Neurology. Education最新文献

Background and objectives: Teaching medical students how to perform an accurate neurologic examination (NE) is a primary objective of the neurology clerkship. Despite this emphasis, medical students often lack confidence in performing the NE. There is limited research on the effect of teacher-centered instruction methods on NE confidence. We designed this study to compare the impact of a lecture-based (LB) didactic and a direct instruction (DI) didactic on medical students' NE confidence during the neurology clerkship.

Methods: We conducted a teacher-centered, NE didactic during a four-week neurology clerkship. Third-year medical students (MS3s) were assigned to an LB didactic providing an overview of the NE or a DI didactic focused on examination pitfalls and practice opportunities. Preclerkship and postclerkship surveys assessed self-reported confidence of MS3s in performing various aspects of the NE and the perceived benefit of each didactic on examination skills. Clerkship evaluations of physical examination skills assessed the impact of each teaching method on NE performance. The primary outcome was change in composite NE confidence scores from baseline. Secondary outcomes were change in individual NE confidence scores from baseline, perceived didactic benefit, and clerkship physical examination scores.

Results: A total of 103 MS3s participated in our study (LB = 52, DI = 51). Change in NE confidence scores from baseline did not differ between groups (LB mean = 7.62, DI mean = 7.66, p = 0.97, d = 0.007). Presurvey strength testing confidence scores were higher in the DI group (LB mean = 3.04, DI mean = 3.44, p = 0.038, d = 0.46). There were no other significant differences in other confidence scores between groups (p > 0.13). Students reported higher agreement with the DI didactic being beneficial for their NE skills than the LB didactic (LB mean = 3.97, DI mean = 4.52, p = 0.0013, d = 0.82). Clerkship physical examination evaluation scores did not differ between groups (LB and DI median = 4, interquartile range [IQR] = 3-4, p = 0.074, r = 0.070).

Discussion: Emphasizing challenging NE pitfalls with DI is perceived by students to be more beneficial for learning examination skills than LB methods. However, DI is not clearly superior to LB teaching methods in improving NE confidence. Future research could further evaluate the efficacy of DI teaching methods with randomized trials and interval assessment of their effects on NE confidence throughout the neurology clerkship.

Background and objectives: Serious games (SGs) are increasingly used in education, although data on their use in neurology education are limited. This study evaluates SG effect on knowledge retention, subjective impression of decision making, and learner satisfaction.

Methods: Using a 6-step approach to curriculum development, we designed a digital interactive course as a SG, incorporating realistic video simulations to teach neurologic emergencies. A randomized intervention study compared the SG method (intervention) with clinical case seminars (seminar groups B and C) and no instruction (control group). Knowledge retention was assessed through multiple-choice (MC) tests immediately and 3 weeks postinstruction. Secondary measures included student satisfaction and usability. Descriptive statistical analyses were performed using IBM SPSS Statistics for Windows, Version 29.0, and free-text responses were analyzed qualitatively.

Results: The survey initially included 77 students (control, n = 16; SG, n = 32; seminar control, n = 29), with 57 completing the follow-up survey. Scores on the MC test were similar immediately after the course (SG: 70.1%, Seminar Group B: 65.0%, Seminar Group C: 67.0%) and declined less for the SG (4.1%) than the seminar groups (10.9% for B, 5.5% for C). Likert scale responses exhibited higher satisfaction and usability in the SG group, with 93.5% of SG participants reporting a reduction in fear of clinical emergencies. Feedback from the SG participants was mostly positive, with many commenting on the engaging structure of the course.

Discussion: Video-based SGs have shown efficacy in teaching neurologic emergency medicine. SG-acquired knowledge is more sustained than that acquired through traditional teaching formats and is well-received by Generation Z students.

Introduction and problem statement: Few formal programs provide structured training in medical education (MedEd) early in a learner's career. MedEd training curricula for medical students may cultivate student understanding (and thus interest) in a MedEd career. The Johns Hopkins Osler Apprenticeship (OA) in Neurology is a structured 1-year program for senior medical students (Osler Apprentices/OAs) created to develop talent in MedEd.

Objectives: By the end of the program, OAs will be better able to (1) cultivate and sustain longitudinal mentorship relationships; (2) design, implement, and present a MedEd project; (3) understand individual leadership strengths; (4) develop and refine skills in educational leadership and integrate feedback to enhance learning experiences; and (5) develop an understanding of the responsibilities of an academic educator.

Methods and curriculum description: The OA is a 1-year program that provides learners with comprehensive exposure to MedEd through key program components of mentorship, a scholarly project, strength coaching, and leadership and experiential opportunities. To evaluate the program's impact on OAs and preceptor motivations for engagement and its benefits, we administered 3 distinct surveys to OAs at exit, OA alumni, and faculty preceptors. We implemented the 4 levels of the New World Kirkpatrick Model to evaluate the impact of the program.

Results and assessment data: Twenty-four of 33 OAs (73%), 18 of 29 alumni (62%), and 6 of 7 preceptors (86%) responded to the surveys. Twenty-one OAs (88%) and 18 alumni (100%) recommended the OA to medical students (level 1). Alumni felt confident participating in educational activities (n = 15/83%), research (n = 15/83%), and leadership (n = 12/67%). Thirty-one OAs (94%) produced educational scholarship (level 2). OAs (n = 22/92%) and alumni (n = 14/78%) agreed that the OA influenced their academic practices and behaviors, and 7 alumni (39%) were recognized or awarded (level 3). Ten alumni (56%) have an educational role (level 4). Preceptors had scholarly output from the OA and reported career or personal development as key factors for participation.

Discussion and lessons learned: The OA made effective progress toward building a pathway for medical educators while supporting the careers of faculty, allowing for program sustainability. These findings suggest the OA may serve as a prototype for more formalized training programs in neurology MedEd.

Background and objectives: The field of neurology has inherent uncertainty, and there is currently a limited focus on how to navigate uncertainty in formal neurology training. This is an integral issue as uncertainty has been shown to correlate with increasing clinician burnout and overall negative health care outcomes. The aim of this study was to address this gap by introducing diagnostic uncertainty using case-based learning during the neurology clerkship. The objective of the study was to compare medical students' perceptions of clinical uncertainty before and after the course.

Methods: Second-year, third-year, and fourth-year medical students participated in a 60-minute case-based learning exercise incorporating uncertainty held at the start of the neurology clerkship. Students were given an optional precourse and postcourse survey incorporating the clinical practice uncertainty domains (CPUDs). Data were collected and analyzed from August 2023 to June 2024.

Results: Eighty-eight medical students participated in this course. There was a statistically significant increase in agreeability to several CPUDs in the postcourse survey compared with the precourse survey, including "I feel prepared to address uncertain situations during clinical clerkships" and "I am confident in my ability to communicate to patients during clinical situations that may be uncertain." Most of the students who responded to the postcourse survey found this session useful.

Discussion: Implementation of a standardized neurology curricular course focused on uncertainty is feasible and potentially valuable. There are several limitations to this study including the use of a postpositivist approach with the use of quantitative methods and the short follow-up period.

[This corrects the article DOI: 10.1212/NE9.0000000000200158.].

Background and objectives: Neurology residents learn through work-based learning, self-directed learning, and formal didactics. US residency program didactic curricula comply with national standards, but there may be wide design variation. No organization collects data on curricula, so the landscape of educational practices is unclear. This makes it difficult for program directors (PDs) to compare their approach with their peers' and identify methods of interest used elsewhere. We sought to describe existing curricular designs, examine features associated with resident attendance, and evaluate utilization of asynchronous learning.

Methods: A survey was designed and validated following established standards. Anonymous online surveys were distributed by email to PDs of US adult neurology programs in April 2023, with responses collected until July 2023. Responding program characteristics were compared with national norms to check representativeness. Descriptive statistics were used to delineate the range of curricular designs. Associations between didactic choices, program characteristics, and attendance were analyzed using nonparametric methods.

Results: Seventy-six (42.0%) of 181 programs responded. Respondents were more likely to be academically based (82% vs 63% nationally, p = 0.004) and with larger mean class sizes (7.9 vs 6.1, p < 0.001). Daily/noon conference (NC) models were more common than academic half-day (AHD) (63% vs 37%), and lectures predominated. AHD was less common in academic centers (30.0% vs 71.4% elsewhere; p = 0.004), the Northeast (14% vs 52.2% elsewhere; p = 0.001), and larger classes (6.4 vs 8.8 NC; p = 0.022). 75% reported that residents were at least "somewhat" responsible for pagers during conference-with various providers providing coverage. The reported attendance was 63.6 ± 22.0% (range 10%-90%). Attendance was not improved by food (p = 0.415) or AHD (p = 0.230), but it was improved by protected time (78% vs 58% unprotected; p < 0.001), fewer didactic hours (p = 0.031), and more PD-led sessions (p = 0.010). 75% of programs encouraged external asynchronous resource usage, and 65% developed internal materials-largely focused on examination preparation and neurophysiology.

Discussion: The results of this survey describe the landscape of formal didactic curricula. Residency programs use a range of strategies to achieve their educational aims, although some elements are more common to certain program types and some were more successful at increasing resident attendance. Further study is needed to determine best practices from available methodologies.

Background and objectives: This study aims to describe the variations in neurology training pathways in all Association of Southeast Asian Nations (ASEAN) countries.

Methods: A cross-sectional survey using questionnaires was conducted among the representatives of ASEAN countries from October 2023 to March 2024.

Results: Neurology training programs are available in 9 of the 11 ASEAN countries except Timor Leste and Cambodia. Despite the growing number of neurologists, with a doubling of the neurologist-to-patient ratio in most countries in the past 2 decades, the neurologist density per 100,000 population remained low. Thailand, Singapore, and Brunei Darussalam have more than 1 neurologist per 100,000 population compared with 2007 when only Singapore and Brunei Darussalam had more than this ratio. In Cambodia, Lao People's Democratic Republic (PDR), Myanmar, and Timur Leste, although the number of neurologists has increased substantially, the ratio of neurologists remains low, with less than 1 in a million population in Myanmar, 1:625,000 population in Lao PDR, 1:526,000 population in Cambodia, and 1:430,000 in Timur Leste. The total duration of training from undergraduate to certified neurologist varies greatly because of compulsory internal medicine (IM) training and postinternship services. To enroll in neurology training, candidates in 4 countries (Brunei, Singapore, Malaysia, and Myanmar) must have completed IM as a prerequisite. Candidates from Thailand and Indonesia must fulfill their 2-year compulsory government or general practice service requirement before they are eligible for neurology training. After fulfilling the eligibility criteria to enter neurology training, the overall training duration ranges from 3 to 13 years. Malaysia and Myanmar are countries where candidates spend more than 10 years becoming certified neurologists.

Discussion: The number of neurologists and the neurologist-to-patient ratio have improved since 2007 in ASEAN countries. Diverse neurology curricula and the variable duration to complete neurology training and subspecialty practice are the main challenges in improving neurology training in ASEAN countries.