Neurology Residency Training Research Articles

Veterinary neurology residency training in Europe-A survey on preparation and plans.

Difficulties in recruitment of veterinary specialists to academia is an ongoing problem for university teaching hospitals. The aim of this study was to determine the proportion of veterinary neurology specialists that plan to work in academia after their residency training and identify the main factors that may influence that decision. An electronic survey was distributed to European College of Veterinary Neurology (ECVN) residents in training and those that completed their residencies within the previous 12 months. Despite similar numbers of residents training in clinical practice and academic institutions, most respondents (79.7%) planned to work in private practice. The most influential factors for deciding future workplace were quality of life, salary, location, and the number of other specialists (with specialists in subjects other than neurology viewed as more important than neurologists) working in the same institution. The most common reasons for not choosing academia were low compensation, excessive bureaucracy, and high administrative workload compared to private clinical practice. Academic institutions need to review support for academic staff and provide stronger mentorship to overcome these problems and ensure provision of high-quality undergraduate teaching in veterinary neurology as well as promoting advancement of the field through basic and applied research.

Application of flipped classroom teaching method based on ADDIE concept in clinical teaching for neurology residents

BackgroundAs an important medical personnel training system in China, standardized residency training plays an important role in enriching residents’ clinical experience, improving their ability to communicate with patients and their clinical expertise. The difficulty of teaching neurology lies in the fact that there are many types of diseases, complicated conditions, and strong specialisation, which puts higher requirements on residents’ independent learning ability, the cultivation of critical thinking, and the learning effect. Based on the concept of ADDIE (Analysis-Design-Development-Implementation-Evaluation), this study combines the theory and clinical practice of flipped classroom teaching method to evaluate the teaching effect, so as to provide a basis and reference for the implementation of flipped classroom in the future of neurology residency training teaching.MethodsThe participants of the study were 90 neurology residents in standardised training in our hospital in the classes of 2019 and 2020. A total of 90 residents were divided into a control group and an observation group of 45 cases each using the random number table method. The control group used traditional teaching methods, including problem based learning (PBL), case-based learning (CBL), and lecture-based learning (LBL). The observation group adopted the flipped classroom teaching method based on the ADDIE teaching concept. A unified assessment of the learning outcomes of the residents was conducted before they left the department in the fourth week, including the assessment of theoretical and skill knowledge, the assessment of independent learning ability, the assessment of critical thinking ability, and the assessment of clinical practice ability. Finally, the overall quality of teaching was assessed.ResultsThe theoretical and clinical skills assessment scores achieved by the observation group were significantly higher than those of the control group, and the results were statistically significant (P < 0.001). The scores of independent learning ability and critical thinking ability of the observation group were better than those of the control group, showing statistically significant differences (P < 0.001). The observation group was better than the control group in all indicators in terms of Mini-Cex score (P < 0.05). In addition, the observation group had better teaching quality compared to the control group (P < 0.001).ConclusionBased on the concept of ADDIE combined with flipped classroom teaching method can effectively improve the teaching effect of standardized training of neurology residents, and had a positive effect on the improvement of residents’ autonomous learning ability, critical thinking ability, theoretical knowledge and clinical comprehensive ability.

Stroke in the very old: A study from the Philippine Neurological Association One Database.

The very old, although a minority in many populations, experience stroke with distinct risk factors and more complications. We sought to understand the profile, stroke subtypes, risk factors and outcomes among the very old compared to younger stroke patients in our population in the Philippine Neurological Association One Database-Stroke (PNA1DB-Stroke). The PNA1DB-Stroke registry (clinicaltrial.gov NCT04972058) is a multi-centre, prospective database of all patients hospitalised for transient ischaemic attack or acute stroke in 11 neurology residency training institutions. Of the 6314 patients with stroke, 463 (7%) were 80 years or older, and among them, 320 (69%) were women. Traditional risk factors were more frequent in the very old compared to the younger group (hypertension 76% vs. 66%, diabetes mellitus 26% vs. 19%, previous stroke 14% vs. 10%, atrial fibrillation 13% vs. 3%; p ≤ .005), while current smoking (5%) and excess alcohol consumption (4%) were less common than in younger stroke patients (p < .001). Overall, in-hospital fatality was not remarkably increased in our very old compared to younger stroke patients, with comparable rates between cases of ischaemic stroke (18%) and intracerebral haemorrhage (20%). However, they had longer hospital stay (mean 13.4 ± 17.2 days vs. 10.9 ± 15.4 days, p = .001), had more medical complications (p < .001) and were more functionally dependent at discharge (p < .0001). Very old stroke patients have relatively more risk factors for stroke. In-hospital fatality rates are comparable between ischaemic and haemorrhagic strokes. Risk factor modification, prevention of medical complications and optimisation of functional recovery are potential strategies in managing stroke in the very old.

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.

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.

Curriculum Innovations: Near-Peer Learning in Neurology Residency Training on Cerebrovascular Disease in a Teaching Hospital in China.

Traditional faculty-led training is teacher-centric and requires substantial investments in teaching faculty and resources. Near-peer learning (NPL) is a teaching strategy in which senior residents instruct juniors who are only 1 or 2 years earlier in their training. NPL promotes student engagement and may enhance teaching competency of participants. We implemented an NPL instructional design for a course on cerebrovascular disease for residents in China. Tutors and tutees will be able to (1) demonstrate knowledge of cerebrovascular anatomy, (2) understand cerebrovascular physiology, and (3) use neuroimaging and physiology to evaluate cerebrovascular pathology. From December 2019 to March 2022, NPL was implemented in a neurology residency training program in China. A series of NPL lectures was conducted in addition to traditional faculty-led lectures. The NPL intervention consisted of senior resident tutors who designed and led lectures on foundational topics in cerebrovascular neurology (e.g., anatomy and imaging of cerebral blood vessels, clinical and imaging features of ischemic and hemorrhagic stroke) under the guidance of faculty instructors. Tutees were junior residents in the same program. Precourse/postcourse examinations and feedbacks through online questionnaires were used to evaluate the effectiveness of the NPL intervention on knowledge acquisition and teaching competency. Over 3 academic years, 57 total residents participated, including 18, 18, and 21, respectively. All participated in the NPL intervention, with some attending more than once. Participants could be assigned as tutor or tutee in different years. Eighteen lectures were delivered by 15 tutors. The rest were tutees. Postcourse examination scores improved significantly compared with precourse scores (64.22 ± 12.11 vs 59.80 ± 15.88, p = 0.003), with the most remarkable improvements seen for the first-year residents and first-time participants. One hundred sixty-two postsession feedbacks from participants (both tutors and tutees) and 15 postprogram feedbacks from tutors were collected. Respondents thought highly of NPL, reporting gain in knowledge and teaching opportunities. NPL enabled residents to acquire foundational knowledge of cerebrovascular diseases and provided senior residents with teaching opportunities.

A Retrospective Observation of Medical Students Matching into Neurology Residencies Following a Change to Clerkship Curriculum (P11-2.004)

<h3>Objective:</h3> To retrospectively observe the proportion of the graduating medical school class pursuing residency training in neurology following a transition of the neurology clerkship to the third year of medical school. <h3>Background:</h3> Neurology is a rapidly growing field, resulting in adaptations in education over the years. In medical schools, there has been a trend to shift neurology clerkship rotations from fourth-year to third-year curriculums which has resulted in improved academic performance and higher enthusiasm for the field of neurology. <h3>Design/Methods:</h3> A retrospective observational study evaluating enrolled clerkship medical students at the Loyola University Chicago Stritch School of Medicine and the match rates into adult and child neurology specialties from 2001–2021. The students were divided into two groups involving those enrolled in clerkship when neurology was during the fourth-year curriculum (2001–2012) and students enrolled in clerkship when neurology was during the third-year curriculum (2013–2021). <h3>Results:</h3> Among the 3,093 students observed during 2001–2021, 59 students (1.9%) matched into adult neurology residencies and 15 students (0.48%) matched into child neurology residencies. There was a higher rate of students matching into both adult and child neurology specialties when neurology clerkship had transitioned to the third-year curriculum (37 students at 2.5% for adult; 11 students at 0.67% for child; <i>p</i> = 0.02) compared to the fourth-year curriculum (22 students at 1.4% for adult; 4 students at 0.28% for child; <i>p</i> = 0.11). <h3>Conclusions:</h3> There was a statistically significant observation of medical students matching into adult neurology residencies after the transition of neurology clerkship to the third-year curriculum. The match into child neurology was not statistically significant and likely due to an overall low events number. This data suggests earlier exposure to neurology can lead to a higher likelihood of students matching into neurology for residency training. <b>Disclosure:</b> Dr. Gill has nothing to disclose. Dr. Garg has nothing to disclose. Dr. Raedy has nothing to disclose. Dr. Pardieck has nothing to disclose.

Educational Research: Multiple Sclerosis (MS) and Neuroimmunology Education in Neurology Residency Training in the United States (P3-3.016)

Educational Research: Multiple Sclerosis (MS) and Neuroimmunology Education in Neurology Residency Training in the United States (P3-3.016)

Improving Residents’ Knowledge and Interest in Outpatient Neurology through an Interactive, Discussion-Based, Patient-Centered Didactic Series (P2-2.006)

<h3>Objective:</h3> Our interactive, discussion-based, patient-centered didactic series aimed to (1) improve residents’ understanding of the roles and responsibilities of outpatient neurologists; (2) share patients’ perspectives of living with chronic neurological disease; and (3) increase residents’ understanding of effective shared decision making (SDM). <h3>Background:</h3> Neurology residency training is inpatient focused, underemphasizing outpatient disorders. We implemented a novel didactic series of facilitated discussions between a patient and their outpatient neurologist to expose residents to outpatient careers, topics, and management. <h3>Design/Methods:</h3> Residents in a large academic neurology program participated. Bimonthly sessions were held in-person in 2016 (n=6) and virtually on Zoom in 2020 (n=6). Each 60-minute session focused on one disorder. The format was conversational and moderated by a course director. Discussion points were pre-planned, focusing on patients’ experiences living with chronic neurological disease and SDM. Residents, faculty, and patients were surveyed for program evaluation. <h3>Results:</h3> A majority of residents, all faculty, and all patients agreed the series met its objectives. Residents and faculty found the format as effective as traditional lectures, without added burden for faculty preparation. The unique format also allowed for instruction on topics rarely covered in lectures. Residents indicated diseases covered were underrepresented in their direct patient care experiences in training. 48% of residents reported increased interest in outpatient careers. Qualitative comments identified hearing patients’ perspectives as the most valuable component. Patients felt sharing their experiences would help physicians better understand their illness and care for future patients; all would participate again. <h3>Conclusions:</h3> Our series educated residents effectively about underrepresented topics in outpatient neurology. Hearing patients’ perspectives was instrumental in achieving our learning objectives. Key factors for successful implementation included a faculty moderator, pre-planned questions, and summary slides emphasizing key learning points. Future work can evaluate if increased knowledge and interest translates into sustained behavior change in residents and more residents choosing outpatient careers. <b>Disclosure:</b> Dr. Gheihman has nothing to disclose. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. Dr. Cho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of an immediate family member of Dr. Cho has received research support from NIH. Dr. Cho has received publishing royalties from a publication relating to health care. Dr. Milligan has nothing to disclose. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Doughty has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Adler¦Cohen¦Harvey¦Wakeman¦Guekguezian, LLP. Dr. Doughty has received research support from NINDS/NeuroNEXT. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving as a Grant Advisory Board Member with Dysimmune Diseases Foundation. Dr. Doughty has received personal compensation in the range of $500-$4,999 for serving as a CME Lecturer with Oakstone Publishing.

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)

Free Neurology Community Health Clinic: Insights on Patient Population and Resident Experience (S29.005)

<h3>Objective:</h3> To describe the patient population at FNCHC and its impact on neurology resident education and training. <h3>Background:</h3> Uninsured patients with neurologic diseases suffer worse healthcare outcomes than insured patients. Limited access to care is exacerbated by lack of subspeciality neurology care in free community health clinics. Our neurology residency partnered with the local free clinic, establishing Free Neurology Community Health Clinic (FNCHC) to provide neurology evaluations for uninsured patients. <h3>Design/Methods:</h3> FCHC operates one half day per month with 4–6 patient slots, staffed by 1–2 neurology residents and one attending. Diagnostics and medications prescribed are free for patients. Patient variables are collected from clinic EHR. Six neurology residents who volunteered 2+ clinics were given feedback surveys pertaining to educational value, clinical decision making, personal fulfillment, and career practice graded on a 5-point Likert Scale from “strongly disagree” to “strongly agree”. <h3>Results:</h3> Over the fifteen months since inception, 73 new or return clinic appointments were scheduled, 66 were seen (91.6% show rate). Most common spoken language was Spanish (66.7%), then Polish (18%). The most frequent chief complaint was headache (50%), then parasthesias (9.1%), double vision (6.1%) and stroke (4.5%). Subspecialities fields represented included vascular, headache, neuromuscular, epilepsy, movement disorders, sleep, and cognitive neurology. Most therapeutics initiated were targeted at headache management, followed by antiseizure medications, and myasthenic medications. 6/6 residents completed feedback surveys. All residents strongly agreed that their FNCHC experiences was fulfilling and educational for CDM in low resource settings. Furthermore, all residents agreed their experiences encouraged continued commitment to underprivileged populations during residency and future careers. <h3>Conclusions:</h3> Diversity of patient population and neurologic disorders are well represented in FNCHC. Resident feedback demonstrated overwhelmingly positive impact on fulfillment and clinical education, as well as future career involvement in underserved populations. Future directions for FNCHC include expanding diagnostics, therapeutics, and formal integration into residency education. <b>Disclosure:</b> Dr. Jia has nothing to disclose. Dr. Deliz Gonzalez has nothing to disclose. Dr. Attarian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clearview. Dr. Attarian has received publishing royalties from a publication relating to health care. Dr. Curran has nothing to disclose. Dr. Cherayil has nothing to disclose. Dr. Carroll has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly &amp; Company. Dr. Carroll has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly &amp; Company. Dr. Carroll has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie.

Correlation between USMLE Step scores, personal attributes and RITE exam performance among neurology residents at an academic center. (S13.003)

<h3>Objective:</h3> We aimed to investigate the correlation between USMLE scores and personal attributes with Residency in-training exam (RITE) performance among residents at our academic neurology residency training program. <h3>Background:</h3> Studies assessing medical and surgical residents’ performance during training and its relation to USMLE Step scores have found differing correlations among different medical specialties. This correlation has never been studied among neurology residents. <h3>Design/Methods:</h3> Data on 51 neurology residents at Medical University of South Carolina between 2005 and 2020 was analyzed. Resident personal attributes included were gender, age at residency enrollment, medical school location, awards/honor degrees during medical school, presence of advanced degree/completion of another residency program, number of peer reviewed publications, and years from medical school graduation. Correlation analysis was conducted between Step 1 and Step 2 CK scores with RITE Exam scores, respectively. Repeated measures ANOVA was utilized to examine differences in mean RITE scores of residents with/without above personal attributes. <h3>Results:</h3> Mean age at residency enrollment was 30.92 years(25 – 48). 68.6% residents were males and 50.9% were IMGs. Statistically significant strong positive correlations were found between Step 1 and RITE scores (PGY-2 r = 0.6, PGY-4 r = 0.69, p&lt;0.01). Weaker but statistically significant positive correlations were found between Step 2 CK and RITE scores (PGY-2 r= 0.56, PGY-4 r = 0.52, p&lt;0.01). Mean PGY-2 RITE score for IMGs was higher than US graduates (p&lt;0.05). Residents with ≥6 publications, and those with honors/award during medical school had higher RITE scores compared to those without. There was no significant difference in RITE scores of males and females, those with and without advanced degrees and those with and without gap years between medical school and residency. <h3>Conclusions:</h3> USMLE Step 1 and Step 2 CK scores, medical school location, awards/honor degrees during medical school, and ≥6 publications correlate with higher RITE scores among neurology residents. <b>Disclosure:</b> Mrs. Al Issa has nothing to disclose. Dr. Kohli has nothing to disclose. Dr. Banerjee has nothing to disclose.

Abstract Number ‐ 275: Novel 3D Virtual Reality Simulator Use in Stroke Code Simulation

Introduction Stroke code simulations have gained popularity as an educational model for neurology resident and fellow training in the diagnosis and management of hyperacute stroke. Previous simulations have used live patients or standardized patients as surrogates for learners to interact with in the simulated codes. While these provide high fidelity, there can be significant costs associated with the training and deployment of standardized patients, as well as potential for inconsistencies from encounter to encounter. A novel 3D virtual reality based simulator (Dancing Eyes LLC, Skaneateles, NY) aims to reduce the costs of running stroke code simulations while maintaining high fidelity and encounter consistency. It can also have the additional benefit of being utilized at the convenience of the trainee’s schedule, reducing logistical hurdles for scheduling and organizing simulations. Methods Neurology residents (who have previously experienced live simulation stroke codes with standardized patients) will undergo simulation encounters using the 3D virtual reality‐based simulator. We will enroll 20–25 residents at post graduate year levels (PGY) 2–4. Following the simulated encounter, a debriefing session is conducted for learners to review the case, share their experience, and provide additional feedback. A post‐simulation survey will be comnducted that solicits trainee experience with the VR simulator in defined domains such as comfort, ease of use, fidelity, and overall educational experience and value. Results The VR simulator has been designed to be worn over the face and can be adjusted for trainee comfort. The simulator integrates imaging, labs, the ability to use a virtual NIH‐stroke‐scale booklet, and other neurologic examination tools by virtually grabbing them or selecting them from a panel user interface. The simulated VR patient registers the trainee’s voice and shows the speech that was detected. It then attempts to answer the question or perform the issued command based on variables that have been pre‐programmed for the specific encounter/simulation. Trainees are able to perform a full NIH stroke scale assessment on the simulated patient. We aim to report the results of our study in time for the SVIN Annual Meeting/update deadline prior to the meeting. Conclusions Figure 1 shows a trainee using the VR simulator in a simulated stroke code encounter, as well as a rendering of the simulated patient. The VR simulator aims to serve as a high‐fidelity, low‐cost, convenient and consistent training modality for stroke code simulation and enhance trainees ability and comfort with diagnosis and management of hyperacute stroke.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

Education Research: The Effect of an X + Y Schedule Model on Neurology Residency Training

Background and Objectives There is a need for earlier outpatient exposure in neurology training. In 2017, 56% of residents on the American Academy of Neurology (AAN) Graduating Resident Survey reported that they felt that the fellowship process started too early, and 46% felt that they did not have adequate outpatient exposure before making a fellowship decision. In addition, the traditional front-loaded resident schedule may contribute to high rates of burnout due to greater work hours and heavier inpatient load, as was suggested in the findings of a 2016 AAN survey comparing burnout among residents and fellows. Methods We created an X + Y model within the UCLA Neurology Residency Program in the 2020–2021 academic year with the goal of increasing outpatient exposure earlier in training. We used a preintervention/postintervention design assessing measures of resident satisfaction, outpatient clinic exposure, number of inpatient handoffs, resident work hours, and scores on the resident in-training examination (RITE). We hypothesized that outpatient clinic exposure would increase, handoffs would diminish, work hours would be reduced, measures of resident satisfaction with inpatient care, outpatient care, and well-being would improve, and that RITE scores would improve. Work hours, handoffs, and number of clinic days were compared across each year via analysis of the resident schedule. Resident perceptions were obtained via an online survey at the end of their PGY-2 year. RITE scores were compared across a variety of subspecialties. Results In the postintervention year, handoffs were reduced by 6.13 (95% CI 4.73–7.54) per week. Average clinic half-days increased by 4.51 (95% CI 7.76–0.53). Resident responses regarding their outpatient experience improved from 42% to 93% satisfied and from 60% to 94% satisfied for their inpatient experience. There was no difference in average work hours per week before and after the intervention. Regarding resident well-being, responses improved from 42% satisfied in the traditional model to 96% in the X + Y model. Among the RITE subjects covering primarily outpatient subspecialties, scores improved in each category. Discussion After implementation of an X + Y model, we observed an improvement in outpatient exposure, learning and career satisfaction, and resident education on subspecialty topics.

Stroke Neurointervention: A Novel Educational Pathway to Improve Neurology Resident Training in Neurointervention and Regional Access to Thrombectomy

Large vessel occlusions account for ≈30% of acute ischemic stroke. Mechanical thrombectomy is a highly beneficial treatment for large vessel occlusion strokes in appropriately selected patients. However, there is significant geographic variability in regional access to this important therapy, and broadening coverage by using non‐neuroscience specialties places patients at risk for suboptimal cerebrovascular care. An alternative solution is to train more neurologists to perform this procedure and consolidate expertise in vascular neurology. However, neurology residents have minimal exposure to the angiography suite and are disadvantaged in this regard when it comes to preparedness for fellowship training. We detail a novel training pathway incorporating neuroendovascular training into the adult neurology residency and an option to continue hybridized stroke–neurointervention training in a vascular neurology fellowship. Here, we present the development of the training curriculum, early trainee experience, and challenges to widespread implementation. The stroke–neurointervention training pathway was created with the intention of improving access to this important therapy by enfolding early training into neurology residency.

P.052 Assessing the competence of neurology residents in performing an interphysician telephone consultation

Background: Neurology Residency training in Canada is transitioned to competence based medical education (CBME) in July 2020 and the Royal College Neurology Specialty Committee has identified “providing consultation for and managing patients at outlying centres,” to be an entrustable professional activity (EPA). At Western University, neurology telephone consultations from outlying centres are attended by both the resident and the staff Neurologist. This scenario provides the ideal situation for direct observation and immediate formative feedback. The resident’s performance was assessed using an entrustment scale along with a short narrative portion. Methods: This mixed methods study aims to determine the reliability and validity of the entrustment scale with narrative feedback in assessing the performance on the telephone consultation by senior neurology residents. Informed consent was obtained from residents (9) and staff (7) involved. Scores on the entrustment scale and narrative comments were analyzed. Results: Information on 37 encounters (involving 9 residents) was collected. Assessment results demonstrated higher entrustment scores in PGY4 and PGY5 levels. Overall, ratings were consistent across the 7 consultant assessors. Conclusions: The use of an entrustment scale appears to be reliable and valid in assessing competence in the telephone consultation and provide coaching feedback to help learners improve their performance.

P.053 Insights from the first eighteen months of CBME implementation across Canadian neurology residency training programs

Background: Canadian neurology residency programs recently transitioned to Competence Based Medical Education (CBME), designed to provide residents with stage-appropriate learning to develop and demonstrate competence. The successful implementation of CBME requires iterative evaluation as the adoption process may differ from the intended design due to systemic or program-specific factors. This study aims to (1) examine the variability in CBME implementation across Canadian neurology residency programs; (2) determine the barriers toward uptake of CBME; and (3) identify the benefits and pitfalls of CBME in neurology residency programs. Methods: A separate national survey was developed for residents and staff neurologists who participated in CBME for at least six months. Surveys were distributed through email, and responses were anonymized. Quantitative data were analyzed by response frequency and mean, where applicable. Free-form responses were analyzed qualitatively. Results: Staff neurologists felt prepared for CBME, but were divided on its fairness and impact on education quality. Residents experienced frequent but not necessarily timely or high-quality feedback. Barriers to implementation included increased paperwork, dissatisfaction with online platforms used to facilitate CBME, and bidirectional burden of initiating evaluations. Conclusions: Staff and residents have expressed unique perspectives on the first iteration of CBME. There remain opportunities for improvement in subsequent iterations.