Simple but Organized Neurology Residency Training Improves the Quality of Acute Stroke Care: From the Outset to Long-Term Effect.
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ABSTRACT:
SUBMITTER: Chang YM
PROVIDER: S-EPMC8189861 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveWe aimed to compare the rates of thrombolysis utilization for acute ischemic stroke in hospitals with neurology residency (NR) to those of other teaching (OT) and nonteaching (NT) hospitals.MethodsA retrospective serial cross-sectional cohort study of a nationally representative sample of stroke patients was conducted. Accreditation Council for Graduate Medical Education-accredited NR program-affiliated hospitals in the United States were cross-matched to the hospitals in the Nationwide Inpatient Sample from 2000 to 2010. ICD-9-CM codes were used for case ascertainment.ResultsA total of 712,433 adult ischemic stroke patients from 6,839 hospital samples were included, of whom 10.1%, 29.1%, and 60.8% were treated in NR, OT, and NT hospitals, respectively. Stroke patients in NR received thrombolysis more frequently (3.74% ± 0.24% [standard error]) than in OT (2.28% ± 0.11%, p < 0.001) and NT hospitals (1.44% ± 0.06%, p < 0.001). The adjusted odds ratios (ORs) of thrombolysis rates in NR vs OT and NR vs NT increased with each decade increment in age. In multivariate analysis, NR was independently predictive of higher thrombolysis rate (adjusted OR 1.51; 95% confidence interval [CI] 1.44-1.59 [NR vs OT], and adjusted OR 1.82; 95% CI 1.73-1.91 [NR vs NT]).ConclusionsAcute stroke care in NR hospitals is associated with an increased thrombolytic utilization. The disparities between the thrombolysis rate in NR and that in OT and NT hospitals are greater among elderly patients.
| S-EPMC3854832 | biostudies-literature
Project description:BackgroundHeadache disorders are the most common neurological disorders worldwide. Despite their widespread prevalence and importance, the topic of headache is inconsistently taught at both the undergraduate and postgraduate levels. The goal of this study is to establish a better picture of the current state of Headache Medicine (HM) training in Neurology postgraduate programs in Canada and describe the impact of the current pandemic on training in this domain.MethodsOnline surveys were sent to senior residents of adult Neurology programs in Canada. We also conducted telephone interviews with Neurology Program Directors. Descriptive statistics were analyzed, and thematic analysis was used to review free text.ResultsA total of 36 residents, and 3 Program Directors participated in the study. Most of the teaching in HM is done by headache specialists and general neurology faculty. Formal teaching is mainly given during academic half day. Most of the programs expose their residents to Onabotulinum toxin A injections and peripheral nerve blocks, but they don't offer much formal teaching regarding these procedures. Residents consider HM teaching important and they would like to have more. They don't feel comfortable performing interventional headache treatments, despite feeling this should be part of the skillset of a general neurologist.ConclusionOur study is the first to establish the current state of headache teaching in post-graduate neurology programs as perceived by trainees and program directors in Canada. The current educational offerings leave residents feeling poorly prepared to manage headaches, including procedural interventions. There is a need to diversify the source of teaching, so the educational burden doesn't lie mostly upon Headache specialists who are already in short supply. Neurology Residency programs need to adapt their curriculum to face the current need in HM.
| S-EPMC10433594 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic presented many challenges for graduate medical education, including the need to quickly implement virtual residency interviews. We investigated how different programs approached these challenges to determine best practices.MethodsSurveys to solicit perspectives of program directors, program coordinators, and chief residents regarding virtual interviews were designed through an iterative process by two child neurology residency program directors. Surveys were distributed by email in May 2021. Results were summarized using descriptive statistics.ResultsResponses were received from 35 program directors and 34 program coordinators from 76 programs contacted. Compared with the 2019-2020 recruitment season, in 2020-2021, 14 of 35 programs received >10% more applications and most programs interviewed ≥12 applicants per position. Interview days were typically five to six hours long and were often coordinated with pediatrics interviews. Most programs (13/15) utilized virtual social events with residents, but these often did not allow residents to provide quality feedback about applicants. Program directors could adequately assess most applicant qualities but felt that virtual interviews limited their ability to assess applicants' interpersonal communication skills and to showcase special features of their programs. Most respondents felt that a combination of virtual and in-person interviewing should be utilized in the future.ConclusionsResidency program directors perceived some negative impacts of virtual interviewing on their recruitment efforts but in general felt that virtual interviews adequately replaced in-person interviews for assessing applicants. Most programs felt that virtual interviewing should be utilized in the future.
| S-EPMC8482581 | biostudies-literature
Project description:Objective• Neurology trainees and program directors recognized a lack of structured breaking bad news training. • Program directors reported that many factors hinder the implementation of breaking bad news education. • Trainees felt capable of breaking bad news, but most did not have lectures, simulations, nor feedback. • Trainees acknowledged negative feelings when breaking bad news, including sadness and helplessness. We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors.MethodsWe performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic.ResultsWe collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training.ConclusionThis study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.
| S-EPMC10118364 | biostudies-literature
Project description:Background and purposeNeurology is rapidly evolving as a result of continuous diagnostic and therapeutic progress, which influences the daily work of neurologists. Therefore, updating residency training programmes is crucial for the future of neurology. Several countries are currently discussing and/or modifying the structure of their neurology residency training programme. A detailed and up-to-date overview of the available European residency training programmes will aid this process.MethodsA questionnaire addressing numerous aspects of residency training programmes in neurology was distributed among 38 national representatives of the Resident and Research Fellow Section of the European Academy of Neurology.ResultsWe obtained data from 32 European countries (response rate 84%). The median (range) duration of the residency training programmes was 60 (12-72) months. In the majority of countries, rotations to other medical disciplines were mandatory, mostly psychiatry (69%), internal medicine (66%) and neurosurgery (59%). However, the choice of medical fields and the duration of rotations varied substantially between countries. In 50% of countries, there were formal regulations regarding training in evidence-based medicine, teaching skills and/or leadership qualities. In many countries (75%), residents had to take an examination.ConclusionsWe found substantial variation among European countries in the duration of residency training programmes, and especially in the choice of obligatory rotations to external medical disciplines. Despite a presumably similar spectrum of patients, neurology residency training programmes across Europe are not harmonized. The structure of the programme should be determined by its relevance for neurologists today and in the future.
| S-EPMC7496990 | biostudies-literature
Project description:BackgroundCommunication skill is a core competency in neurology residency training. Specific training in this area at the residency level is often lacking, especially regarding difficult conversations. The aim of this study is to evaluate the current state in teaching residents about difficult conversations in 5 Chinese accredited neurology residency training programs and determine whether there is a perceived need for a formalized curriculum in this field.MethodsAn anonymous, 27-question, cross-sectional online survey addressing difficult conversations for neurological residents were distributed to five grade-A, class-3 hospitals selected from the affiliated teaching hospitals of medical schools qualified to provide neurology residency training in China.ResultsA total of 182 residents responded to the survey, and the response rate was 67.16% (182/271). Of the participants, 84.6% were female and the average age was 26.8 years. The majority of respondent residents (n = 168; 92.31%) reported being exposed to at least one difficult conversation in their medical careers. Only 43 (23.63%) participants reported having previously received formal communication skills training. In comparison with residents without previous training, those with previous training indicated significantly more confidence (P = 0.003) and were under lower pressure (P = 0.037) in managing difficult conversations. Only 97 (53.3%) residents indicated interest in receiving formal training. Time, lack of enthusiasm, lack of educational materials and faculty expertise were commonly cited barriers to formalized training.ConclusionThis survey provides a preliminary assessment of the current status of education on the topic of difficult conversations in five accredited Chinese neurology residency training programs. Our results suggest that there is an unmet need to further develop and implement educational activities by teaching residents to lead difficult conversations. Future efforts should be made to establish and promote a standard and targeted communication curriculum in difficult conversation for Chinese neurological residents.
| S-EPMC7525953 | biostudies-literature
Project description:ImportanceFundoscopic examination is an essential component of the neurologic examination. Competence in its performance is mandated as a required clinical skill for neurology residents by the American Council of Graduate Medical Education. Government and private insurance agencies require its performance and documentation for moderate- and high-level neurologic evaluations. Traditionally, assessment and teaching of this key clinical examination technique have been difficult in neurology residency training.ObjectiveTo evaluate the utility of a simulation-based method and the traditional lecture-based method for assessment and teaching of fundoscopy to neurology residents.Design, setting, and participantsThis study was a prospective, single-blinded, education research study of 48 neurology residents recruited from July 1, 2015, through June 30, 2016, at a large neurology residency training program. Participants were equally divided into control and intervention groups after stratification by training year. Baseline and postintervention assessments were performed using questionnaire, survey, and fundoscopy simulators.InterventionsAfter baseline assessment, both groups initially received lecture-based training, which covered fundamental knowledge on the components of fundoscopy and key neurologic findings observed on fundoscopic examination. The intervention group additionally received simulation-based training, which consisted of an instructor-led, hands-on workshop that covered practical skills of performing fundoscopic examination and identifying neurologically relevant findings on another fundoscopy simulator.Main outcomes and measuresThe primary outcome measures were the postintervention changes in fundoscopy knowledge, skills, and total scores.ResultsA total of 30 men and 18 women were equally distributed between the 2 groups. The intervention group had significantly higher mean (SD) increases in skills (2.5 [2.3] vs 0.8 [1.8], P = .01) and total (9.3 [4.3] vs 5.3 [5.8], P = .02) scores compared with the control group. Knowledge scores (6.8 [3.3] vs 4.5 [4.9], P = .11) increased nonsignificantly in both groups.Conclusions and relevanceThis study supports the use of a simulation-based method as a supplementary tool to the lecture-based method in the assessment and teaching of fundoscopic examination in neurology residency.
| S-EPMC5822185 | biostudies-literature
Project description:Quality and Patient Safety education for resident physicians is necessary to prepare them for independent practice and to meet accreditation requirements. Integrating such education into the residents' routine work can provide them with valuable practical experience, while advancing the institution's quality priorities. We committed to Quality and Patient Safety education for our pathology residents but found no published program that met their specific needs. To fill this gap in pathology residency education, we designed and implemented a new curriculum that spans the 4-year duration of residency training. Curriculum content was drawn from the pathology milestones, and educational strategies were based on the principles of adult learning. The curriculum was implemented in the 2018 to 19 academic year, and residents were assessed before and after their participation. The residents engaged in several Quality and Patient Safety activities and projects under faculty supervision, and improved their scores on objective assessments (Quality and Patient Safety quiz and in-service examination). Implementation was facilitated by a Quality and Patient Safety chief resident, and the recruitment of faculty with demonstrated Quality and Patient Safety interest. Our comprehensive Quality and Patient Safety curriculum is feasible to implement and can help pathology residents develop the knowledge and skills needed to lead quality initiatives. We believe that the curriculum framework is readily adaptable to other residency programs.
| S-EPMC7983410 | biostudies-literature
Project description:Physicians underrecognize and undertreat anaphylaxis. Effective interventions are needed to improve physician knowledge and competency regarding evidence-based anaphylaxis diagnosis and management (ADAM). We designed and evaluated an educational program to improve ADAM in pediatrics, internal medicine, and emergency medicine residents from two academic medical centers. Anonymous questionnaires queried participants' demographics, prior ADAM clinical experience, competency, and comfort. A pretest assessing baseline knowledge preceded a 45-minute allergist-led evidence-based presentation, including practice with epinephrine autoinjectors, immediately followed by a posttest. A follow-up test assessed long-term knowledge retention twelve weeks later. 159 residents participated in the pretest, 152 participated in the posttest, and 86 participated in the follow-up test. There were no significant differences by specialty or site. With a possible score of 10, the mean pretest score (7.31 ± 1.50) was lower than the posttest score (8.79 ± 1.29) and follow-up score (8.17 ± 1.72) (P < 0.001 for both). Although participants' perceived confidence in diagnosing or managing anaphylaxis improved from baseline to follow-up (P < 0.001 for both), participants' self-reported clinical experience with ADAM or autoinjector use was unchanged. Allergist-led face-to-face educational intervention improves residents' short-term knowledge and perceived confidence in ADAM. Limited clinical experience or reinforcement contributes to the observed decreased knowledge.
| S-EPMC4779520 | biostudies-literature
Project description:The American Heart Association developed criteria dubbed "Life's Simple 7" defining ideal cardiovascular health: not smoking, regular physical activity, healthy diet, maintaining normal weight, and controlling cholesterol, blood pressure, and blood glucose levels. The impact of achieving these metrics on survival after stroke is unknown. We aimed to determine cardiovascular health scores among stroke survivors in the United States and to assess the link between cardiovascular health score and all-cause mortality after stroke.We assessed cardiovascular health metrics among a nationally representative sample of US adults with stroke (n=420) who participated in the National Health and Nutrition Examination Surveys in 1988-1994 (with mortality assessment through 2006). We determined cumulative all-cause mortality by cardiovascular health score under the Cox proportional hazards model after adjusting for sociodemographic characteristics and comorbidities. No stroke survivors met all 7 ideal health metrics. Over a median duration of 98 months (range, 53-159), there was an inverse dose-dependent relationship between number of ideal lifestyle metrics met and 10-year adjusted mortality: 0 to 1: 57%; 2: 48%; 3: 43%; 4: 36%; and ≥5: 30%. Those who met ≥4 health metrics had lower all-cause mortality than those who met 0 to 1 (hazard ratio, 0.51; 95% confidence interval, 0.28-0.92). After adjusting for sociodemographics, higher health score was associated with lower all-cause mortality (trend P-value, 0.022).Achieving a greater number of ideal cardiovascular health metrics is associated with lower long-term risk of dying after stroke. Specifically targeting "Life's Simple 7" goals might have a profound impact, extending survival after stroke.
| S-EPMC4845235 | biostudies-other