Nowadays, the “flipped classroom” approach is taking the center stage within medical education. However, very few reports on the implementation of the flipped classroom in neurology have been published to date, and this educational model still represents a challenge for students and educators alike. In this article, neurology educators from the American Academy of Neurology's A. B. Baker Section on Neurological Education analyze reports of flipped classroom in other medical/surgical subspecialties, review the current implementation in neurology, and discuss future strategies to flip the neurology curriculum through contextualization of the benefits and the consequences. ANN NEUROL 2020;87:4–9
How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.
A 63-year-old woman with myotonic dystrophy type 2 1 and obstructive sleep apnea by polysomnography, not on medications traditionally known to cause REM behavior disorder (RBD), had dream-enacting behavior (DEB). Overnight continuous positive airway pressure titration captured an episode of DEB with clear recall (video on the Neurology ® Web site at www.neurology.org). There was absence of muscle atonia and excessive phasic muscle bursts during REM, confirming RBD ( figure).RBD, commonly seen with neurodegenerative diseases, particularly synucleinopathies, 2 has not been described in myotonic disorders, making this a novel presentation. We speculate that RBD may have resulted from brainstem involvement of her multisystem generalized membrane disorder. The top 6 channels represent EEG recording with electrodes placed according to the international 10-20 electrode placement system. E1-M1 and E2-M1 represent left and right electrooculogram (EOG) channels with reference to the left mastoid (M1). The chin channel represents EMG activity from the mentalis muscle. Multiple muscle recording includes EMG activity recorded from the following muscles: right sternocleidomastoid (RtSterno1), bilateral biceps and triceps, lumbar paraspinals (Paraspinals) and bilateral quadriceps femoris referenced to the respective iliac crests (Rt-Quad), bilateral gastrocnemius (Gast1) and tibialis anterior (Tib) muscles. Chest and abdominal effort were measured using respiratory inductive plethysmography belts. EKG (electrocardiography), SaO 2 (oxygen saturation by finger oximetry), HR (heart rate), and snore channels are also displayed. The C-flow channel demonstrates obstructive apneas with arousals. The epoch represents REM sleep, as evidenced by rapid eye movements in the EOG channels and a desynchronized, low voltage EEG; however, there are excessive phasic bursts in the chin and limb EMG channels. This activity was present in more than 50% of REM epochs, meeting the criteria for REM without atonia.
The American Academy of Neurology’s (AAN) 2017 Gender Disparity Report identified improving mentorship as a key intervention to fill the leadership and pay gaps for women in neurology. Here we summarize the literature on mentoring women, provide an outline of ideal components of programs geared toward closing gender gaps, and present a mentoring program for AAN members. The strategies discussed share similarities with those for closing gaps related to race, ethnicity and religion. Developing effective mentorship and sponsorship programs is essential to ensure a sufficiently diverse pool of academic faculty and private practitioners, and to establish equal representation in leadership roles in this field.
Over the past few decades, medical education has seen increased interest in the use of active learning formats to engage learners and promote knowledge application over knowledge acquisition. The field of psychiatry, in particular, has pioneered a host of novel active learning paradigms. These have contributed to our understanding of the role of andragogy along the continuum of medical education, from undergraduate to continuing medical education. In an effort to frame the successes and failures of various attempts at integrating active learning into healthcare curricula, a group of educators from the A. B. Baker Section on Neurological Education from the American Academy of Neurology reviewed the state of the field in its partner field of medical neuroscience. Herein we provide a narrative review of the literature, outlining the basis for implementing active learning, the novel formats that have been used, and the lessons learned from qualitative and quantitative analysis of the research that has been done to date. While preparation time seems to present the greatest obstacle to acceptance from learners and educators, there is generally positive reception to the new educational formats. Additionally, most assessments of trainee performance have suggested non-inferiority (if not superiority). However, occasional mixed findings point to a need for better assessments of the type of learning that these new formats engender: knowledge application rather than acquisition. Moreover, this field is relatively nascent and, in order to ascertain how best to integrate active learning into psychiatry education, a framework for quantitative outcome assessments is needed going forward.
Background Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the classic clinical triad of gait, cognitive, and urinary dysfunction, albeit incomplete in a relevant proportion of patients. The clinical findings and evolution of these symptoms have been variably defined in the literature. Objectives To evaluate how the phenomenology has been defined, assessed, and reported, we performed a critical review of the existing literature discussing the phenomenology of iNPH. The review also identified the instrumental tests most frequently used and the evolution of clinical and radiologic findings. Methods The review was divided into 3 sections based on gait, cognitive, and urinary dysfunction. Each section performed a literature search using the terms “idiopathic normal pressure hydrocephalus” (iNPH), with additional search terms used by each section separately. The number of articles screened, duplicates, those meeting the inclusion criteria, and the number of articles excluded were recorded. Findings were subsequently tallied and analyzed. Results A total of 1716 articles with the aforementioned search criteria were identified by the 3 groups. A total of 81 full‐text articles were reviewed after the elimination of duplicates, articles that did not discuss phenomenological findings or instrumental testing of participants with iNPH prior to surgery, and articles with fewer than 10 participants. Conclusions “Wide‐based gait” was the most common gait dysfunction identified. Cognitive testing varied significantly across articles, and ultimately a specific cognitive profile was not identified. Urodynamic testing found detrusor overactivity and “overactive bladder” as the most common symptom of urinary dysfunction.
Objective: The COVID-19 pandemic has rapidly changed the neurology training landscape. The study was designed to assess the effects of COVID-19 on the education, practice, and well-being of US neurology trainees. Methods: A 36-item survey was distributed to neurology residents and fellows in the United States through various media platforms. Results: Over an 8-week period, 286 responses were received, 285 were included. Almost all (93%) trainees were in an academic setting. Tele-neurology use by trainees was minimal (13%) prior to the pandemic; however, during the pandemic 91% reported using it. A majority (84%) of trainees did not receive training in tele-neurology prior to the pandemic. Most trainees felt that the pandemic impacted their education with fewer lectures being available, and 77% resorted to getting lectures from outside institutions. Tele-lecturing with video conferencing was the most common mode of education during the pandemic. A third (33%) of trainees felt that they did not have enough PPE during the pandemic. Most trainees worried about exposing themselves or their families to COVID-19, and had increased stress levels. Conclusion: This study demonstrates that most neurology trainees had no training nor exposure to tele-neurology prior to the pandemic, and were rapidly thrusted into tele-neurology during the pandemic. Trainees had an overall negative educational impact, and were stressed during the pandemic. Use of technology and availability of outside institutions’ lectures were most helpful to continue with educational activities during this time.
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