Neurology Residents Research Articles

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

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

Curriculum Innovation: Design and Implementation of Synchronous and Asynchronous Curricula to Enhance Residents' EEG Knowledge and Experience.

There is a need for structured EEG education opportunities to enhance neurology resident education. To address this need, the American Epilepsy Society (AES) supported the development and implementation of both synchronous and asynchronous EEG courses. To produce EEG curricula that enhance resident EEG learning, increase interest in EEG and improve participants' knowledge, and to ensure that courses were highly used and available to the broadest range of learners. A multi-institutional group of EEG educators developed both courses. The synchronous curriculum consisted of a mixture of brief "mini-lectures" and interactive small group activities with self-assessment quizzes at the start and end of the course. The online asynchronous EEG curriculum consisted of self-directed slide sets, multiple-choice self-assessment quizzes and a structured EEG self-assessment tool. Courses were evaluated using postcourse surveys, analysis of pretest and posttest data, and analysis of user data from the asynchronous curriculum. Between 2019 and 2021, 56 residents participated in the synchronous EEG courses. On the resident survey, mean Likert scores for course design, planning, and learning outcomes ranged from 4.6 to 5.0 for the in-person courses and from 3.9 to 4.5 for the virtual course. On the 24-item pretests and posttests, overall median scores increased from 60% (14.5/24) to 75% (18/24; p < 0.001). More than 2,300 learners completed the first submodule of the asynchronous curriculum, but only 164 completed all sections. Most of those who completed the asynchronous curriculum reported that it was effective and appropriate for resident-level learning. The AES EEG courses provide EEG learning opportunities for neurology residents beyond what is available at their home institutions. There is evidence for the effectiveness of the synchronous course, but the scope is limited to a small number of attendees. The asynchronous curriculum is more broadly available, but very few learners completed all elements. Future steps will include expansion of the in-person synchronous course and providing guidance to learners about the core and optional components of the asynchronous curriculum to increase the impact of both educational offerings.

Introduction of a novel global neurology didactic series into Suny downstate neurology residents’ education

Introduction of a novel global neurology didactic series into Suny downstate neurology residents’ education

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.

Diagnostic accuracy of large and medium vessel occlusions in acute stroke imaging by neurology residents and stroke fellows: A comparison of CT angiography alone and CT angiography with CT perfusion.

Neurology senior residents and stroke fellows are first to clinically assess and interpret imaging studies of patients presenting to the emergency department with acute stroke. The aim of this study was to compare the diagnostic accuracy of brain CT angiography (CTA) with and without CT perfusion (CTP) between neurology senior residents and stroke fellows. In this neuroimaging study, nine practitioners (four senior neurology residents (SNRs) and five stroke fellows (SFs)) clinically assessed and interpreted the imaging data of 50 cases (15 normal images, 21 large vessel occlusions (LVOs) and 14 medium vessel occlusions (MeVOs) in two sessions, 1 week apart in comparison to final diagnosis of experienced neuroradiologist and experienced stroke neurologist consensus. Interrater agreement of CTA alone and CTA with CTP was quantified using kappa statistics, sensitivity, specificity and overall accuracy. Overall, arterial occlusions were correctly identified in 221/315 (70.1%) with CTA alone and in 266/315 (84.4%) with CTA and CTP (p < 0.001). The sensitivity of overall arterial occlusions detection with CTA alone was 94.2% (95% CI: 90.8%-96.6%) while with addition of CTP was 98% (95% CI: 95.6%-99.3%), The specificity of CTA alone was 74.7% (95% CI: 67.2%-81.3%) which increased with CTP to 84.4% (95% CI: 77.7%-89.8%). The likelihood of correct identification with CTA alone was 156/189 (82.54%) for LVOs and 65/126 (51.59%) for MeVOs. This increased to 169/189 (89.42%; p = 0.054) for LVOs and 97/126 (76.98%; p < 0.001) for MeVOs when the CTA images with CTP were viewed. There was good overall interrater agreement between readers when using CTA alone (k 0.71, 95% CI, 0.62-0.80) and almost perfect (k 0.85, 95% CI, 0.76-0.94) when CTP was added to the image for interpretation. CTA and CTP had a significantly lower median interquartile range (IQR) interpretation time than CTA alone (114 [IQR, 103-120] s vs 156 [IQR, 133-160] s, p < 0.001). In cerebral arterial occlusions, the rate of LVO and MeVOs detections increases when adding CTP to CTA. The accuracy and time for diagnosing arterial occlusion can be significantly improved if CTP is added to CTA. As MeVOs are commonly missed by front-line neurology senior residents or stroke fellows, cases with significant deficits and no apparent arterial occlusions need to be reviewed with neuroradiological expertise.

Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment.

Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion. This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States. We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion. For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10). As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation.

Abstract 264: Enhancing Stroke Care: Neurology Residents' Clinical Prediction of Large Vessel Occlusions for Faster Endovascular Activation

Introduction Large vessel occlusions (LVO) account for approximately 15 to 30% of acute ischemic strokes, necessitating rapid clinical recognition to facilitate timely endovascular team activation and reduce door‐to‐reperfusion time for mechanical thrombectomy (MT). Existing clinical LVO scales, such as RACE, FASTED, and VAN, designed for utilization by Emergency Medical Services (EMS), lack reliability and have not been widely adopted for pre‐activation of endovascular teams. Typically, endovascular team activation occurs after LVO confirmation through neuroimaging, highlighting the need for improved methods to identify LVO during early assessments by neurologists. Methods A prospective observational study was conducted at University Hospital, involving all stroke codes activated by the Emergency Department (ED) or EMS. Neurology residents responding to the codes performed initial assessments, encompassing patient history, physical examination, and NIH Stroke Scale (NIHSS) evaluations. Based on the onset and severity of symptoms, presence of cortical signs, and NIHSS scores, patients were classified into four categories: A) probable LVO and stroke, B) possible LVO and stroke, C) not LVO but probable stroke, and D) probable stroke mimic. All assessments were completed before CT scanning. Results Over a ten‐month period, 159 stroke codes were evaluated by neurology residents. Among these, 27 patients were diagnosed with LVO, while 132 patients had no LVO. The neurology residents classified 18 patients into the probable stroke group, demonstrating a sensitivity of 48%, specificity of 96%, a positive predictive value (PPV) of 72%, and a negative predictive value (NPV) of 90%. Combining the probable and possible stroke groups, the residents identified 34 patients with a sensitivity of 74%, specificity of 89%, a PPV of 5%, and an NPV of 94%. Regrettably, seven patients with LVO were misclassified as either stroke mimics or non‐LVO strokes. Among these cases, five patients presented with low NIHSS scores, two had LVO in the posterior circulation, and one developed an in‐stent thrombus. Conclusion Our study revealed that neurology residents' ability to predict LVO was comparable to other LVO prediction scales in terms of sensitivity and specificity, but significantly improved in PPV. With a PPV exceeding 70%, the clinical prediction of LVO by neurology residents proves to be a valuable tool for activating the endovascular team promptly. This approach holds promise for enhancing stroke care in both the emergency department and pre‐hospital ambulance‐based settings. Nevertheless, larger studies are warranted to validate and further refine these findings. Implementing the neurology residents' clinical judgment in LVO identification can potentially optimize patient outcomes and treatment timelines in acute ischemic strokes.

Abstract 023: Early Medical Student Introduction to Interventional Neurology: Integrating Neuroendovascular Simulation to Foster Engagement

Introduction Interventional Neurology (IN) is a rapidly expanding field, with new devices and techniques broadening the range of cerebrovascular diseases that can be treated (1). Despite this, medical students are not commonly exposed to IN either during their preclinical years or neurology clerkship. Other reports have indicated significant interest in IN through neurology residency despite a poorly structured pathway to the career (2). There remains a paucity of educational focus on endovascular specialties among medical schools; simulation‐based approaches present an opportunity to address this (3‐5). We piloted an engaging didactic and hands‐on Mentice® Neuroendovascular simulation seminar to increase awareness and interest in IN. Methods Through the Student Interest Group in Neurology (SIGN) at Emory School of Medicine, we recruited 20 students (55% M1, 5% M2, 30% M3, 10% M4; 50% female) to participate in an IN didactic and simulation seminar. Before and after the seminar, participants were administered a 28‐question survey regarding their knowledge of and interest in a career in IN. All participants provided consent. A didactic session led by a fellowship trained Interventional Neurologist and a simulation session including 3 stations: diagnostic angiography, thrombectomy, and aneurysm coiling. All participants rotated at all 3 stations and all questions were answered. Results The survey was broken into subjective and objective questions regarding student interest, familiarity, and knowledge of IN. The subjective questions were recorded on Likert scales from 1‐5 while objective questions focused on endovascular procedures and their indications. Exposure to IN was limited; 70% of medical students reported no formal exposure to the field. Prior to the event, only 30% of students were interested or very interested (4 or 5 on Likert scales) in a career in IN compared to 50% post‐survey. 20% of students felt familiar or very familiar with the field prior to the seminar compared to 50% post‐survey. More students recognized the training pathways to Neurointervention (Radiology, Neurosurgery, and Neurology), could name at least 3 IN procedures, and showed improved knowledge of basic IN treatments and pathology after the event. Conclusion Interventional Neurology remains a relatively new field and is often not included in traditional medical student curriculums, even at sites where training occurs within a Comprehensive Stroke Center. Our survey demonstrated the lack of knowledge and comfort level regarding IN amongst medical students. Uniquely curated seminars targeted at medical students can lead to an increase in awareness and interest in IN (6‐8). Early exposure has been shown to increase recruitment and dispel erroneous assumptions about the specialty (4). We believe these survey results show the importance of incorporating lecture and simulation based IN procedures for medical students, especially those interested in procedural specialties. Increasing students’ knowledge of IN also provides a better understanding of career options in neurology and the extent of therapeutic options a neurologist can offer patients (2,4).

Effect of online public domain representation in neurosurgical resident recruitment and decision-making

OBJECTIVE Over the past 20 years, female representation in neurosurgical residency programs has steadily increased. Still, the number of Black women and Black neurosurgical residents overall has remained stagnant. The authors aimed to understand the factors that led to this stagnation and how online public domain representation informs current and upcoming resident recruitment and decision-making. METHODS The authors performed a retrospective study using the following public domain sources: Doximity, neurosurgical residency program websites, and LinkedIn. The authors collected data from all neurosurgery residents who matriculated into a US neurosurgical residency program from 2015 to 2022. Variables, including name, race, gender, year of matriculation, medical school, and undergraduate institution, were recorded. RESULTS The authors analyzed resident data from 110/113 (97.3%) US neurological surgery residency programs. Of these programs, 106 (96.4%) matriculated and retained ≥ 1 female resident over the study period. There were 408 (22.6%) female neurosurgical residents, with 37 (33.6%) programs accounting for 57.8% of all female neurosurgical residents. For those states with a female resident, the lowest percentage of female residents by state was in Iowa (6.25%) and the highest was in New Hampshire (50%). Of all programs, 60 (54.5%) matriculated and retained ≥ 1 Black resident over the study period. There were 88 (4.9%) Black neurosurgical residents, with 19 (17.3%) programs accounting for 55.7% of all Black neurosurgical residents. For those states with a Black resident, the lowest percentage of Black residents by state was in Maryland (2.0%) and the highest was in Arkansas (23.1%). CONCLUSIONS Recruiting and retaining female and Black residents has increasingly become a focus of neurosurgical programs across the country. The authors’ data show that female and Black residents overwhelmingly choose to apply to and matriculate into programs that demonstrate a commitment to diversity via their online presence. Programs wishing to recruit more diverse residents should make efforts to relay their dedication to diversity, inclusion, and performance through their online presence.

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.

Deciphering the contextual barriers to mainstreaming the implementation of stroke thrombolysis in a Ghanaian hospital: Findings from the activate mixed-methods study

BackgroundEach year, stroke-related death and disability claim over 143 million years of healthy life globally. Despite accounting for much of the global stroke burden, acute stroke care in Low-and-Middle-Income Countries remains suboptimal. Thrombolysis, an effective treatment option for stroke, is only received by a minority of stroke patients in these settings. AimTo determine the context-specific barriers and facilitators for the implementation of mainstream stroke thrombolysis in a Ghanaian hospital. MethodsWe employed a mixed-methods approach involving key stakeholders (recipients, providers, and leaders) in the acute stroke care continuum. Surveys were administered to acute stroke patients, and in-depth key informant interviews were conducted with experts in stroke care, including a neurologist, medical director, neurology residents, a stroke nurse, emergency physicians, a radiologist, and a pharmacist. The data collected from these interviews were transcribed and analysed using content analysis with the CFIR (Consolidated Framework for Implementation Research) model as a guiding template. Two independent coders were involved in the analysis process to ensure reliability and accuracy. ResultsThe stroke thrombolysis rate over a 6-month period was 0.83% (2 out of 242), with an average door-to-needle time among thrombolyzed patients being 2 hours, 37 minutes. Only 12.8% of patients (31 out of 242) presented within 4.5 hours of stroke symptom onset. The most significant obstacle to the implementation of acute stroke thrombolysis was related to the characteristics of the individuals involved, notably delays in presenting to the hospital among stroke patients due to a lack of knowledge about stroke symptoms and cultural beliefs. Additionally, a significant bottleneck that contributed to the discrepancy between the number of patients who presented within the 4.5-6 hour window and the number of patients who actually received thrombolysis was the inability to pay for the cost of thrombolytic agents. This was followed by challenges in the implementation processes. ConclusionsAddressing challenges related to stroke awareness, and financial constraints via multi-level stakeholder engagement, and enactment of stroke protocols are crucial steps in ensuring a successful implementation of a stroke thrombolysis program in a resource-limited setting.

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

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

Discovering Why Neurology Residents Don't Identify Social Determinants of Health Using Design Thinking (and How to Fix it!).

Discovering Why Neurology Residents Don't Identify Social Determinants of Health Using Design Thinking (and How to Fix it!).

The Concept of Neuro-ophthalmology in the Context of Ayurveda

The academic specialization of neuro-ophthalmology combines the sciences of neurology and ophthalmology and frequently deals with complicated systemic disorders that appear in the visual system. Initially completing a residency in either neurology or ophthalmology, neuro-ophthalmologists then pursue a fellowship in a related specialty. A thorough medical history and physical examination are required and neuro-ophthalmologists frequently spend a lot of time with their patients because diagnostic tests can be normal in individuals with substantial neuro-ophthalmic disease1. Common pathology referred to a neuro-ophthalmologist includes afferent visual system disorders (e.g. optic neuritis, optic neuropathy, papilledema, brain tumors or strokes) and efferent visual system disorders (e.g. anisocoria, diplopia, ophthalmoplegia, ptosis, nystagmus, and blepharospas, seizures of the eye or eye muscles, and hemifacial spasm). The North American Neuro-Ophthalmological Society (NANOS) 2, which hosts an annual congress and disseminates the Journal of Neuro-Ophthalmology, is the biggest worldwide organization of neuro-ophthalmologists. Large university-based medical centers frequently employ neuro-ophthalmologists as faculty members. The neuro-ophthalmologist frequently serves as a liaison between the ophthalmology department and other departments at the medical Centre since patients frequently have co-existing disorders in other domains (rheumatology, endocrinology, cancer, cardiology, etc.)3. In Ayurveda concept of patala is very much required to understand the diseases of neuro ophthalmology. When vitiated dosha reaches at particular patala then particular symptom is seen. According to Susruta when vitiated doshas reaches in 1st, 2nd and 3rd patala it is known as Timir, vitiated doshas reaches in 3rd patala and ragata prapti occurs (pigmentation) it is known as Kacha. Vitiated doshas reaches in 4th patala it is known as Linganasha.According to Vagbhata, vitiated doshas reaches in 1st, 2nd patala it is known as Timir. vitiated doshas reaches in 2rd patala and ragata prapti occurs (pigmentation) it is known as Kacha vitiated doshas reaches in 4th patala it is known as Linganasha4. In this Review article we try to find out the co relation between different diseases in neuro ophthalmology and different Dristi gata roga.

A cost analysis of medical students applying to neurological surgery residency: An analysis of the Texas STAR database

IntroductionMedical Students applying to neurosurgery residency programs incur substantial costs associated with interviews, away rotations, and application fees. However, few studies have compared expenses prior to and during the COVID-19 pandemic. This study evaluates the financial impact of COVID-19 on the neurosurgery residency application and identifies strategies that may alleviate the financial burden of prospective neurosurgery residents. MethodsThe TEXAS STAR database was surveyed for applicants of neurosurgical residency programs during the COVID-19 pandemic (2021) and post-pandemic (2022). 66 applicants for the 2021 application cycle and 50 applicants for the 2022 application cycle completed the survey. We compared application fees, away rotations cost, interview cost, and total expenses as reported by the neurosurgery applicants of the 2021 and 2022 application cycle. A Shapiro-Wilk test was used to test for data normality, and a Mann-Whitney U-Test was used to compare costs during the 2021 and 2022 neurosurgery application cycle. ResultsThere was a statistically significant reduction in total expenses in 2021 vs 2022 ($3,934 vs $9,860). Interview and away rotation expenses decreased in 2021 vs 2022 (interview expenses $786 vs $4511, away rotation $1,083 vs $3,000, p < 0.001). Application fee expenses were not different between 2021 and 2022. The greatest reduction in application cost ($11,908) was seen in the South for 2021. ConclusionsThe COVID-19 pandemic significantly reduced total fees associated with the neurosurgical residency application. Virtual platforms in place of in-person interviews could lessen the financial burden on applicants and alleviate socioeconomic barriers in the neurosurgical application process after COVID-19.

Neurological Surgery Residency Programs in the United States: A National Cross-Sectional Survey.

The Accreditation Council for Graduate Medical Education has approved 117 neurological surgery residency programs which develop and educate neurosurgical trainees. We present the current landscape of neurosurgical training in the United States by examining multiple aspects of neurological surgery residencies in the 2022-2023 academic year and investigate the impact of program structure on resident academic productivity. Demographic data were collected from publicly available websites and reports from the National Resident Match Program. A 34-question survey was circulated by e-mail to program directors to assess multiple features of neurological surgery residency programs, including curricular structure, fellowship availability, recent program changes, graduation requirements, and resources supporting career development. Mean resident productivity by program was collected from the literature. Across all 117 programs, there was a median of 2.0 (range 1.0-4.0) resident positions per year and 1.0 (range 0.0-2.0) research/elective years. Programs offered a median of 1.0 (range 0.0-7.0) Committee on Advanced Subspecialty Training-accredited fellowships, with endovascular fellowships being most frequently offered (53.8%). The survey response rate was 75/117 (64.1%). Of survey respondents, the median number of clinical sites was 3.0 (range 1.0-6.0). Almost half of programs surveyed (46.7%) reported funding mechanisms for residents, including R25, T32, and other in-house grants. Residents received a median academic stipend of $1000 (range $0-$10 000) per year. Nearly all programs (93.3%) supported wellness activities for residents, which most frequently occurred quarterly (46.7%). Annual academic stipend size was the only significant predictor of resident academic productivity (R 2 = 0.17, P = .002). Neurological surgery residency programs successfully train the next generation of neurosurgeons focusing on education, clinical training, case numbers, and milestones. These programs offer trainees the chance to tailor their career trajectories within residency, creating a rewarding and personalized experience that aligns with their career aspirations.

Residents need competence not confidence: A retrospective evaluation of the new competency education program for Korean neurology residents.

The objective of our study was to scrutinize the learning experiences of Korean neurology residents, with an emphasis on the implications of the novel competency-based curriculum implemented in 2021. We hypothesized that this revised curriculum could modulate residents' cognitive conduct, primarily the manifestation of overconfidence, in distinctive ways across different stages of training. Our investigative framework was three-fold. Initially, we began with a qualitative inquiry involving in-depth interviews with a purposively selected cohort of eight residents from four training sites. This approach facilitated comprehensive insight into their perceptions of their competence and confidence across the continuum of a four-year residency program. Subsequently, we incorporated the K-NEPA13 assessment instrument, administered to the residents and their overseeing supervisors. This stage aimed to dissect potential cognitive biases, particularly overconfidence and consistency, within the resident population. The final study involved a comprehensive survey administered to a group of 97 Korean neurology residents, allowing us to consolidate and validate our preceding findings. Our findings revealed that junior residents portrayed heightened confidence in their clinical capabilities compared to their senior peers. Intriguingly, junior residents also displayed a stronger inclination towards reevaluating their clinical judgments, a behavior we hypothesize is stimulated by the recently introduced competency-based curriculum. We identified cognitive divergence between junior and senior residents, with the latter group favoring more consistent and linear cause-and-effect reasoning, while the former demonstrated receptiveness to introspection and reconsideration. We speculate this adaptability might be engendered by the supervisor assignment protocol intrinsic to the new curriculum. Our study highlights the essentiality of incorporating cognitive behaviors when devising medical education strategies. Acknowledging and addressing these diverse cognitive biases, and instilling a spirit of adaptability, can nurture a culture that persists in continuous learning and self-reflection among trainee doctors.

Demographics, Practice Analysis, and Geographic Distribution of Neuro-Ophthalmologists in the United States in 2023

To assess the demographic characteristics and geographic distribution of neuro-ophthalmologists practicing in the US. A cross-sectional study. Neuro-ophthalmologists across the US. In this cross-sectional study, public databases from the American Academy of Ophthalmology, North American Neuro-ophthalmology Society, American Neurological Association, and American Academy of Neurology were used to identify neuro-ophthalmologists in the US as of April 2023. Providers' office locations were geocoded using ArcGIS pro, version 2.9 (Esri). Data on age, sex, and residency and fellowship training were collected. Analysis was performed using SPSS 28.0 (IBM Corp, Armonk, NY). Neuro-ophthalmologists' demographics, and information about their medical education, post-graduate education, residency training, fellowship training, years in practice, practice environment, and geographic distribution of neuro-ophthalmologists across US. A total of 635 neuro-ophthalmologists (436 male, 68.7%) were identified. The strong majority (599, 94.3%) graduated from an allopathic medical school. Most of the 85 physicians who held a secondary graduate degree had a PhD (54, 63.5%). Although nearly three-quarters (429, 67.6%) completed their residency in ophthalmology, 159 (25%) did residency in neurology and 47 (7.4%) in both. Nearly one-third (191, 30.0%) were trained in more than one fellowship, including oculoplastic (78, 12.3%) or pediatric ophthalmology (53, 8.3%). The average post-fellowship years of experience was 23.8 ±13.7 years, with 134 (21.1%) in their early career (< 10 years), 120 (18.9%) in their mid-careers (10 - 19 years), and 381 (60.0%) in their late careers (> 20 years). Male neuro-ophthalmologists had 10.5 ± 1.1 more years of experience than females (p < 0.001). Three states (Maine, South Dakota, Wyoming) and 2897 counties (93.2%) had no neuro-ophthalmologists. Counties without a neuro-ophthalmologist had lower median income (p < 0.001), lower access to a vehicle (p = 0.024), and lower rates of health insurance (p = 0.012). Practicing neuro-ophthalmologists are mostly male and are often trained in more than one subspecialty. More than half of the practicing neuro-ophthalmologists are in their late careers, which may further exacerbate the existing geographic and socioeconomic disparities in access to neuro-ophthalmology.

Dual Residency Training in Neurology and Psychiatry: History and Current Practice.

In the early 20th century, neurology training included more experience in psychiatry, and psychiatry training included more training in neurology than what is currently required. After World War I, the increased need for differential diagnosis of what might now be called functional neurological disorders resulted in the military encouraging combined residency training in neurology and psychiatry and the promulgation of the term "neuropsychiatry" for this specialty. Thirty-six percent of physicians certified by the American Board of Psychiatry and Neurology in its first decade (1935-1945) held certification in both neurology and psychiatry. However, the term neuropsychiatry gradually became used interchangeably with general psychiatry-to distinguish it from psychoanalysis-and lost its specificity. It is widely held that the popularity of psychoanalysis resulted in psychiatrists perceiving less need for neurological knowledge, and inclusion of neurology content in psychiatry training decreased. Dual residency training programs in neurology and psychiatry began to increase in popularity again in the 1980s as advances in neuroscience, neuroimaging, and pharmacology, paired with the growth of behavioral neurology, laid the foundation for meaningful practice of neuropsychiatry. The author surveyed 207 physicians who graduated from both a neurology and psychiatry residency and 18 current trainees in combined neuropsychiatry residency programs to collect information on their current practice, academic activity, and opinions about their training. The response rate was 64%. Respondents' attitudes toward the value of their dual neurology and psychiatry training were overwhelmingly positive. Reasons for the lack of growth of combined residency programs in neurology and psychiatry are examined.