Pub Date : 2023-06-02DOI: 10.1212/ne9.0000000000200077
Joseph R. Geraghty
{"title":"A Call for Standardized Interview Offer Dates in the Neurology Residency Application Process","authors":"Joseph R. Geraghty","doi":"10.1212/ne9.0000000000200077","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200077","url":null,"abstract":"","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126714725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1212/ne9.0000000000200075
R. Strowd
{"title":"The First Year ofNeurology: Education","authors":"R. Strowd","doi":"10.1212/ne9.0000000000200075","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200075","url":null,"abstract":"","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"260 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124787748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-26DOI: 10.1212/ne9.0000000000200071
Catherine Albin, Melissa B. Pergakis, E. Sigman, N. Bhatt, Spencer K. Hutto, Sitara Koneru, Ehizele M Osehobo, J. A. Vizcarra, Nicholas A. Morris
Simulation bootcamps are used to onboard neurology trainees. It is not known whether these bootcamps result in competency for acute ischemic stroke (AIS).For this prospective, single-center pre-post educational intervention study, the Angoff standard setting method was used to determine a Minimum Passing Score (MPS) and Mastery Score for 2 AIS simulations. Junior neurology residents completed precourse knowledge and confidence assessments and had traditional didactic teaching. A week later, each resident completed the first scored AIS simulation. Each resident then practiced stroke care in an unscored simulation. Two to 8 weeks later, each resident was evaluated in an unannounced AIS simulation (the post-test). Postgraduate year (PGY)-3 adult neurology senior residents also completed a knowledge and confidence assessment and were scored on just the AIS post-test case. Using independent and pairedttests, respectively, we compared the junior residents' retention test performance to their baseline assessment and to senior residents' performance.Thirteen junior residents (9 PGY-2 adult neurology residents and 4 PGY-3 child neurology residents) participated in the course. Only 3 junior residents (23%) initially achieved the MPS in the first AIS simulation. After the simulation course, 9 junior residents (69%) achieved the MPS threshold. Although none achieved mastery, junior residents' mean performance score in the simulation improved (mean score preintervention [SD] = 10.3 [2.8] vs mean score postintervention [SD] = 15.7 [2.6],p< 0.001) and their confidence increased (mean score preintervention [SD] = 3.3 [1.9] vs mean score postintervention [SD] = 4.9 [1.2],p< 0.001,d= 1.7). Eight PGY-3 adult neurology residents were scored on the AIS post-test. Five reached MPS (63%), and 1 demonstrated mastery. The simulation scores of the postcourse juniors and seniors were similar (junior resident mean score [SD] = 15.7 [2.6] vs senior resident mean score [SD] = 16.0 [2.5],p= 0.793).A brief AIS simulation course may improve junior residents' performance and confidence to a level comparable with senior residents, although not to mastery.
{"title":"Education Research: Junior Neurology Residents Achieve Competency but Not Mastery After a Brief Acute Ischemic Stroke Simulation Course","authors":"Catherine Albin, Melissa B. Pergakis, E. Sigman, N. Bhatt, Spencer K. Hutto, Sitara Koneru, Ehizele M Osehobo, J. A. Vizcarra, Nicholas A. Morris","doi":"10.1212/ne9.0000000000200071","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200071","url":null,"abstract":"Simulation bootcamps are used to onboard neurology trainees. It is not known whether these bootcamps result in competency for acute ischemic stroke (AIS).For this prospective, single-center pre-post educational intervention study, the Angoff standard setting method was used to determine a Minimum Passing Score (MPS) and Mastery Score for 2 AIS simulations. Junior neurology residents completed precourse knowledge and confidence assessments and had traditional didactic teaching. A week later, each resident completed the first scored AIS simulation. Each resident then practiced stroke care in an unscored simulation. Two to 8 weeks later, each resident was evaluated in an unannounced AIS simulation (the post-test). Postgraduate year (PGY)-3 adult neurology senior residents also completed a knowledge and confidence assessment and were scored on just the AIS post-test case. Using independent and pairedttests, respectively, we compared the junior residents' retention test performance to their baseline assessment and to senior residents' performance.Thirteen junior residents (9 PGY-2 adult neurology residents and 4 PGY-3 child neurology residents) participated in the course. Only 3 junior residents (23%) initially achieved the MPS in the first AIS simulation. After the simulation course, 9 junior residents (69%) achieved the MPS threshold. Although none achieved mastery, junior residents' mean performance score in the simulation improved (mean score preintervention [SD] = 10.3 [2.8] vs mean score postintervention [SD] = 15.7 [2.6],p< 0.001) and their confidence increased (mean score preintervention [SD] = 3.3 [1.9] vs mean score postintervention [SD] = 4.9 [1.2],p< 0.001,d= 1.7). Eight PGY-3 adult neurology residents were scored on the AIS post-test. Five reached MPS (63%), and 1 demonstrated mastery. The simulation scores of the postcourse juniors and seniors were similar (junior resident mean score [SD] = 15.7 [2.6] vs senior resident mean score [SD] = 16.0 [2.5],p= 0.793).A brief AIS simulation course may improve junior residents' performance and confidence to a level comparable with senior residents, although not to mastery.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126608052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-15DOI: 10.1212/ne9.0000000000200070
M. Koretzky, Katemanee Burapachaisri, Bernadette Clark, Michael R. Halstead, C. Gamaldo, R. Salas, Doris G. Leung, Carlos G Romo
Medical students on their clinical neurology clerkship often encounter ethically challenging situations, yet formal neuroethics training is limited. This study sought to evaluate a case-based small-group workshop that was implemented to introduce students to important neuroethics concepts and resources.(1) To define decision-making capacity and describe how it is assessed in neurologic illness; (2) to define the legal category of brain death and its evolution over time; (3) to describe the legal process for surrogate decision making in the state of Maryland; (4) to identify barriers to goals-of-care conversations; and (5) to reflect on how personal beliefs of patients and physicians influence delivery of care and medical decision making.A 1.5-hour interactive curriculum for medical students on the neurology clerkship covering ethical considerations in brain death, surrogate decision making, and navigating conversations surrounding these topics (with reference to lesbian, gay, bisexual, transgender, queer/questioning, and others' health and health disparities) was designed and implemented over 2 years. Curriculum outcomes were measured by preworkshop and postworkshop self-assessment surveys. Learner reactions were measured by self-reported interest in ethics and perceived utility of the curriculum. Content knowledge was measured through multiple-choice questions on brain death and capacity assessment, which were scored for correctness by the study team, and self-reported confidence in ethical reasoning. Changes in these metrics were analyzed for paired precourse and postcourse responses to determine the effectiveness of the session.The study recruited 234 of 356 rotating students (65.7% response rate). Presurvey data revealed that 36% had encountered a challenging clinical scenario before the intervention. Preintervention and postintervention paired data were available for 184 (79%) respondents. Of these, 66% reported increased confidence in their knowledge of ethics, and 42% reported increased interest in ethics. Presession performance on content questions did not differ significantly based on prior clinical ethics experience. Performance on neuroethics content questions improved significantly after the session as demonstrated by the increase in the percentage of students providing correct answers to content questions between the presurvey and postsurvey (17% increase for capacity assessment, 19% increase for brain death, and 22% increase for surrogate decision making,p< 0.0001).An interactive neuroethics workshop using a case-based discussion format integrates ethics and health disparity education into the clinical neurology curriculum and enhanced knowledge and confidence in medical ethics. This curriculum increases student interest in ethics, confidence in their ability to perform ethical reasoning tasks, and content knowledge of brain death and surrogate decision making.
{"title":"Curriculum Innovation: Teaching Neuroethics Through a Case-Based Undergraduate Medical Education Workshop","authors":"M. Koretzky, Katemanee Burapachaisri, Bernadette Clark, Michael R. Halstead, C. Gamaldo, R. Salas, Doris G. Leung, Carlos G Romo","doi":"10.1212/ne9.0000000000200070","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200070","url":null,"abstract":"Medical students on their clinical neurology clerkship often encounter ethically challenging situations, yet formal neuroethics training is limited. This study sought to evaluate a case-based small-group workshop that was implemented to introduce students to important neuroethics concepts and resources.(1) To define decision-making capacity and describe how it is assessed in neurologic illness; (2) to define the legal category of brain death and its evolution over time; (3) to describe the legal process for surrogate decision making in the state of Maryland; (4) to identify barriers to goals-of-care conversations; and (5) to reflect on how personal beliefs of patients and physicians influence delivery of care and medical decision making.A 1.5-hour interactive curriculum for medical students on the neurology clerkship covering ethical considerations in brain death, surrogate decision making, and navigating conversations surrounding these topics (with reference to lesbian, gay, bisexual, transgender, queer/questioning, and others' health and health disparities) was designed and implemented over 2 years. Curriculum outcomes were measured by preworkshop and postworkshop self-assessment surveys. Learner reactions were measured by self-reported interest in ethics and perceived utility of the curriculum. Content knowledge was measured through multiple-choice questions on brain death and capacity assessment, which were scored for correctness by the study team, and self-reported confidence in ethical reasoning. Changes in these metrics were analyzed for paired precourse and postcourse responses to determine the effectiveness of the session.The study recruited 234 of 356 rotating students (65.7% response rate). Presurvey data revealed that 36% had encountered a challenging clinical scenario before the intervention. Preintervention and postintervention paired data were available for 184 (79%) respondents. Of these, 66% reported increased confidence in their knowledge of ethics, and 42% reported increased interest in ethics. Presession performance on content questions did not differ significantly based on prior clinical ethics experience. Performance on neuroethics content questions improved significantly after the session as demonstrated by the increase in the percentage of students providing correct answers to content questions between the presurvey and postsurvey (17% increase for capacity assessment, 19% increase for brain death, and 22% increase for surrogate decision making,p< 0.0001).An interactive neuroethics workshop using a case-based discussion format integrates ethics and health disparity education into the clinical neurology curriculum and enhanced knowledge and confidence in medical ethics. This curriculum increases student interest in ethics, confidence in their ability to perform ethical reasoning tasks, and content knowledge of brain death and surrogate decision making.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131890074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-15DOI: 10.1212/ne9.0000000000200073
Fábio A. Nascimento, S. Beniczky
{"title":"Teaching the 6 Criteria of the International Federation of Clinical Neurophysiology for Defining Interictal Epileptiform Discharges on EEG Using a Visual Graphic","authors":"Fábio A. Nascimento, S. Beniczky","doi":"10.1212/ne9.0000000000200073","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200073","url":null,"abstract":"","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130092279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.1212/ne9.0000000000200072
Yuehui Hong, Ning Su, Hanhui Fu, Yuze Cao, M. Yao, Li-xin Zhou, J. Ni, Y. Zhu
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.
传统的教师主导的培训是以教师为中心的，需要在教师队伍和资源上进行大量投资。近同伴学习(NPL)是一种由老年住院医师指导比自己早1、2岁的初级住院医师进行培训的教学策略。NPL促进了学生的参与，并可能提高参与者的教学能力。我们实施了一项针对中国居民的脑血管疾病课程的NPL教学设计。导师和学生将能够(1)展示脑血管解剖学知识，(2)了解脑血管生理学，(3)使用神经影像学和生理学来评估脑血管病理学。2019年12月至2022年3月，NPL在中国神经内科住院医师培训项目中实施。除了传统的教师主导讲座外，还举办了一系列国家物理实验室讲座。NPL干预由高级住院医师导师在指导教师的指导下设计和主持脑血管神经学基础主题的讲座(如脑血管解剖与成像、缺血性和出血性中风的临床和影像学特征)。Tutees是同一项目的初级住院医师。采用课前/课后考试和在线问卷反馈的方法，评估NPL干预对知识获取和教学能力的影响。在3个学年中，共有57名居民参与，分别为18人、18人、21人。所有人都参加了NPL的干预，有些人参加了不止一次。参加者可在不同年级担任导师或辅导班。15位导师共讲授18堂课。其余的都是学生。课程后的考试分数与课程前的分数相比有显著提高(64.22±12.11 vs 59.80±15.88,p= 0.003)，其中第一年住院医师和首次参与者的进步最为显著。参与者(导师和学生)的课后反馈共162份，导师的课后反馈共15份。受访者对NPL的评价很高，报告了知识的增长和教学机会。NPL使住院医师掌握了脑血管疾病的基础知识，并为老年住院医师提供了教学机会。
{"title":"Curriculum Innovations: Near-Peer Learning in Neurology Residency Training on Cerebrovascular Disease in a Teaching Hospital in China","authors":"Yuehui Hong, Ning Su, Hanhui Fu, Yuze Cao, M. Yao, Li-xin Zhou, J. Ni, Y. Zhu","doi":"10.1212/ne9.0000000000200072","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200072","url":null,"abstract":"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.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130837803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.1212/ne9.0000000000200074
E. Butler, Jack Slatton, Sheffield Sharp, Lauren Schattinger, M. Turchan, Phillip D. Charles, K. Harper
The aging US population has led to the increased prevalence of neurodegenerative diseases and the critical need for specialists with advanced training in the management of these conditions. Focus on Common Movement Disorders (FOCMD), a 2-day educational course hosted by Vanderbilt University, was started 16 years ago to provide neurology residents with exposure to the diagnosis and treatment of movement disorders.The aim of the course was to provide early-career neurology residents with relevant exposure to the field of movement disorders, through which we hope to increase medical knowledge of movement disorders and common Food and Drug Administration (FDA)-approved therapies and inspire residents to pursue fellowship training in the field.FOCMD consists of lectures and small-group workshops that provide an overview of common movement disorders and approved therapies. All North American neurology residency program directors are invited to nominate a first-year or second-year resident. Attendees are administered standardized multiple-choice precourse and postcourse examinations to assess foundational knowledge of common movement disorders and FDA-approved therapies and to measure acquisition of the course material. Past participants are regularly surveyed to gauge their impression of the course's effect on fellowship selection and their utilization of therapies common in the treatment of movement disorders.Since 2008, FOCMD has trained 854 neurology residents from 113 programs. Between 2010 and 2020, 507 residents completed the precourse and postcourse examinations. There was an increase of 22.4 (95% CI 20.67–24.49;p< 0.001) percentage points between the precourse and postcourse examinations or an additional 3.8 questions were answered correctly. Follow-up surveys were sent to 414 past participants, and 116 were completed. Survey responses revealed that 84% of past attendees completed a fellowship, 44% of which were in the field of movement disorders. In addition, 82% of past participants reported that the course affected subspecialty selection and 63% reported treating patients with movement disorders in their current practice.Experience with FOCMD has shown it to be successful in introducing neurology residents to the subspecialty early in their career and increasing medical knowledge on movement disorders. An educational program of this format may also positively influence fellowship selection.
美国人口老龄化导致神经退行性疾病的患病率增加，迫切需要在这些疾病的管理方面受过高级培训的专家。关注常见运动障碍(FOCMD)是由范德比尔特大学(Vanderbilt University)主办的为期两天的教育课程，始于16年前，旨在为神经内科住院医师提供运动障碍的诊断和治疗。该课程的目的是为早期的神经内科住院医师提供运动障碍领域的相关接触，通过该课程，我们希望增加对运动障碍和美国食品和药物管理局(FDA)批准的常用疗法的医学知识，并激励住院医师在该领域进行奖学金培训。FOCMD由讲座和小组研讨会组成，提供常见运动障碍和批准治疗的概述。所有北美神经内科住院医师项目主任被邀请提名一年级或二年级住院医师。参与者在课前和课后进行标准化的多项选择考试，以评估常见运动障碍和fda批准的治疗方法的基础知识，并衡量课程材料的获取情况。过去的参与者定期接受调查，以评估他们对课程对奖学金选择的影响以及他们对运动障碍治疗中常见疗法的使用情况的印象。自2008年以来，FOCMD已经从113个项目中培训了854名神经内科住院医师。2010年至2020年间，507名住院医生完成了课程前和课程后的考试。在课程前和课程后的考试中，增加了22.4个百分点(95% CI 20.67-24.49;p< 0.001)或额外的3.8个问题被正确回答。对414名过去的参与者进行了后续调查，116人完成了调查。调查结果显示，过去84%的参与者完成了奖学金，其中44%是在运动障碍领域。此外，82%的过去参与者报告说，该课程影响了亚专科的选择，63%的人报告说，在他们目前的实践中治疗了运动障碍患者。FOCMD的经验表明，它成功地将神经内科住院医生引入了他们职业生涯早期的亚专科，并增加了他们对运动障碍的医学知识。这种形式的教育计划也可能对奖学金的选择产生积极的影响。
{"title":"Curriculum Innovations: Inspiring Neurology Residents to Pursue Fellowship Training in Movement Disorders","authors":"E. Butler, Jack Slatton, Sheffield Sharp, Lauren Schattinger, M. Turchan, Phillip D. Charles, K. Harper","doi":"10.1212/ne9.0000000000200074","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200074","url":null,"abstract":"The aging US population has led to the increased prevalence of neurodegenerative diseases and the critical need for specialists with advanced training in the management of these conditions. Focus on Common Movement Disorders (FOCMD), a 2-day educational course hosted by Vanderbilt University, was started 16 years ago to provide neurology residents with exposure to the diagnosis and treatment of movement disorders.The aim of the course was to provide early-career neurology residents with relevant exposure to the field of movement disorders, through which we hope to increase medical knowledge of movement disorders and common Food and Drug Administration (FDA)-approved therapies and inspire residents to pursue fellowship training in the field.FOCMD consists of lectures and small-group workshops that provide an overview of common movement disorders and approved therapies. All North American neurology residency program directors are invited to nominate a first-year or second-year resident. Attendees are administered standardized multiple-choice precourse and postcourse examinations to assess foundational knowledge of common movement disorders and FDA-approved therapies and to measure acquisition of the course material. Past participants are regularly surveyed to gauge their impression of the course's effect on fellowship selection and their utilization of therapies common in the treatment of movement disorders.Since 2008, FOCMD has trained 854 neurology residents from 113 programs. Between 2010 and 2020, 507 residents completed the precourse and postcourse examinations. There was an increase of 22.4 (95% CI 20.67–24.49;p< 0.001) percentage points between the precourse and postcourse examinations or an additional 3.8 questions were answered correctly. Follow-up surveys were sent to 414 past participants, and 116 were completed. Survey responses revealed that 84% of past attendees completed a fellowship, 44% of which were in the field of movement disorders. In addition, 82% of past participants reported that the course affected subspecialty selection and 63% reported treating patients with movement disorders in their current practice.Experience with FOCMD has shown it to be successful in introducing neurology residents to the subspecialty early in their career and increasing medical knowledge on movement disorders. An educational program of this format may also positively influence fellowship selection.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134488556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-23DOI: 10.1212/ne9.0000000000200055
Nicholas Ludka, A. Brummett, J. Wasserman
Varied meanings of death within medicine, bioethics, and society at large often produce disagreement and frustration between physicians and surrogate decision makers. We investigated whether teaching medical students about the philosophical aspects of death would change their attitude toward surrogate decision makers who assert nonstandard views of death.An 80-minute lecture covering philosophical debates surrounding medico-legal standards of death was given to second-year medical students at Oakland University William Beaumont School of Medicine during a neuroscience course. Participants completed a questionnaire containing Likert scale and open-ended questions before and after the intervention assessing their acceptance of, frustration toward, and likelihood of accommodating a request for surrogate decision makers who posited either a whole-brain, high-brain, or circulatory view of death. Change in knowledge was analyzed using the McNemar test, whereas attitudinal scores were compared with pairedttests. Open-ended responses were narratively analyzed to identify themes that elaborate quantitative findings.A total of 43 paired responses were analyzed from second-year medical students. Following the intervention, students expressed less frustration (χ¯diff= −0.64, 95% CI −0.15 to −1.15), greater likelihood of accommodating ventilator removal (χ¯diff= 0.60, 95% CI 0.41–0.85), and greater acceptance (χ¯diff= 0.63, 95% CI 0.28–0.91) of surrogates who endorsed a whole-brain view of death. Although students rated the high-brain view as more acceptable after the lecture (χ¯diff= 0.63, 95% CI 0.28–0.91), they were not more likely to remove a ventilator from a patient who had experienced high-brain death (χ¯diff= 0.19, 95% CI −0.30 to 0.67). Students were less likely to continue artificial ventilation for a brain-dead patient (χ¯diff= −0.61, 95% CI −0.91 to −0.30) despite no change in frustration toward the surrogate (χ¯diff= −0.26, 95% CI 0.20 to −0.70).Changes in attitudes across the 3 views of death suggest that increased awareness of the philosophical debate facilitates reflection of students' understanding and opinion of death. These findings support implementation of educational interventions to prepare students for future work with surrogate decision makers holding diverse sets of views on death.
在医学、生物伦理学和整个社会中，死亡的不同含义经常导致医生和替代决策者之间的分歧和沮丧。我们调查了教授医学生关于死亡的哲学观点是否会改变他们对主张非标准死亡观点的代理决策者的态度。在奥克兰大学威廉博蒙特医学院的一门神经科学课程上，一场80分钟的讲座涵盖了围绕死亡的医学法律标准的哲学辩论。参与者在干预前后完成了一份问卷，其中包含李克特量表和开放式问题，评估他们对替代决策者的接受程度、挫败感和适应的可能性，这些替代决策者假设了全脑、高脑或循环死亡观。知识的变化是用McNemar测试来分析的，而态度得分是用配对测试来比较的。对开放式回答进行叙述性分析，以确定阐述定量发现的主题。对医二学生的43份配对问卷进行分析。干预后，学生表现出较少的挫败感(χ¯diff= - 0.64, 95% CI - 0.15至- 1.15)，更有可能接受取下呼吸机(χ¯diff= 0.60, 95% CI 0.41-0.85)，并且更容易接受支持全脑死亡观的替代物(χ¯diff= 0.63, 95% CI 0.28-0.91)。尽管学生在讲座结束后认为高脑死亡率观点更容易被接受(χ¯diff= 0.63, 95% CI 0.28-0.91)，但他们不太可能从经历高脑死亡率的患者身上取下呼吸机(χ¯diff= 0.19, 95% CI - 0.30至0.67)。学生对脑死亡患者继续人工通气的可能性较小(χ¯diff= - 0.61, 95% CI - 0.91至- 0.30)，尽管对替代物的沮丧感没有变化(χ¯diff= - 0.26, 95% CI 0.20至- 0.70)。三种死亡观点态度的变化表明，提高对哲学辩论的认识有助于反映学生对死亡的理解和看法。这些发现支持实施教育干预措施，使学生为将来与对死亡持有不同看法的替代决策者一起工作做好准备。
{"title":"Education Research: Changes in Medical Students' Knowledge and Attitudes Toward Clinical Death After Teaching the Philosophy of Death","authors":"Nicholas Ludka, A. Brummett, J. Wasserman","doi":"10.1212/ne9.0000000000200055","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200055","url":null,"abstract":"Varied meanings of death within medicine, bioethics, and society at large often produce disagreement and frustration between physicians and surrogate decision makers. We investigated whether teaching medical students about the philosophical aspects of death would change their attitude toward surrogate decision makers who assert nonstandard views of death.An 80-minute lecture covering philosophical debates surrounding medico-legal standards of death was given to second-year medical students at Oakland University William Beaumont School of Medicine during a neuroscience course. Participants completed a questionnaire containing Likert scale and open-ended questions before and after the intervention assessing their acceptance of, frustration toward, and likelihood of accommodating a request for surrogate decision makers who posited either a whole-brain, high-brain, or circulatory view of death. Change in knowledge was analyzed using the McNemar test, whereas attitudinal scores were compared with pairedttests. Open-ended responses were narratively analyzed to identify themes that elaborate quantitative findings.A total of 43 paired responses were analyzed from second-year medical students. Following the intervention, students expressed less frustration (χ¯diff= −0.64, 95% CI −0.15 to −1.15), greater likelihood of accommodating ventilator removal (χ¯diff= 0.60, 95% CI 0.41–0.85), and greater acceptance (χ¯diff= 0.63, 95% CI 0.28–0.91) of surrogates who endorsed a whole-brain view of death. Although students rated the high-brain view as more acceptable after the lecture (χ¯diff= 0.63, 95% CI 0.28–0.91), they were not more likely to remove a ventilator from a patient who had experienced high-brain death (χ¯diff= 0.19, 95% CI −0.30 to 0.67). Students were less likely to continue artificial ventilation for a brain-dead patient (χ¯diff= −0.61, 95% CI −0.91 to −0.30) despite no change in frustration toward the surrogate (χ¯diff= −0.26, 95% CI 0.20 to −0.70).Changes in attitudes across the 3 views of death suggest that increased awareness of the philosophical debate facilitates reflection of students' understanding and opinion of death. These findings support implementation of educational interventions to prepare students for future work with surrogate decision makers holding diverse sets of views on death.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127615612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-23DOI: 10.1212/ne9.0000000000200060
Morgan C. Jordan, Zahari N. Tchopev, J. McClean
To describe the current landscape of gender and racial diversity among adult neurology residency and fellowship program directors (PDs). Diversity in medicine affects the quality of care provided to a diverse patient population. There are efforts in nearly every field of medicine to increase the diversity of the physician workforce. While there has been improvement in some of the known disparities in medicine such as gender disparities, these disparities have persisted in more senior academic positions in medicine.A data set was generated by the Association of American Medical Colleges for the purpose of this study using a variety of sources. The data included deidentified, person-level variables, including self-reported gender, race, or ethnicity, and the type of program for all PDs of Accreditation Council for Graduate Medical Education–accredited residencies and fellowships. This retrospective descriptive survey study sought to (1) describe the current gender and race climate of neurology PDs and (2) identify groups that may be disproportionally underrepresented in these positions compared with those in other specialties and levels of medical training. Descriptive statistics and tests of nonrandom association were performed to address the objectives.We found that 56.7% of residency PDs and 58% of fellowship PDs are male. The male to female ratio of PDs was similar to current neurology residents who are 53.4% male. There were significantly more female medical students (51.5%) compared with all other categories of academic rank other than neurology residency PDs (41.1%). Only 4.3% of residency PDs were Black and only 3.7% were Hispanic. There were no Black fellowship PDs, and 5.1% were Hispanic. There were significantly more non-White medical students and trainees compared with each PD group. The breakdown of gender and ethnic diversity of neurology PDs was similar to that of PDs from all residencies and fellowships.While there are many barriers to achieving diversity in medicine, program leadership in graduate medical education may be one of them. This report describes the current landscape of diversity among PDs of residency and fellowship programs in the United States. This study shows one snapshot in time, which can be used as a baseline during this era of change.
{"title":"Education Research: Diversity in Neurology Graduate Medical Education Leadership","authors":"Morgan C. Jordan, Zahari N. Tchopev, J. McClean","doi":"10.1212/ne9.0000000000200060","DOIUrl":"https://doi.org/10.1212/ne9.0000000000200060","url":null,"abstract":"To describe the current landscape of gender and racial diversity among adult neurology residency and fellowship program directors (PDs). Diversity in medicine affects the quality of care provided to a diverse patient population. There are efforts in nearly every field of medicine to increase the diversity of the physician workforce. While there has been improvement in some of the known disparities in medicine such as gender disparities, these disparities have persisted in more senior academic positions in medicine.A data set was generated by the Association of American Medical Colleges for the purpose of this study using a variety of sources. The data included deidentified, person-level variables, including self-reported gender, race, or ethnicity, and the type of program for all PDs of Accreditation Council for Graduate Medical Education–accredited residencies and fellowships. This retrospective descriptive survey study sought to (1) describe the current gender and race climate of neurology PDs and (2) identify groups that may be disproportionally underrepresented in these positions compared with those in other specialties and levels of medical training. Descriptive statistics and tests of nonrandom association were performed to address the objectives.We found that 56.7% of residency PDs and 58% of fellowship PDs are male. The male to female ratio of PDs was similar to current neurology residents who are 53.4% male. There were significantly more female medical students (51.5%) compared with all other categories of academic rank other than neurology residency PDs (41.1%). Only 4.3% of residency PDs were Black and only 3.7% were Hispanic. There were no Black fellowship PDs, and 5.1% were Hispanic. There were significantly more non-White medical students and trainees compared with each PD group. The breakdown of gender and ethnic diversity of neurology PDs was similar to that of PDs from all residencies and fellowships.While there are many barriers to achieving diversity in medicine, program leadership in graduate medical education may be one of them. This report describes the current landscape of diversity among PDs of residency and fellowship programs in the United States. This study shows one snapshot in time, which can be used as a baseline during this era of change.","PeriodicalId":273801,"journal":{"name":"Neurology: Education","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132891750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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