursuing vascular neurology fellowship and propose an actionable plan for improvement. This was a cross-sectional study of race/ethnicity of neurology residents and vascular neurology fellows using published Graduate Medical Education census reports from 2006, when race/ethnicity data were first included, to 2018. Percentage of trainees underrepresented in medicine are reported for 3-year epochs and were analyzed using the Cochran-Armitage test (χ2 test for trend). Across the study period, underrepresented in medicine representation has not changed significantly among all neurology residents and subspecialty fellows (11.9% in 2006-2009; 12.5% in 2015-2018, P=0.82) nor among neurology residents alone (12.0% in 2006-2009; 12.6% in 2015-2018, P=0.81). Among vascular neurology fellows, however, there was a significant downtrend of underrepresented in medicine representation from 16.9% in 2006 to 2009 to 9.3% in 2015 to 2018 (P=0.013). Racial/ethnic underrepresentation among all neurology residents as well as those pursuing vascular neurology fellowship has persisted across the study period. Concerted efforts should be pursued to increase diversity in neurology residents and vascular neurology fellowship training.

Neurology Trainee Attitudes Toward Neurointervention: Results From an International Survey

BackgroundThe rapidly changing treatment landscape for large vessel occlusion acute ischemic stroke, now more than ever, has added to the complexity of emergent decision making and the demand for neurointerventionists. Ensuring exposure of neurology trainees to neurointervention and the availability of well‐defined pathways for those interested in this career is crucial. Here we report the results from our large survey of neurology trainee attitudes toward neurointervention training.MethodsAn online survey targeting trainee impressions on the current state of vascular neurology, neurocritical care, and neurointervention training was conducted as a mandatory requirement for trainee registration in the Society for Vascular and Interventional Neurology Break meeting in April 2020. Quantitative results are reported in proportions, and qualitative results are described. Chi‐square test was used to determine association between categorical variables.ResultsOf the 725 respondents from 49 countries who participated in this conference, 450 (62%) were trainees. A total of 30% of trainees did not have access to neurointervention training, and 40% believed that neurology residency, vascular neurology, or neurocritical care fellowship do not adequately prepare them for a career in neurointervention. A total of 237/321 (73%) trainees whose institutional neurointervention practice included neurologists or a mix of subspecialty backgrounds including a neurologist had an opportunity to spend elective time in a neurology–angiography suite compared with 49/89 (55%) if the institutional neurointervention practice consisted of neurosurgeons or radiologists alone (P=0.001). A total of 49% of trainees each preferred the introduction of a mandatory or an elective neurointervention module during residency. A total of 60% of trainees preferred no to minimal exposure at the medical student level.ConclusionsThis international survey of trainees reinforces the existing gap in neurointervention exposure for neurology trainees. Inclusion of neurointervention faculty that come from a neurology training background and exposure to neurointervention will be crucial to support trainees interested in a neurointervention career pathway.

Clinical Neurophysiology Fellowships—They Can and Should Change

This Viewpoint discusses why neurology residencies should offer more precise curriculum based on practice settings and Clinical Neurophysiology fellowships should be replaced by Comprehensive Ambulatory Neurology fellowships.

Trends in Demographics of Neurology House Staff in the United States.

BackgroundThe lack of an adequate number of neurologists is a worldwide problem. As populations age, the prevalence of neurological disorders will likely increase, thereby increasing the demand for neurologists. In addition to the growing demand, inadequate diversity in the neurology healthcare workforce still exists. The purpose of this study is to examine the demographic characteristics of neurology residents and fellows.MethodologyThis cross-sectional study used data from the following publicly available databases: Accreditation Council for Graduate Medical Education, Association of American Medical Colleges, and the United States Census Bureau. Trends (from 2007 to 2018) in demographic characteristics were assessed using the slope and the associated p-value of a simple linear regression model, with the year as the independent variable. All p-values of <0.05 were considered significant.ResultsFrom 2007 through 2018, the percentage of US medical school graduates in neurology residency decreased from 58% to 55% (slope = -0.25; p = 0.0004), while the percentage of international medical graduates (IMGs) decreased from 36% to 32% (slope = -0.29; p = 0.0141) and doctor of osteopathy (DO) graduates increased from 6% to 13% (slope = 0.58; p < 0.0001). Although the percentage of female neurology residents increased from 39.5% in 2007 to 43.1% in 2018 (slope = 0.03; p = 0.8659), female physicians were underrepresented in vascular neurology fellowship (34% in 2018). Collectively, the percentage of underrepresented minorities in neurology residencies was low and increased only slightly over time (from 8% in 2011 to 9% in 2018; slope = 0.17; p = 0.0788). In 2018, the proportion of underrepresented minorities was smaller in neurology fellowships (5.5% neurophysiology, 12.5% epilepsy, 10.4% neuromuscular, and 12.4% vascular) compared to the population as a whole (31.3%).ConclusionsIMGs still play an important role in filling a significant portion of the neurology residencies and fellowships. DO graduates have slowly increased in neurology residencies and fellowships. Members of several racial/ethnic minority groups and women are underrepresented in neurology house staff and efforts need to be taken to increase diversity.

Gender and Racial Trends Among Vascular Neurology Fellowship Programs: By Design or By Default.

IntroductionBenefits of increasing diversity in teams include the addition of different perspectives leading to increased innovation and creativity, faster problem solving, improved workforce morale, and reduced burnout leading to improved patient outcomes. This article reviewed the trend of gender and racial disparity in vascular neurology fellowship programs.MethodsWe retrospectively analyzed the data extracted from the Accreditation Council for Graduate Medical Education (ACGME)’s annual Data Resource Books from 2007 to 2019. ACGME cataloged gender as men and women and race/ethnicity was categorized as White/Non-Hispanic, Asian or Pacific Island, Hispanic, Black/Non-Hispanic, Native American/Alaskan, others, and unknown. Counts, proportions, relative, and absolute percentage changes were calculated to highlight trends in resident appointments over time and across the specialty of vascular neurology.ResultsThe representation of females increased steadily; with a relative increase of 11.78% from the year 2007 to 2019. Race/ethnicity was reported starting from the year 2011. When averaged across the nine-year study period, 35% of the study sample was White (Non-Hispanic), followed by Asian/Pacific Islanders at 25%. The representation of Hispanics was 4.8%, Black/African Americans were 3%, Native Americans/ Alaskans were 0.23% and Others were 13% of the total study population. For 17.7% of the fellows, racial data were not known and was categorized as Unknown racial distribution.ConclusionOur study concludes that gender and racial disparity persists within the fellowship programs of vascular neurology. Effective strategies at individual, administrative, and national levels are needed to engage women and under-represented minorities in vascular neurology as a career choice.