Neurology Residents Research Articles

Can a Single Acute Ischemic Stroke Simulation Course Facilitate Mastery? (P9-2.001)

<h3>Objective:</h3> To assess the impact of an acute ischemic stroke (AIS) simulation course on residents’ performance, confidence, and knowledge. <h3>Background:</h3> Previous studies have demonstrated that simulation can promote mastery learning in non-stroke neurological emergencies. <h3>Design/Methods:</h3> We designed an AIS simulation course with three independent scenarios based on previously reported consensus. For each scenario a Minimum Passing Score (MPS) and Mastery Score (MS) was determined by the Angoff method. Thirteen junior neurology residents completed a 20-point knowledge test and 7-point Likert scale confidence survey about AIS before the course and after didactic teaching. A week later, each resident participated in a scored AIS case and then practiced stroke care in second unscored case. Residents again completed the knowledge and confidence assessments. Several weeks later, without notice, each resident was evaluated in a third AIS scenario. For comparison, eight senior residents completed the knowledge test, confidence survey, and the third acute stroke case. Pre-post and between groups comparisons were conducted using paired t-tests and independent t-tests, respectively. <h3>Results:</h3> Junior residents scored better on the knowledge test after the didactic session (mean score pre: 40% to post: 52.2%, p&lt;0.05), but only 3 (23%) initially achieved the MPS score in the first AIS simulation. After the simulation course, 9 junior residents (69%) achieved the MPS threshold. Although none achieved Mastery, junior residents’ mean score in the simulation improved (10.3 (SD=2.8) vs 15.7 (SD=2.6), p&lt;0.001) and their confidence increased (pre mean=3.3 (SD=1.9) vs. post mean =4.9 (SD=1.2), p&lt; 0.001). Eight seniors completed the simulation: five reached MPS (63%) and one achieved Mastery. The simulation scores of the post-course juniors and seniors were similar (mean=15.7 (SD=2.6) vs mean=16.0 (SD=2.5), p=0.793). <h3>Conclusions:</h3> This pilot study suggests that a brief AIS simulation course may improves junior residents’ performance and confidence to a level similar to senior residents, but not to mastery. <b>Disclosure:</b> Dr. Albin has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum: Life Long Learning in Neurology. Dr. Albin has received research support from American Academy of Neurology. Dr. Albin has received publishing royalties from a publication relating to health care. Dr. Albin has received personal compensation in the range of $500-$4,999 for serving as a Instructor with Resuscitation Leadership Academy. Dr. Sigman has nothing to disclose. Dr. Pergakis has nothing to disclose. Dr. Bhatt has nothing to disclose. Dr. Hutto has nothing to disclose. Dr. Koneru has nothing to disclose. Dr. Osehobo has nothing to disclose. Dr. Vizcarra has nothing to disclose. The institution of Dr. Morris has received research support from American Board of Psychiatry and Neurology. The institution of Dr. Morris has received research support from UMB ICTR through NIH NCATS&amp;CTSA grant 1UL1TR003098. The institution of Dr. Morris has received research support from University of Maryland Medical Center.

Near-Peer Learning in Neurology Residency Training on Cerebrovascular Disease in A Teaching Hospital in China (P2-2.003)

Near-Peer Learning in Neurology Residency Training on Cerebrovascular Disease in A Teaching Hospital in China (P2-2.003)

A Telehealth Training Program for Neurology Residents (P8-2.005)

<h3>Objective:</h3> Neurologists in-training will become proficient in skills needed for an effective teleneurology visit. <h3>Background:</h3> Telehealth has improved patient access to clinicians and reduced time/cost burden on patients. Video appointment are now offered in most practices. The AAMC has outlined telehealth domains whereby clinicians must demonstrate proficiency. The Neurology RRC has endorsed support for resident telehealth encounters. We developed a no-cost reproducible telehealth training program to improve resident skills. <h3>Design/Methods:</h3> Thirteen residents recorded a telehealth counseling session pre-intervention for a patient considering botulinum toxin injections for migraines. (Time 1) Feedback was provided. Residents received a one-hour lesson outlining tele-etiquette, communication and exam skills. Trainees then underwent two 20-minute encounters with faculty trained as standardized patients. (Time 2) A second reviewer also scored the session on video review. Each resident received feedback then completed a third 20-minute clinical encounter at one-year follow-up. (Time 3) Resident confidence in skillset was also measured prior to Time 1 and upon training completion. Statistical analysis was conducted via Wilcoxin Paired t-test <h3>Results:</h3> Comparison of pre and post-course resident surveys revealed significant improvement in telehealth comfort in all categories (3.2 ± 0.8 to 4.3 ± SD 0.5 (p &lt;0.005)). Comparison of initial recording and post-course encounter revealed improvement in tele-communication and “webside” manner ((2.4 ± 0.3, 2.7 ± 0.3), (1.9 ± 0.3, 2.4 ± 0.5) (p &lt;0.05)). Comparison of initial visit and one-year follow up revealed improvement in communication, professionalism and “web-side” manner ((2.4 ± 0.3, 3 ± 0), (2.4 ± 0.7, 3 ± 0), (2.4 ± 0.7, 3 ± 0) (p &lt;0.05)). Additionally, improvement was observed in professionalism between post-course encounter and one year follow up (2.4 ± 0.7, 3 ± 0, (p &lt;0.05)). <h3>Conclusions:</h3> A low resource, no cost, telehealth training program can be effectively integrated into resident curriculum and improve tele-related interpersonal skills, communication skills, and professionalism. <b>Disclosure:</b> Dr. Davitz has nothing to disclose. Dr. Leaver has nothing to disclose. Dr. Skliut has nothing to disclose. Dr. Katsnelson has nothing to disclose. Dr. Swan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NACME. The institution of Dr. Swan has received research support from Sanofi Genzyme. The institution of Dr. Swan has received research support from Abbvie. The institution of Dr. Swan has received research support from Biogen. The institution of Dr. Swan has received research support from Sage . Dr. Shanker has nothing to disclose.

Implementation of Depression Screening and Interventions Protocol in a Pediatric Neurology Residents’ Continuity Clinic: A Quality Improvement Project (P11-9.001)

<h3>Objective:</h3> We developed and implemented a depression screening and interventions (S&amp;I) protocol in our pediatric neurology residents’ continuity clinic. <h3>Background:</h3> The prevalence of depression in children with neurological disorders ranges from 10–30%. Co-morbid depression is an important factor in the care and quality of life of these patients. Early recognition of depression can lead to early engagement of mental health services and improvement of depressive symptoms. However, ubiquitous depression screening in pediatric neurology clinics remains a challenge. <h3>Design/Methods:</h3> A multidisciplinary team (resident leaders, program director, clinic manager, nurses, medical assistants, and social workers) developed the depression S&amp;I protocol. Patient Health Questionnaire-9 Adolescent (PHQ-9A) was administered to patients age 12 to 18 years, who were developmentally capable and agreed to complete the screening. Patients received individualized interventions based on our algorithm. Serial Plan-Do-Study-Act (PDSA) cycles were performed, over nine months, to improve efficacy and workflow. PDSA cycle 1 included protocol initiation and education of residents and clinic staff. PDSA cycle 2 included further promotion and addition of dotphrases in the electronic medical record (EMR) documentation. PDSA cycle 3 consisted of re-education and provision of reminder cards at workstations. Measures included percent of eligible patients screened and percent of screened patients who received appropriate interventions. <h3>Results:</h3> During PDSA cycle 1, 57% of eligible patients were screened, of which 79% received appropriate interventions. After PDSA cycle 2, screening and appropriate intervention rates remained stable at 58% and 81%, respectively. Following PDSA cycle 3, the screening rate increased by 13% while the appropriate intervention rate was relatively maintained (78%). During the study, 19% of patients had moderate and severe scores, and one patient endorsed active suicidal ideation. <h3>Conclusions:</h3> After implementation of the depression S&amp;I protocol, patient screening rates increased through education and EMR-based changes. Future research will include assessment of trends in patients’ scores and symptoms after protocol implementation. <b>Disclosure:</b> Dr. Choudhari has nothing to disclose. Dr. Lorenzo has nothing to disclose. Dr. Said has a non-compensated relationship as a Board of Directors, Representative of PCN with UCNS that is relevant to AAN interests or activities. Dr. Said has a non-compensated relationship as a Member, Professional Advisory Board with Epilepsy Foundation of Texas that is relevant to AAN interests or activities. Dr. Said has a non-compensated relationship as a Member, Diversity, Equity and Inclusion Committee with American Epilepsy Society that is relevant to AAN interests or activities.

The Utility of a Novel Walk-Through/Talk-Through Stroke Simulation Model for Medical Student Education. (S10.008)

<h3>Objective:</h3> Our aim is to evaluate the perceptions of medical students regarding a novel “Walk-Through/Talk-Through” style stroke simulation in which trainee stress is minimized, and demonstration, self-pacing, and frequent debriefing are emphasized. <h3>Background:</h3> Medical simulation exercises have become a standard of modern medical education and proved beneficial for trainees in acquiring both technical (1) and non-technical (2) skills. However, simulation exercises are often purposefully emotionally and physiologically stressful for learners (3,4). No research was found that studied simulation efficacy and trainee perspectives when simulation stress was minimized, and demonstration, self-pacing, and frequent debriefing were emphasized. <h3>Design/Methods:</h3> Thirty-two upper-level medical students (study ongoing) participated in a one-hour “code-stroke” small-group simulation led by upper-level neurology residents utilizing a novel Walk-Through/Talk-Through model of learning. This simulation began with an overview presentation, followed by a resident-led NIH-SS demonstration, a student Walk-Through/Talk-Through NIH-SS exam, a resident-led code-stroke demonstration, and lastly a student Walk-Through/Talk-Through code-stroke session. Pre-/post-simulation questionnaires were collected regarding medical students’ perspectives of the simulation. <h3>Results:</h3> Of the 27/32 students who completed both questionnaires, significant improvement (p&lt;0.001) in trainee comfort scale (1–10) was found in pre-/post-simulation scores in managing a code-stroke (median 4 pre-sim vs. 8 post-sim), performing the NIH-SS (median 4 pre-sim vs. 8 post-sim), performing a focused stroke history (median 5 pre-sim vs. 8 post-sim), and making decisions regarding thrombolytics (median 5 pre-sim vs. 8 post-sim). The pace, frequent debriefing, and overall Walk-Through/Talk-Through simulation model were perceived as very helpful for student learning in 81%, 78%, and 78% of participants, respectively. Additionally, 85% of participants indicated that the Walk-Through/Talk-Through model would be helpful in other clinical simulations. <h3>Conclusions:</h3> This novel Walk-Through/Talk-Through stroke simulation model that aims to minimize stress while maximizing demonstration, self-pacing, and frequent debriefing is perceived by medical student as beneficial for their learning and likely applicable to other clinical simulations. <b>Disclosure:</b> Dr. Dolbow has received publishing royalties from a publication relating to health care. Dr. Sadek has nothing to disclose. Dr. Al-Shaibi has nothing to disclose. Miss Sponaugle has nothing to disclose. Dr. Xiong has nothing to disclose.

Neuropalliative Curriculum in Neurology Residency Program (P1-2.003)

Neuropalliative Curriculum in Neurology Residency Program (P1-2.003)

Acute Neurological Emergencies: Using Neurology-Trained Standardized Patients To Promote Active Learning in a Case-Based Simulation Curriculum for Neurology Clerkship Students (P9-2.004)

<h3>Objective:</h3> To describe the impact of using live, neurology-trained standardized patients (SPs) in a case-based simulation curriculum for clerkship students. <h3>Background:</h3> Simulation in neurology is limited by the inadequacy of manikins to portray neurologic exam findings. We designed a simulation curriculum using live, neurology-trained resident SPs residents for clerkship students to (1) practice taking a neurologic history, (2) perform a neurologic exam, and (3) recognize and triage neurological emergencies. <h3>Design/Methods:</h3> Two scenarios were developed: (1) evaluation of dizziness and management of acute stroke and (2) treatment of new-onset seizure. Monthly sessions involved 4–5 students. Residents SPs mimicked expected exam findings. Pre- and post-session surveys evaluated students’ self-rated knowledge, clinical skills, and confidence in gathering a history, performing a neurological exam, presenting a case, and recognizing, working up, and managing strokes and seizures. Students also rated the overall session quality and provided feedback about the experience. Paired t-tests were performed for quantitative items. <h3>Results:</h3> 54 students participated. Post-session, students reported significantly higher self-confidence in all neurological knowledge domains and clinical skills (p&lt;0.003 for all). Over 90% of students agreed sessions met the learning objectives, the course was valuable, and the simulation was a safe learning environment and would improve their clinical performance. 94% would recommend the session to others. Over 80% agreed the simulation was realistic, well-organized, and an effective way to practice teamwork and clinical skills. In open responses, students reported they appreciated evaluating neurologic emergencies, performing the exam with a trained SP, and making treatment decisions. Students wanted more cases and time; they suggested smaller groups. <h3>Conclusions:</h3> A simulation curriculum with neurology residents portraying the patient increased students’ knowledge, clinical skills, and self-confidence in recognizing and managing acute neurological emergencies. Resident SPs were cited as the most effective educational component. Future research should evaluate the sustainability of benefits gained and assess clinical skills objectively. <b>Disclosure:</b> Dr. Gheihman has nothing to disclose. Dr. Harrold has nothing to disclose. The institution of Dr. Howard has received research support from Genentech. The institution of Dr. Howard has received research support from Novartis. Dr. Howard has received personal compensation in the range of $50,000-$99,999 for serving as a Clinical Fellow with National Multiple Sclerosis Society. Dr. Albin has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum: Life Long Learning in Neurology. Dr. Albin has received research support from American Academy of Neurology. Dr. Albin has received publishing royalties from a publication relating to health care. Dr. Albin has received personal compensation in the range of $500-$4,999 for serving as a Instructor with Resuscitation Leadership Academy. Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis . Dr. Kaplan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono .

Impact of Specialty on Cases Performed During Spine Surgery Training in the United States

Two general pathways exist for spine surgery training in the United States: orthopedic surgery and neurological surgery. Previous studies have not quantified the impact of fellowship training when comparing case volumes between these 2 training pathways. This study compares reported spine surgery case volume upon graduation from orthopedic surgery and neurological surgery training. This was a retrospective cohort study of recent graduates from orthopedic surgery and neurological Surgery training programs in the United States (2018-2021). The Accreditation Council for Graduate Medical Education provided case logs for residents in neurological surgery and orthopedic surgery as well as fellows in orthopedic spine surgery. Case volumes were compared for adult and pediatric spine surgery cases using parametric tests. Case logs from 3146 orthopedic surgery residents, 107 orthopedic spine surgery fellows, and 766 neurological surgery residents were included in this study. Across each cohort, neurological surgery trainees reported more total adult spine surgery cases than orthopedic surgery trainees (514±206 vs. 383±171, P < 0.001). Orthopedic surgery trainees reported more total pediatric spine surgery cases (21±14 vs. 17±12, P= 0.006). Neurological surgery training affords a greater volume of adult spine surgery cases, but orthopedic surgery affords more pediatric spine surgery cases. Identification of relative strengths and weaknesses can help facilitate multidisciplinary training experiences in spine surgery.

414 Competitive Advantage: An Analysis of Matched and Unmatched United States Neurological Surgery Residency Applicants From 2009-2021

INTRODUCTION: National Resident Matching Program releases a detailed report of residency match statistics for each specialty. Securing a training position in a United States neurological surgery residency program is notoriously competitive, and the subspecialty has long maintained a match rate much lower than other specialties. There remains a paucity of recently studied longitudinal trends in academic and extracurricular characteristics of successfully matched neurological surgery residency applicants. METHODS: Residency applicant self-reported data, obtained from the American Association of Medical Colleges Electronic Residency Application Service, were collected from yearly “Results and Data: Main Residency Match” (2009-2021) and biennial “Charting Outcomes in the Match” (2009-2020) National Residency Match Program summary reports. RESULTS: From 2009-2021, the number of neurological surgery residency programs and positions increased from 97 to 115 and 191 to 234, respectively. Matched applicants’ average United States Medical Licensing Exam (USMLE) Step 1 scores significantly increased (239 to 248; p = 0.01332), while average USMLE Step 2 Clinical Knowledge scores rose (237 to 252; p = 0.05682) during the study period. Average number of distinct research experiences among matched applicants increased (3.3 to 6.1; p = 0.5398), while the average number of abstracts, presentations, and publications increased from 7.8 to 23.4 (p = 0.0746). Lastly, Alpha Omega Alpha (AOA) membership (p = 0.00077) and percentage graduating from a top National Institutes of Health-funded medical school (p = 0.00396) significantly differed between matched and unmatched neurological surgery residency applicants. CONCLUSIONS: Matched neurological surgery residency applicants had significantly fewer average number of distinct specialties ranked, higher USMLE Step 1 scores, greater AOA membership, and more frequently graduated from top 40 NIH-funded medical schools than their unmatched counterparts. Additional research considering applicant-level intersectional data is warranted to further understand the match process.

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.

Analysis of Current Neurological Surgery Residents and Prior Medical Education: Do Medical School Attributes Matter?

With the recent changes to the U.S. Medical Licensing Examination grading system, an understanding of the factors that influence the neurological surgery residency match process is crucial for residency directors. The aim of the present retrospective study was to explore the associations of medical school location, ranking, private school status, size, and presence of an American Association of Neurological Surgeons (AANS) chapter or neurological surgery interest group (NSIG) with the neurosurgery match outcomes. An enrollment list of all accredited U.S. neurosurgery residency programs was compiled on June 28, 2021. For the included residents, the residency program, degree, and previously attended medical school were retrieved. The geographic location, ranking, private school status, and size were collected for the residency programs and medical schools attended by the residents at each program. A total of 1437 residents from 101 neurosurgery residency programs (89%) were included. Graduates from the top 25 medical schools were more likely to match into their home residency programs (P < 0.001) and highly ranked residency programs (P < 0.001). Students from larger medical schools were also more likely to match into larger (P < 0.001) and highly ranked (P < 0.001) programs than were applicants from smaller schools. Students from medical schools with an AANS chapter or NSIG were also more likely to match into top ranked programs (P < 0.001 for both). Medical students from the top 25 medical schools, private medical schools, medical schools with an AANS chapter, and medical schools with an NSIG were more likely to match into a prestigious residency program. These findings suggest that underlying biases might be present for program directors to consider in the resident selection process.

Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil.

• Neurology trainees and program directors recognized a lack of structured breaking bad news training. • Program directors reported that many factors hinder the implementation of breaking bad news education. • Trainees felt capable of breaking bad news, but most did not have lectures, simulations, nor feedback. • Trainees acknowledged negative feelings when breaking bad news, including sadness and helplessness. We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.

A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills.

Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.

Global neurology: It's time to take notice.

Global neurology: It's time to take notice.

Education Research: Appraisal of Outpatient Clinical Experience During Neurology Residency.

Outpatient clinical experience is a key component of neurology residency. Understanding the educational environment for residents in the outpatient setting can inform educators to maximize teaching and learning opportunities, enhance resident exposure to subspecialty diagnoses and management, and deliver quality care. We studied the continuity clinic experience of 5 neurology residents over the course of their residency to determine the breadth of their ambulatory experience. We used administrative health data from new and return patient visits scheduled with 5 neurology residents of the same class over 3 years of continuity clinic. International classification of disease codes pertaining to neurologic diagnoses and symptoms associated with these visits were analyzed. Frequency and proportions of the most commonly evaluated diagnoses and symptoms were tabulated. These were compared with previously published data about resident experience during training. We also analyzed resident experience over time. Five neurology residents evaluated 948 patients (mean 189.6; range 180-202; 59.2% female) during 2,699 clinic visits (mean 539.8; range 510-576) over 3 years in their continuity clinics. There were 6,555 international classification of disease codes associated with these visits (2,948 [44.9%] neurologic diagnoses, 2,249 [34.3%] neurologic symptoms, and 1,358 [20.8%] comorbidities). The most common neurologic diagnoses were as follows: headache disorders (24.5%), neuromuscular disorders (17.3%), movement disorders (12.1%), cerebrovascular disorders (11.5%), and epilepsy (7.5%). The most common neurologic symptoms evaluated by residents were as follows: seizure-like events (16.5%), sensory symptoms (12.4%), pain (10.3%), headache (9.7%), and motor symptoms (8.1%). The clinical experience of residents in the continuity clinic was diverse, but it was skewed toward headache, neuromuscular, and movement disorders, which constituted 54% of the workload. When compared with previous studies, the range of resident's outpatient clinical experience differed from that of inpatient experience. Based on the results of this study, we made changes to our outpatient curriculum by adding 2-month-long rotations in subspecialty clinics from postgraduate year 2 to 4 with the aim of boosting resident exposure to neurologic disorders in the outpatient setting.

Education Research: Neurology Residents Report Improved Skills After Initiation of a Lumbar Puncture Clinic

Background and Objectives Neurology residents have limited opportunities to perform lumbar punctures (LPs). We hypothesized that establishing a clinic for residents to perform LPs would increase success rates, improve resident comfort with LPs, reduce the need for assistance by attending physicians, and improve patient care. Methods The Vanderbilt University Medical Center neurology residency began a resident LP clinic and measured residents' input and clinical data to see whether the clinic affected resident LP skills. Before and after the launch of LP clinic, neurology residents were invited to complete online surveys at the end of the academic year and during their LP clinic rotation. Completion of the surveys was voluntary and considered consent. The surveys assessed LP attitudes and experience (e.g., confidence with LPs and number performed) and LP clinic procedural data (e.g., LP success rate). Attitudes were measured by assessing confidence; experience by quantifying the number of LPs performed; procedural success was measured by the number of LPs with successful CSF acquisition. Differences in resident attitude and LP outcomes were analyzed using Spearman correlations and logistic regressions. Results Prior to the launch, 15/25 (60% response) residents responded to the clinic survey. After the launch, 6/21 (29%) responded to the first-year follow-up survey and 12/21 (57%) to the second-year follow-up survey. Resident confidence and the number of LPs performed were unchanged. Success rate reported by individual residents increased 15% (p = 0.04), which did not correlate with the overall LP clinic success rate. In the first year of the clinic, 83% of postgraduate year (PGY)3s needed an attending's assistance compared with 29% of PGY4s. In the second year, 44% of PGY3s and 32% of PGY4s needed an attending's assistance. Discussion This structured clinic provided an opportunity for informal resident-to-resident teaching, which may have reduced the need for attending assistance.

Education Research: The Inappropriate Consult

Background and Objectives As resident physicians specialize, they lose familiarity with knowledge central to other fields. This can yield what we term the dual fallacies: (1) the sense that their own expertise is common knowledge, and (2) unfamiliar clinical situations seem beyond their scope. In graduate medical education, these dual fallacies may engender the perception of inappropriate consults among specialties. This project evaluated biases in residents' perceptions of expected knowledge and inappropriate consults to improve interdisciplinary education among neurology residents (neurologists) and internal medicine residents (internists). Secondarily, we evaluated whether these biases were mitigated after implementing an educational intervention. Methods Resident neurologists and internists at a large, urban, academic medical center answered board-style questions reflecting neurology and medicine consultation scenarios. They then rated the extent to which each scenario reflected common knowledge to both specialties and whether a consult was warranted. After revising the internal medicine residency curriculum to include a neurology rotation, another cohort of residents was surveyed and participated in semistructured interviews. Paired sample t tests and qualitative data analysis were performed. Results Neurologists and internists participated in phase 1 (n = 23) and phase 2 (n = 42) of the study. Residents from both fields answered more questions correctly from their own specialty than the other in phase 1 (p &lt; 0.05) and phase 2 (p &lt; 0.001). Neurologists and internists in both cohorts thought that each other should know more neurology answers than they actually did (p &lt; 0.05). Neurologists were less likely to agree than internists that medicine questions deserved a consult (p = 0.014). Interviews revealed themes regarding perceived consult appropriateness, affected by educational, communication, clinical, and administrative factors. In addition, residents agreed that appropriate consults must pose a specific question and occur only after an initial investigation was performed, but that this rarely happens. Discussion Our findings support that discordant expectations of expertise contribute to a perception of inappropriate consults among neurologists. Nonclinical factors, from cognitive biases to contextual considerations, inform clinical consultation and interdisciplinary patient care. Implementing rotations on other services alone is insufficient to eradicate discordant expectations; however, we propose additional interventions that may prove valuable in medical education.

Modern Neurology Training Is Failing Outpatients

This Viewpoint describes the pressure on neurology residents to pursue subspecialty training in a fellowship program even though the need for general neurologists is sizable and increasing.

Role of narrative medicine-based education in cultivating empathy in residents

ObjectiveTo explore the role of narrative medicine-based education in standardized empathy training for residents.MethodsAmong the 2018–2020 residents at the First Affiliated Hospital of Xinxiang Medical University, 230 receiving neurology training were enrolled in this study and randomly divided into study and control groups. The study group received narrative medicine-based education and standardized routine resident training. The Jefferson Scale of Empathy–Medical Student version (JSE–MS) was used to evaluate empathy in the study group, and the neurological professional knowledge test scores of the two groups were also compared.ResultsIn the study group, the empathy score was higher than the preteaching score (P < 0.01). The neurological professional knowledge examination score was higher in the study group than in the control group, albeit not significantly.ConclusionThe addition of narrative medicine-based education in standardized training improved empathy and may have improved the professional knowledge of neurology residents.

Experience and perception of utilizing virtual clinic in neurological assessment in Saudi Arabia.

The World Health Organization defined electronic health as "the unified usage of information technology and electronic communications in the health sector." In the Kingdom of Saudi Arabia, outpatient encounters were largely shifted to virtual clinics due to the crisis caused by COVID-19. This study aimed to evaluate the neurology consultants', specialists', and residents' experience and perception of utilizing virtual services for neurological assessment in Saudi Arabia. This cross-sectional study was conducted by sending an anonymous online survey to neurologists and neurology residents in Saudi Arabia. The survey was developed by the authors and contained three main sections: demographics, subspecialty and years of experience after residency, and virtual clinics during the coronavirus disease 2019 (COVID-19) pandemic. A total of 108 neurology-practicing physicians in Saudi Arabia responded to the survey. Overall, 75% experienced virtual clinics, and 61% of them used phones for consultation. In neurology clinical practice, there was a significant difference (P < 0.001) regarding the teleconsultations for follow-up patients compared to the newly referred patients, being more suitable for the follow-up cases. Additionally, most neurology practicing physicians showed more confidence in performing history-taking tasks virtually (82.4%) than in physical examination. However, it was found that consultants were significantly (P < 0.03) more confident to virtually perform the cranial nerve, motor, coordination, and extrapyramidal assessments than the neurology residents. Physicians deemed it more suitable to conduct teleconsultations for patients with headaches and epilepsy than for those with neuromuscular and demyelinating diseases/multiple sclerosis. Furthermore, they agreed that patients' experiences (55.6%) and physicians' acceptance (55.6%) were the two main limitations to implementing virtual clinics. This study revealed that neurologists were more confident in performing history-taking in virtual clinics than in physical exams. On the contrary, consultants were more confident in handling the physical examination virtually than the neurology residents. Moreover, the most accepted clinics to be handled electronically were the headache and epilepsy clinics in comparison to the other subspecialties, being mainly diagnosed using history. Further studies with larger sample sizes are warranted to observe the level of confidence in performing different duties in neurology virtual clinics.