Neurology. Education最新文献

Background and objectives: Medical students increasingly rely on online resources, many of which are unvetted or behind paywalls, creating variability in quality and access. To address this, Johns Hopkins University School of Medicine (JHUSOM) and Harvard Medical School (HMS) developed NeuroBricks-peer-reviewed, case-based neurology modules designed to strengthen clinical reasoning and decision making. This study evaluated their feasibility, effectiveness, and scalability by examining student satisfaction and perceived educational impact across 2 institutions with different curricular structures.

Methods: We conducted a retrospective feasibility and evaluation study of the NeuroBricks Library, analyzing anonymous survey data from medical students at JHUSOM and HMS collected between January 2023 and June 2025. At JHUSOM, NeuroBricks were required during the neurology clerkship; at HMS, they were offered as optional resources. Surveys assessed satisfaction, perceived improvements in clinical skills, and preferred learning modalities. Five pilot NeuroBricks were initially released, expanding to 13 by November 2024. Likert scale responses were analyzed descriptively, and open-ended comments underwent thematic analysis. We also collected informal feedback on participant perceptions of the NeuroBrick creation process, along with anonymized platform analytics on global reach and usage.

Results: A total of 343 medical students participated. At JHUSOM, mean satisfaction ratings for the 5 pilot NeuroBricks ranged from 4.08 to 4.11 (5-point scale). Among 71 students evaluating the complete 13-module library, most reported improved recognition of neurologic symptoms (54 [76.1%]), interpretation of abnormal findings (48 [67.6%]), and preparedness for patient encounters (52 [73.2%]). Most preferred asynchronous learning (49 [69%]) and rated interactive features as engaging (48 [67.6%]). At HMS, 85% (17/20) were likely to recommend NeuroBricks, with thematic analysis revealing increased confidence, targeted learning, and supplemental value for shelf examination preparation. Module developers reported positive perceptions of the creation process, and analytics demonstrated global reach across 34 countries.

Discussion: The multi-tiered mentorship model successfully supported the creation of the NeuroBricks Library while students demonstrated strong satisfaction with its content and perceived impact. Required integration into clerkships promoted greater engagement than optional use. By providing peer-reviewed, clinically focused modules, this scalable, open-access approach helps overcome key barriers in neurology education and can be extended to other specialties, particularly where faculty or resources are limited.

Background and objectives: Professional identity formation during residency is often catalyzed by emotionally complex experiences that extend beyond structured curricula. This study explores how neurology residents navigate autonomy, mentorship, and workload during training, using transformative learning theory to examine identity formation beyond skill acquisition.

Methods: We conducted a qualitative study at a US academic neurology residency program. Participants included current PGY-3 and PGY-4 residence and recent alumni (graduated 208-2021) from a single four-year ACGME-accredited neurology program. Individuals were recruited through email and completed demographic surveys before participating in a 45-minute Zoom interview. Interviews were guided by a semistructured protocol and explored expectations, stressors, mentorship, and pivotal learning moments. Transcripts were analyzed thematically using MAXQDA. Two independent, blinded coders applied a shared codebook and achieved interrater reliability (Cohen κ ≥ 0.70). Reflexive journaling and interdisciplinary team debriefs enhanced analytic rigor.

Results: Twenty-one participants (mean age 35.4 ± 5.3 years; 57% female; 48% White; 38% DO, 43% MD) completed interviews. Three intersecting domains of transformation emerged (1) balancing autonomy and mentorship, (2) adapting to high workload, and (3) discovering meaning in clinical work. Most participants described their development as nonlinear, driven by "selective emulation" of mentors and emotionally charged scenarios requiring reflection and adaptation. The majority (67%) reported growth through a blend of autonomy and mentorship. Coping strategies for workload were predominantly self-reliant (62%) or relational (57%), with fewer citing institutional supports (33%). Meaning was most often derived from patient-centered care (67%), followed by alignment with a subspecialty (43%) or systemic contributions through teaching or advocacy (33%).

Discussion: This study provides a theoretically grounded framework for understanding identity formation in neurology residency. High-responsibility clinical moments were reframed as developmental turning points when paired with reflection and supportive mentorship. Findings underscore the value of psychologically attuned environments that facilitate adaptive coping, meaning-making, and progressive autonomy. Limitations include single-site sampling and potential recall bias among alumni. Future research should explore longitudinal identity trajectories and examine how early meaning-making predicts later professional fulfillment and resilience.

Neurologists increasingly face clinical situations marked by diagnostic ambiguity, ethical complexity, and disorders that challenge traditional concepts of consciousness, personhood, and agency. Yet most neurology training programs remain focused on biomedical knowledge and procedural skills, offering limited preparation for these profound and often morally charged aspects of care. This educational gap may undermine clinical reasoning, ethical sensitivity, and the formation of a reflective professional identity. This review proposes the integration of 3 underrepresented but essential domains-epistemology, ethics, and philosophy of mind-into neurology education. Guided by Kern's 6-step curriculum development model, the article outlines theory-informed, evidence-based strategies to embed philosophical competencies within postgraduate training. Epistemology supports diagnostic reasoning through metacognitive insight, recognition of bias, and tolerance for ambiguity. Ethics education strengthens moral judgment and communication in scenarios involving capacity assessment, end-of-life care, and neurotechnological interventions. Philosophy of mind offers conceptual clarity for understanding disorders of consciousness, neurodegeneration, and altered personhood. Curricular strategies include narrative debriefings, ethics Objective Structured Clinical Examinations (OSCEs), interdisciplinary seminars, and reflective bedside teaching, all of which can be embedded into core clinical rotations such as neuro-intensive care unit (ICU) and cognitive neurology. Learning objectives are aligned with Accreditation Council for Graduate Medical Education milestones and supported by validated assessment tools, including reflective writing rubrics, structured ethical evaluations, and measures of ambiguity tolerance. Implementation barriers-including faculty readiness and curricular constraints-are addressed through faculty development, co-teaching models, and modular integration. By reframing philosophy as a clinical competency rather than a theoretical enrichment, this review offers a pragmatic and forward-looking approach to neurology education. Embedding philosophical reasoning into training enhances diagnostic precision, ethical engagement, and patient-centered care. The integration of philosophy into neurology education is not a veneration of the past, but a forward-looking complement, offering a humanistic framework to guide clinical reasoning and professional identity in an era shaped by artificial intelligence and neurotechnology.

Background and objectives: Multimodal education uses cognitive learning theory strategies. Neurophobia, "the fear of neurology and clinical neuroscience," affects medical students and doctors worldwide. Novel approaches to neurology undergraduate education can improve undergraduate knowledge, enhance student perception of clinical neurology, and reduce neurophobia. We examine the effect of ANSWER (Analogy, Switch to Clinical, Embody the Signs and Recall Learning), a multimodal undergraduate neurology teaching intervention, on neurophobia and neurology knowledge in final-year medical students.

Methods: Final-year medical students were randomly distributed into 2 groups: an intervention group (ANSWER teaching) and a control group (usual teaching). A randomized crossover design was used. Knowledge acquisition was assessed using the multiple-choice question examination (MCQE). Neurophobia was assessed using a validated scale, Neuro-Combined Measure (NCM). The Kirkpatrick model evaluated the teaching program.

Results: Seventy-seven final-year medical students participated. Neurology knowledge significantly improved after the intervention (MCQE: median = 14, interquartile range (IQR) = 4 vs 11, IQR = 3; p < 0.001; r _ββ = 0.77), and neurophobia significantly decreased (NCM: median = 26, IQR = 7 vs 29, IQR = 7; p = 0.004; r _ββ = 0.51). A four-week washout demonstrated sustained improvements (MCQE: p < 0.001, r _ββ = 1.00; NCM: p < 0.001, r _ββ = 1.00). The control group showed no significant change in knowledge (z = -1.78, p = 0.075, r _ββ = 0.30) or neurophobia (z = 1.10, p = 0.27, r _ββ = 0.21). Across groups, MCQE median scores increased, with the most significant gain observed in the intervention group (11 [95% CI 9.80-12.20] to 14 [95% CI 12.57-15.43]). NCM scores declined in both the intervention and washout groups but remained stable in the control group. Most participants reported that the intervention improved their neurology knowledge and clinical performance.

Discussion: ANSWER teaching demonstrated improvement in neurology knowledge and neurophobia among final-year medical students. Students reported that ANSWER teaching improved their understanding of neurology and preparedness for examinations, suggesting that it is a promising tool for teaching neurology.

Background and objectives: Exposure to emotionally taxing patients can lead to secondary trauma that can result in burnout and emotional exhaustion in healthcare providers. Understanding whether secondary trauma is present in medical students could provide an opportunity to address the issue earlier in physician training. We sought to determine if secondary trauma characteristics exist in third-year medical students during a combined neurology/emergency medicine clerkship.

Methods: Six cohorts of third-year medical students at a MD-granting institution were invited to complete the Professional Quality of Life Survey, a widely used tool for assessing secondary trauma and its associated symptoms of compassion fatigue and burnout in healthcare workers. This was combined with supplemental questions and a standard postrotation survey to explore medical students' emotional experiences during the clerkship. The strength of the associations was measured with Cramér's V.

Results: The survey had a 51% response rate (n = 100) with 11.3% reporting symptoms of secondary trauma. Of the respondents, 81% identified as White, 6% as Black/African American, 6% as Asian, and 2% as American Arab/Middle Eastern/North African; 60% identified as female and 37% as male. Contributors to secondary trauma could be grouped into 4 themes: 1, feeling helpless in the student role; 2, witnessing the physical consequences of patient diseases; 3, personal trauma history; and 4, empathy burden. Most students expected the level of emotional distress they experienced during the clerkship. Hobbies, wellness activities, talking to others, and avoidance were common reported coping strategies. Participation in hobbies was associated with less emotional exhaustion (Cramér's V = 0.372; p = 0.001). Feelings of increased preparedness were associated with less emotional exhaustion (Cramér's V = 0.395; p = 0.005).

Discussion: Secondary trauma characteristics were identified in 11.3% of third-year medical students during a combined neurology/emergency medicine clerkship. This provides an opportunity to incorporate interventions that are effective in reducing secondary trauma characteristics in physicians during this early stage of training. Recognizing and proactively reducing secondary trauma during the clerkship experience may have longer-term benefits during later stages of medical training and practice.

Background and objectives: The objective of this study was to improve functional neurologic disorder (FND) education by identifying knowledge gaps among providers who registered for an online course on FND. The field of FND is rapidly evolving with new frameworks for understanding the diagnosis, pathophysiology, and treatment. This leads to the potential for knowledge gaps among clinicians who care for patients with FND. The shift away from terminologies such as "psychogenic" or "conversion" disorders underscores advances in how FND is conceptualized. Yet, gaps in the assimilation of this new knowledge among medical providers have been consistently found in surveys. This study is a qualitative analysis, allowing participants to state their specific knowledge gaps and identify content areas most in need of additional education.

Methods: Providers from various disciplines including neurologists and other physicians, psychologists, and physical therapists enrolled in a virtual course containing 9 asynchronous lectures on various FND topics followed by 2 live webinars (fndsociety.org/fnd-education/virtual-education-course). Participants were invited to optionally submit questions for the live webinars to the expert panel about the care of FND in various treatment settings. A qualitative descriptive research design was used, with conventional content analysis applied to identify themes from participant questions.

Results: One hundred ninety-one responses were collected from 268 participants over 2 months for a 71% response rate. Participant responses clustered on specific clinical presentations (e.g., functional seizures [FSs]), communication challenges with patients and other providers, inpatient challenges (e.g., when admission might be warranted), and outpatient challenges, such as limited access to multidisciplinary teams. Some participants explicitly stated outdated attitudes about FND.

Discussion: Qualitative analysis of the participant responses revealed priority areas of knowledge gaps, indicating potential underexplored avenues for high-impact education on FND. These areas include diagnostic uncertainty, such as the presence of comorbid medical illness, FSs, and tools to help the patient when best practice models are not available. Developing case-based learning to better foster illness scripts and modules on psychoeducation and psychological treatments for the nontherapist FND provider would enhance existing educational tools to allow providers in every setting to better care for patients with FND.

Background and objectives: Direct ophthalmoscopy (DO) is a core diagnostic skill for neurology residents. Although the importance of DO is accepted among neurology faculty and residents, proficiency in DO has declined because of limited training opportunities. The objectives of this study were to (1) provide neurology residents with supervised and unsupervised DO practice, (2) improve their competency and confidence in performing DO, and (3) develop a curriculum model adaptable to residencies with limited neuro-ophthalmology exposure.

Methods: A longitudinal, practice-based optometry or ophthalmology elective was implemented at 2 neurology residency programs, guided by Kern's 6-step approach to curriculum development. The rotation included both supervised and graduated independent practice. Residents completed anonymized pre-rotation and post-rotation questionnaires measuring confidence in performing DO and underwent objective skills assessments to measure competence in DO.

Results: A total of 13 neurology residents in postgraduate years 2-4 participated in the elective for an average of 4.8 half-days per resident over the course of the academic year. Residents demonstrated a significant increase in the number of ocular examinations performed by the end of the rotation. On completion of the elective, residents reported a mean increase in confidence (Likert scale 1-5) in focusing on the retina (+2.0 [95% CI 1.3-2.7], p = 0.005), finding the optic disc (+1.7 [0.9-2.6], p = 0.013), finding retinal blood vessels (+1.8 [1.1-2.5], p = 0.008), and recognizing optic disc pathology (+1.4 [0.7-2.1], p = 0.013). Mean DO objective assessment scores improved by 46.6% [27.8%-64.7%] (p = 0.006). Residents who performed 50 or more undilated DO examinations and those who were confident in finding the optic disc were more likely to incorporate DO into their clinical practice.

Discussion: Integrating an optometry or ophthalmology rotation into neurology residencies enhanced both subjective confidence and objective competence in DO, underscoring the importance of deliberate, structured practice in mastering diagnostic examination skills. Incorporation of self-regulated learning techniques and user-friendly technology may further enhance curricular efficacy. These findings demonstrate the feasibility of adopting this curriculum across various residency programs, particularly those that recognize the value of fundoscopic examination but lack adequate training opportunities.

[This corrects the article DOI: 10.1212/NE9.0000000000200220.].