Neurology Residency Programs Research Articles

Collaborative Preclinical/Clinical Efforts Aimed at Strengthening a Neurology Residency Program: Challenges, Activities and Outcomes

AbstractRecent trends in medical education have included efforts to better integrate traditionally preclinical content with subject matter included in the clinical years of the curriculum. The participation of clinical faculty in preclinical courses is well established; however, involvement of biomedical science faculty in resident education is less common. We describe here a project in which a basic science faculty member participated in a neurology residency program to address specific basic science knowledge weaknesses identified by the neurology department chair. We address issues and challenges associated with planning and implementation. Benefits to both the residents and the biomedical scientist are described.

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.

Education Research: Burnout and Perception of Value in a Cross-Section of Neurology Residency Program Directors.

There are no dedicated studies specifically assessing burnout in neurology residency program directors (PDs). A study of residency and fellowship directors across specialties found neurology residency PDs had the highest work-related Copenhagen Burnout Inventory (CBI) score, which may reflect high-level burnout in neurology in general. Indeed, the American Academy of Neurology Burnout Task Force reported burnout in 60% of neurologists. The aims of this study are to determine the level of burnout in adult and pediatric neurology residency PDs, and to determine whether perception of value is related to burnout. In an IRB-approved study, 184 neurology residency PDs were emailed an anonymous survey consisting of the full CBI, demographic information, and 2 items addressing perception of value in the PD role: "I feel valued by my department in my educational role," to which the participant could respond "strongly disagree, disagree, agree, or strongly agree," and "satisfaction with current percent effort for the educational role," to which the participant could respond "very dissatisfied, dissatisfied, satisfied, or very satisfied." Data were analyzed through analysis of variance and ordinal logistic regression. A total of 85 PDs (46%) responded to the survey. The average ± SEM personal, work-related, and patient-related CBI scores were 41.8 ± 2.2, 39.7 ± 2.2, and 32.4 ± 2.2, respectively. Higher personal and work-related CBI scores were associated with less positive perception of value (proportional odds ratio 1.03, 95% CI 1.01-1.06, p = 0.004 and proportional odds ratio 1.04; 95% CI 1.01-1.06, p = 0.003, respectively). Higher personal and work-related CBI scores were also associated with greater dissatisfaction with percent effort granted for the PD role. Level of burnout did not differ between adult and pediatric PDs. Burnout was not related to sex, years in practice, years as PD, academic rank, or percentage effort granted for the PD role. Despite working in a field associated with high burnout, neurology residency PDs were found to have lower-level burnout than previously reported. Ninety-four percent of the PDs reported feeling valued in their role which was associated with lower-level personal and work-related burnout and may represent a key target for reflection and burnout intervention in the future.

Education Research: The Current Landscape of Clinician Educator Tracks in Adult Neurology Residency Programs: A National Survey of Program Directors.

As the concept of a clinician-educator (CE) evolves and the multiple competencies of the role become better defined, there seems to be a growing need for targeted training for clinicians pursuing a career in medical education. This study aims to describe the current state of CE tracks in adult neurology residency programs and to identify the barriers to implementation, potential solutions, and program goals and outcomes. We characterized CE tracks using 2 methods. First, we reviewed the websites of all US adult neurology residency programs to determine the availability of a CE track and its characteristics. Second, we administered a 20-item survey to program directors (PDs) of all US neurology residency programs, with questions focused on track availability, characteristics, perceived benefits of CE tracks on resident career development, barriers to implementation, and ideas for national initiatives that may facilitate track development or improvement. Fifty-eight of 177 (33%) PDs responded to the survey. Combining the results of the website reviews and surveys, we found that 34 of 179 (19%) programs have CE tracks. Seventy percent of PDs felt that CE tracks are very impactful or impactful for participating residents' careers, a perception more common among PDs of programs with tracks. The greatest perceived benefit was in preparing residents for educational leadership roles. The greatest barriers to implementation were a lack of teaching faculty, a lack of resources, and limited resident time. The highest ranked idea for a national initiative that can facilitate track development was live and recorded lectures on medical education topics. Although most PDs surveyed agreed that CE tracks are impactful for preparing residents as teachers and education leaders, such tracks are available in only 19% of adult neurology residency programs. PDs report that the benefits of CE tracks extend beyond the participants, with implications for the health of the residency program and the neurology department. While some programs have significant barriers to implementation, national initiatives may help reduce the resource burden on individual programs. Future areas of study include assessing the development and outcomes of national initiatives and analyzing the outcomes associated with CE tracks.

Education Research: Establishing a Postgraduate Year-1 Director Enhances Well-Being for Adult Neurology Residents.

Adult neurology clinical trainees in Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs spend their postgraduate year (PGY)-1 within the internal medicine department, potentially causing a perceived disconnect with their neurology program. Our Adult Neurology Clinical Competency Committee found this disconnect may decrease resident well-being. We hypothesized implementing a novel PGY-1 Director role focusing on unique aspects of this first year would improve resident well-being and connection to the neurology program. The PGY-1 Director was established as an associate program director in the adult neurology residency program with goals to improve wellness, advocacy, compliance with ACGME requirements, education, and communication. Anonymous surveys compared preintervention (before the PGY-1 Director role) with postintervention resident opinions on PGY-1 experience, assessing wellness, burnout, and perception of advocacy. A total of 15 (75%) preintervention residents and 23 (96%) postintervention residents completed the study surveys. 53.7% of preintervention residents agreed or strongly agreed to feeling burned out, while only 17.4% of postintervention residents agreed they felt burned out and none strongly agreed. Significant improvement occurred in feeling supported clinically and emotionally and feeling validated. Most postintervention residents felt the PGY-1 Director was valuable and directly led to positive change. The relationship between the neurology and internal medicine departments was improved. A dedicated PGY-1 Director position can improve trainee wellness outcomes and relationships between preliminary and matched departments. This mutually benefits both programs but requires substantial resources. We propose this as a best practice when feasible for ACGME programs with the following suggestions: (1) provide dedicated full-time equivalent time, (2) meet with preliminary program leadership regularly, (3) meet with PGY-1 trainees during orientation and at least quarterly, (4) serve as an advocate, and (5) facilitate mentorship in areas of interest.

Gender Disparities in the Academic Performance of Neurology Residents in Portugal.

Implicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women's career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.

Effects of Implementation of a Night Float System in a Neurology Residency Program (P4-7.007)

Effects of Implementation of a Night Float System in a Neurology Residency Program (P4-7.007)

Variability in Brain Death Education Across US Neurology Residency Programs (P6-7.008)

Variability in Brain Death Education Across US Neurology Residency Programs (P6-7.008)

@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 Priority Setting: A Multi-stakeholder Survey Study of the Didactic Curriculum of an Adult Neurology Residency Program (P6-7.002)

Education Priority Setting: A Multi-stakeholder Survey Study of the Didactic Curriculum of an Adult Neurology Residency Program (P6-7.002)

Use of Simulation in Medical Education Across Adult Neurology Residency Programs in the US (P8-7.003)

Use of Simulation in Medical Education Across Adult Neurology Residency Programs in the US (P8-7.003)

Keeping the Flame Alive: Burnout and Perception of Value in the Role of Neurology Residency Program Director (S39.007)

Keeping the Flame Alive: Burnout and Perception of Value in the Role of Neurology Residency Program Director (S39.007)

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa.

The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

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.

Feasibility and utilization of a national virtual EEG course for Canadian residents and fellows.

Electroencephalography (EEG) is an essential tool for the diagnosis and management of epilepsy. There is a gap in EEG education for residents in Canadian neurology programs as EEG is only listed in the training requirements as a procedural skill. There is currently no standardized EEG curriculum among Canadian epilepsy fellowship programs. We conducted two iterations of a structured virtual EEG course from June to October 2021, and from March to June 2022. Trainees were recruited via Canadian neurology residency and epilepsy fellowship programs and were required to join the Canadian League Against Epilepsy (CLAE) as junior members. We obtained trainee demographic information before and after each course as well as analytical data on the video recordings posted on the CLAE website. A total of 77 trainees registered for the two courses; majority of trainees were adult neurology residents (34%) and adult epilepsy fellows (32%). Prior theoretical EEG teaching was reported as limited by more than half (53%) of participants. The average number of unique viewers per recorded video in 2021 was 29.7 interquartile range (16-35.5), while in 2022, the average was 22.5, interquartile range (16-28). Post-course questionnaire data revealed that 82% of participants strongly agreed that the course enhanced their knowledge. All participants were either likely (27%) or very likely (73%) to recommend the course to their peers. National virtual EEG education is both feasible and accessible; therefore, this is a promising modality of teaching to meet the significant demand for high-quality EEG education among neurology trainees.

Facial phantom model: a low-cost and safe tool for teaching botulinum toxin application in neurology residencies.

The application of botulinum toxin (BoNT) in the treatment of blepharospasm and hemifacial spasm (HS) is a well-established practice. However, neurology residency programs often rely on real patients for training, which has limitations in terms of patient availability and skill acquisition. Assess the efficacy of a new facial phantom model for acquiring motor skills in BoNT application. An anthropomorphic facial phantom model was developed in collaboration with a medical training simulator start-up. A group of seven neurologists and one ophthalmologist with expertise in BoNT application evaluated the model using an adapted learning object review instrument (LORI). The instrument assessed aspects such as: content quality, alignment of learning objectives, feedback and adaptation, motivation, presentation design, and accessibility. The facial phantom model received high scores in the LORI evaluation, with the highest ratings given to alignment with learning objectives and motivation. The model also scored well in terms of accessibility, content quality, and presentation design. However, feedback and adaptation received a lower score due to the static nature of the model. The facial phantom model shows promise as a valuable tool for teaching and developing competence in BoNT application for HS and blepharospasm. The model reduces the reliance on real patients for training, providing a broader and safer learning experience for neurology residents. It also provides a realistic learning experience and offers portability, cost-effectiveness, and ease of manufacturing for use in various medical training scenarios. It is an effective and accessible tool for teaching BoNT application.

Relevamiento de residencias y concurrencias de neurología en Argentina

IntroductionIn Argentina, physicians can obtain specialization certification through a university postgraduate program, courses provided by recognized medical associations or through a residency or concurrence. Neurologists constitute a small percentage of specialists, with only 0.67% of the available slots in the unique exam allocated to neurology. Accurate data regarding the current situation of training centers in this specialty is lacking. The objective of this study is to assess the current status of neurology residencies and concurrencies in our country. Materials and methodsDescriptive observational study. Data were collected on institutions offering neurology services and training in the country. A representative from each institution was contacted and administered a questionnaire regarding the presence and number of residents, concurrents, chief resident, resident instructor, with a breakdown by year of training. Information on membership in the Argentine Neurological Society was also obtained. ResultsA total of 52 centers with neurology residency and/or concurrence programs were surveyed. 61.5% (n=32) were located in the City of Buenos Aires (CABA) and the Province of Buenos Aires (PBA). The total number of residents was 222, with 49 concurrents; 70.8% were undergoing training in CABA (n=146) and PBA (n=46). The 71.2% of the centers were public institutions (n=37), encompassing 69.4% of neurologists in training. Only 37.5% of professionals (n=116) were members of the Argentine Neurological Society. ConclusionWe observed a significant disparity in the geographical distribution of neurology training programs in Argentina, contributing to the shortage of neurologists in less populated areas. A collaborative and periodic survey is needed to improve the distribution of future neurologists in the country.

Education Research: Neuroradiology Curriculum and Competencies Among Canadian Adult Neurology Residency Programs: A Cross-Sectional Study.

While benefitting from neuroradiologists' reports, neurologists use their own image interpretation to guide clinical decisions, especially in acute care settings. This calls for robust neuroradiology training in neurology residency, informed by current educational gaps and practices. This study aims to (1) characterize the formal neuroradiology curriculum among Canadian neurology residency programs; (2) assess neurology residents' neuroimaging interpretation competencies; and (3) define neurology residents' and program directors' (PDs) attitudes toward the current curriculum and future directions. Anonymous surveys were sent to Canadian neurology residents and PDs, querying neuroradiology learning activities, imaging modalities covered, assessment modalities, perceived residents' competencies to interpret different modalities, and attitudes regarding neuroradiology training. Residents were asked to interpret 15 neuroimaging cases. Descriptive and inferential analyses were performed. Potential differences in residents' interpretation success rates by seniority, self-perceived proficiency, and perception of curriculum sufficiency were examined using 2-tailed Welch tests with a 95% CI and Holm-Bonferroni comparison adjustment. Statistics were computed using Excel. Seventy-eight (32.6%) residents and 11 (68.8%) PDs participated. Ten of 11 PDs reported including a mandatory neuroradiology rotation, and 9/11 offered a formal neuroradiology curriculum covering head CT, head and neck CT angiography (CTA), spine MRI, and head MRI. Programs predominantly offered additional didactic lectures (9/11), teaching cases (8/11), and imaging websites (8/11). Most of the residents agreed with a minimum 1-month long rotation and desired regular didactics from neuroradiologists. Residents favored learning about head MRI (88.5%), head and neck CTA (76.9%), and spine MRI (69.2%). Senior residents' self-perceived competencies were highest for head CT, head MRI, and head and neck CTA, but lower than PDs' perception. Senior residents had greater interpretation scores than juniors (84.5% ± 13.2% vs 69.1% ± 19.9%; p < 0.0001). Most PDs (7/11, 63.6%) expressed satisfaction with current curricula vs 32.1% of residents. PDs identified time and educator shortages as main barriers to increased training. Neuroradiology training varies among programs. Residents expressed strong interest in commonly taught modalities, for which they also expressed high self-perceived competencies. However, PDs expressed greater satisfaction than residents with the current training. Leveraging interactions with neuroradiologists and online case-based learning while emphasizing trainees' interests can enhance postgraduate neuroradiology training for this useful skill.

Education Research: Virtual Residency Interviews and the Second Look: The Mayo Clinic Neurology Tri-Site Experience.

The 2023 Match cycle was the third virtual interview season for adult neurology residency programs. This recruitment cycle differed from years prior because an in-person second-look event was offered by some programs to complement the virtual interview day. We sought feedback from those who interviewed for adult neurology residency positions at Mayo Clinic in Arizona, Florida, and Minnesota to gain applicants' perspectives on such events and identify best practices to improve the interview experience for future applicants. Virtual interviews were conducted for adult neurology residency positions at Mayo Clinic in Arizona, Florida, and Minnesota for the 2023 Match. Each site hosted optional, in-person, no-stakes second-look events after program rank lists were finalized. After Match Day, interviewees at all 3 sites were invited to complete an anonymous electronic survey using Qualtrics software to gather feedback on the in-person events. Of the 240 interviewees for adult neurology residency positions at Mayo Clinic, 52 candidates participated in the in-person second-look event on the Arizona, Florida, or Minnesota campus in 2023. One-third of applicants (80/240) completed the anonymous survey, and of them, 34% (27/80) of respondents had attended a Mayo Clinic second-look event. The desire to step foot on campus, meet the residents in person, and visit the geographic area were the most important reasons driving attendance. Those who did not participate cited financial burden, lack of time, and insufficient notice to make travel plans as the most common factors influencing their decision not to attend. Nearly half of attendees who responded to the survey (10/21, 48%) changed their rank order list after the in-person event. Most of them who participated in a Mayo Clinic second-look event (19/21, 91%) would encourage future applicants to partake. While there are many advantages to virtual residency interviews, most applicants who participated in second-look events found that having an opportunity to visit the program in person was valuable when determining their rank list. Offering an optional, no-stakes, in-person visit allows interviewees to make more informed rank lists. Second-look events have the potential to complement the virtual interview day and may ultimately lead to greater satisfaction for matched applicants.

Insights From the Transition to Competency-Based Medical Education in Neurology Programs.

Canadian neurology residency programs recently transitioned to Competency-Based Medical Education (CBME). Iterative evaluation is required to optimize CBME implementation. This study aimed to examine the variability and challenges in uptake of CBME in neurology residency programs and identify its benefits and pitfalls. Neurology residents and faculty participated in respective anonymous surveys. Common barriers to uptake were identified from both perspectives. Orientation to CBME was adequate, but workload was increased and contributed to burnout for faculty and residents. It is premature to draw conclusions regarding benefits of CBME. Future research considerations include standardization of entrustment scales and reduction of stakeholder burden.