Accelerated Implementation of a Virtual Neurology Clerkship Amid a Global Crisis

The standard neurology clinical experience in medical school focuses primarily on bedside patient encounters; however, the limitations of the clinical environment due to the current COVID-19 pandemic have accelerated the need for virtual curriculum development. To provide guidance to Neurology clerkship directors during this unprecedented time, the American Academy of Neurology (AAN) Undergraduate Education Subcommittee (UES) formed a workgroup to develop an outline for a ‘virtual curriculum’, provide recommendations, and describe models of integrating virtual curricula into the neurology clerkship.In this overview, we discuss different methods of virtual instruction, hybrid models of clerkship training and the challenges to its implementation, professionalism issues, and modification of feedback and assessment techniques specific to the virtual learning environment. We also offer suggestions for implementation of a hybrid virtual curriculum into the neurology clerkship.The virtual curriculum is intended to supplement the core neurology in-person clinical experience and should not be used for shortening or replacing the required neurology clinical clerkship.

A Pilot Study to Compare the Standardized Patient's Perception of Empathy Among the American Medical Graduates and International Medical Graduates Applying for Residency Training in the United States

Background:Empathy is an essential ingredient of patient-centered care. Traditional neurology clerkship does not provide a structured way to teach, evaluate and inculcate the virtue of empathy among our medical students while dealing with various complex neurological conditions. We designed an innovative Objective Structured Clinical Evaluations (O.S.C.E.s) entitled as Empathetic Neurological Care (ENC) O.S.C.E.s as a part of clerkship evaluation to assess empathy among American Medical Graduates (A.M.G.s) and International Medical Graduates (I.M.G.s) and establish the need of training of empathy skills to future professionals.Study Objective: We aim to illustrate the model of Empathetic Neurological Care (ENC) O.S.C.E. & to report the comparative analysis of empathy scores among the A.M.G.s and I.M.G.s.Methods: This is a pilot study comparing empathy among A.M.G.s and I.M.G.s, measured by the Standardized Patients (SPs) using the Jefferson Scale of Empathy (7-point Likert type scale) during pre-designed ENC-OSCEs. The proposed curriculum included complex neurological cases involving breaking bad news (e.g., delivering the diagnosis of A.L.S.), opioid addiction counseling, disclosing medical error (stroke), and explaining the diagnosis of non-epileptic seizures.Results: 12 students (6 AMGs, 3 Males/ 3 Females and 6 IMGs 4 Males/2 Females) completed the OSCE. A.M.G.s scored higher in empathy scores graded by S.P.s than I.M.G.s (P=0.0004). Conclusion: A.M.G.s scored higher empathy as compared to I.M.G.s by the S.P.s during ENC-OSCEs. We highlight the importance of focused empathy training with assessment during neurology clerkship rotations for A.M.G.s & the need of formal curricular training as a part of the orientation program at the beginning of residency training for I.M.G.s.

Education Research: The medical student perspective on challenging conversations

ObjectiveMedical students experience difficult conversations with patients during clinical clerkships. This study aimed to characterize barriers to and opportunities for learning in the setting of challenging conversations.MethodsNeurology clerkship medical students were enrolled prospectively in a concurrent nested mixed methods study. Qualitative data were collected using a postclerkship survey and semi-structured focus groups. Students were asked to reflect on challenging conversations they experienced with patients and to identify the top reasons why conversations were challenging. Responses were analyzed using directed content analysis.ResultsA total of 159 medical students were enrolled (MS2: n = 35 [22%]; MS3: n = 97 [61%]; MS4: n = 27 [17%]). Three themes of difficulty were identified in survey and focus group data: (1) tough clinical realities: how the clinical environment makes conversations challenging; (2) communication skill needs: the difficulty of finding the words to say; and (3) navigating emotions: of patients, clinicians, and students themselves. Tough clinical realities were cited by over two-thirds of students in all years (MS2: n = 30 [86%]; MS3: n = 74 [76%]; MS4: n = 23 [85%]). Communication skills needs were cited most frequently by third-year students (MS2: n = 15 [43%]; MS3: n = 55 [57%]; MS4: n = 10 [37%]). Students early in training were more likely to cite difficulty navigating emotions (MS2: n = 28 [80%]; MS3: n = 71 [73%]; MS4: n = 19 [70%]).ConclusionsMedical students frequently observe and participate in challenging conversations with patients. Here, students identified what makes these conversations most difficult. Communication curricula should leverage clinical communication encounters, prepare students for inherent clinical realities, and help students navigate emotions in the health care setting.

The Role of Residents in Medical Students’ Neurology Education:Current Status and Future Perspectives

Background: Neurophobia, a well-described fear of neurology, affects medical students worldwide and may be one of the factors contributing to a shortage of neurologists in the United States. Residents spend a considerable amount of time with medical students; therefore, we sought to understand better the impact neurology residents have on medical students during their neurology clerkship and their subsequent interest in neurology. We aimed to identify and implement strategies to decrease neurophobia and increase the number of students pursuing neurology as a career. Methods: Third-year medical students (n=234) of UTHealth’s McGovern Medical School rotating through their neurology core clerkship completed two surveys regarding their rotation experiences. Surveys were completed anonymously before and after the clerkship to measure their interest and confidence in neurology and the impact of their interactions with the neurology residents during the clerkship. In parallel, residents participated in a teaching workshop focused on small group teaching to improve their teaching effectiveness. Non-parametrical comparison and ordinal regression analyses were utilized for data analyses. Results: Medical students reported a statistically significant increase in their confidence in managing neurological conditions and interest in pursuing a neurology residency after their clerkship. There was a significant association between the medical students’ overall rotation experience and the residents’ teaching effectiveness. The overall clerkship experience correlated with the medical students’ interest and confidence in neurology. There was a trend towards an increase in residents’ teaching effectiveness and students’ rotation experience after a resident teaching workshop. Additionally, of note, students who rotated on both and outpatient and inpatient sites during their clerkship reported an increased interest in neurology. Conclusion: Our study supports that resident-led teaching efforts are important in improving medical students’ neurologic education and their interest in neurology . Our data also supports that the interest in neurology increased for medical students after their neurology clerkship. We examined future strategies to implement “near-peer” teaching activities to enhance the medical students' neurologic educational experience. These strategies could potentially mitigate neurophobia and ultimately lead to a much-needed increase in future neurologists.

The role of residents in medical students’ neurology education: current status and future perspectives

Background: Neurophobia, a well-described fear of neurology affects medical students worldwide and may be one of the factors contributing to a shortage of neurologists in the United States. Residents spend a considerable amount of time with medical students, therefore, we sought to better understand the impact neurology residents have on the medical students experience during their neurology clerkship and their subsequent interest in neurology. We aimed to identify and implement strategies to decrease neurophobia and increase the number of students pursuing neurology as a career. Methods: Third-year medical students (n=234) of UTHealth’s McGovern Medical School rotating through their neurology core clerkship completed two surveys regarding their rotation experiences. Surveys were completed anonymously before and after the clerkship to measure their interest and confidence in neurology and the impact of their interactions with the neurology residents during the clerkship. In parallel, residents participated in a teaching workshop focused on small group teaching to improve their teaching effectiveness. Non-parametrical comparison and ordinal regression analyses were utilized for data analyses. Results: Medical students reported a statistically significant increase in their confidence in managing neurological conditions and interest in pursuing a neurology residency after their clerkship. There was a significant association between the medical students’ overall rotation experience and the residents’ teaching effectiveness. Their overall clerkship experience correlated with their interest and confidence in neurology. There was a trend towards an increase in residents’ teaching effectiveness and students’ rotation experience after the resident workshop. Additionally, students who rotated in both and outpatient and inpatient site reported an increased interest in neurology. Conclusion: Our study supports that resident-led teaching efforts are important in improving medical students’ neurologic education and their interest in neurology . We examined future strategies to implement “near-peer” teaching activities to enhance the medical students' neurologic educational experience. These strategies could potentially mitigate neurophobia and ultimately lead to a much-needed increase in future neurologists.

Abstract WP351: Strokophobia Among Neurology, Internal Medicine and Emergency Medicine Residents

Clinical care of acute stroke patients can be handled by multiple specialties yet the concept of “strokophobia”, or the fear of dealing with stroke patients has not been explored in the literature. We explore some of the roots of that fear in residents of the neurology, emergency medicine (EM) and internal medicine (IM) specialties. An anonymous survey was sent to neurology, IM and EM residents at two different academic institutions. The survey inquired about the respondent’s demographics, training, and the first time the had a strong discomfort dealing with stroke. More detailed questions followed regarding some of the common perceived misconceptions and reasons behind the fear of caring for stroke patients. The questionnaire also inquired about some available resources to mitigate that fear. Of the 47 respondents, 47% were male. 57% were in IM, 38% were in neurology, and 4% from EM. 23% were in their PGY1 of training, 30 % were PGY2, 32% PGY3, and 15% PGY4. Most residents (83%) had an inpatient component in their neurology clerkship. 66% report having some fear in dealing with stroke patients. 28% report the fear to originally stem from the clinical years of medical school and 28% during residency. 40% of residents agreed that more neuroanatomy teaching is needed and 36% did not think enough education was given in medical school. 11% did not have a neurology clerkship in their medical school, 4% did not have an opportunity to work with a neurologist in medical school. 25% of residents report having limited exposure to stroke patients. 23% of residents consult neurology out of fear of missing significant pathology, while 23% were not comfortable with their exam skills. 38 % residents blame excessive paperwork for the lack of education while 23% think it was witnessing some attendings uncomfortable with stroke patients. The high acuity of these patients would deter 30% of the residents from caring for them. 11% of residents shy away due to having to establish adequate time windows or asking for help. 72% agree that more hands-on teaching is needed while 38% state that more tutorial videos could be helpful. In this first-ever exploratory analysis of strokophobia, the results show that the phenomenon is prevalent and more education is needed in order to mitigate it amongst residents.

Education Research: The Narrative Evaluation Quality Instrument

ObjectiveDetermining the quality of narrative evaluations to assess medical student neurology clerkship performance remains a challenge. This study sought to develop a tool to comprehensively and systematically assess quality of student narrative evaluations.MethodsThe Narrative Evaluation Quality Instrument (NEQI) was created to assess several components within clerkship narrative evaluations: performance domains, specificity, and usefulness to learner. In this retrospective study, 5 investigators scored 123 narrative evaluations using the NEQI. Inter-rater reliability was estimated by calculating interclass correlation coefficients (ICC) across 615 NEQI scores.ResultsThe average overall NEQI score was 6.4 (SD 2.9), with mean component arm scores of 2.6 for performance domains (SD 0.9), 1.8 for specificity (SD 1.1), and 2.0 for usefulness (SD 1.4). Each component arm exhibited moderate reliability: performance domains ICC 0.65 (95% confidence interval [CI] 0.58–0.72), specificity ICC 0.69 (95% CI 0.61–0.77), and usefulness ICC 0.73 (95% CI 0.66–0.80). Overall NEQI score exhibited good reliability (0.81; 95% CI 0.77–0.86).ConclusionThe NEQI is a novel, reliable tool to comprehensively assess the quality of narrative evaluation of neurology clerks and will enhance the study of interventions seeking to improve clerkship evaluation.