Using Objective Structured Clinical Exams (OSCE) to Teach Neurology Residents to Disclose Prognosis after Hypoxic Ischemic Brain Injury
BACKGROUND:Neurologists need to be adept at disclosing prognosis and breaking bad news. Objective structured clinical examinations (OSCE) allow trainees to practice these skills. METHODS:In 2017, in conjunction with the NYU School of Medicine Simulation Center, neurology faculty designed an OSCE case in which a resident had to inform a standardized patient (SP) her father had severe global hypoxic ischemic injury. The residents were surveyed on the experience using a Likert scale from 1 (worst) to 5 (best). The SP completed a behavioral anchored checklist and marked items as "not done," "partly done," or "well done". RESULTS:57 third and fourth year neurology residents completed the case from 2018 to 2020, 54 (95%) of whom completed the post-OSCE survey. Residents reported feeling moderately prepared for the simulation (mean Likert score 3.7/5), and thought their performance was average (3.4/5). Overall, they found the case to be very helpful (4.6/5). The residents performed well in the realms of maintaining professionalism (64% rated "well done"), developing a relationship (62% rated "well done"), and information gathering (61% rated "well done"). There was room for improvement in the realms of providing education and presenting the bad news (39% and 37% rated "partly/not done," respectively). CONCLUSIONS:OSCE cases can be used to teach neurology trainees how to discuss prognosis and break bad news. Feedback about this simulation was positive, though its efficacy has yet to be evaluated and could be a future direction of study.
Sleep-deprived residents and rapid picture naming performance using the Mobile Universal Lexicon Evaluation System (MULES) test
Objective/UNASSIGNED:The Mobile Universal Lexicon Evaluation System (MULES) is a rapid picture naming task that captures extensive brain networks involving neurocognitive, afferent/efferent visual, and language pathways. Many of the factors captured by MULES may be abnormal in sleep-deprived residents. This study investigates the effect of sleep deprivation in post-call residents on MULES performance. Methods/UNASSIGNED:Â =Â 18) and a group of similar-aged controls not taking call (nÂ =Â 18). Differences in times between baseline and follow-up MULES scores were compared between the two groups. Results/UNASSIGNED:Â <Â 0.001, Wilcoxon rank sum test). The change in MULES time from baseline was significantly correlated to the change in subjective level of sleepiness for call residents and to the amount of sleep obtained in the 24Â h prior to follow-up testing for the entire cohort. For call residents, the duration of sleep obtained during call did not significantly correlate with change in MULES scores. There was no significant correlation between MULES change and sleep quality questionnaire score for the entire cohort. Conclusion/UNASSIGNED:The MULES is a novel test for effects of sleep deprivation on neurocognition and vision pathways. Sleep deprivation significantly worsens MULES performance. Subjective sleepiness may also affect MULES performance. MULES may serve as a useful performance assessment tool for sleep deprivation in residents.
Using an osce to teach neurology residents to discuss prognosis after hypoxic ischemic brain injury [Meeting Abstract]
INTRODUCTION: Clinicians caring for critically-ill patients must be able to discuss prognosis and deliver bad news. To teach Neurology residents how to do this, we designed an objective structured clinical examination (OSCE) case in which trainees discussed prognosis with a standardized patient (SP).
METHOD(S): In 2017, in conjunction with the NYU School of Medicine Simulation Center, neurology faculty designed an OSCE case in which a resident was tasked with informing a SP her father had severe global hypoxic ischemic injury. The SP was instructed to assess the resident's ability to 1) explain the neurologic findings and 2) to respond to an emotional outburst. A neurology attending observed the encounter via one-way glass. After a 10-minute encounter, the resident was provided 5 minutes of feedback. The residents were surveyed on how prepared they felt for the OSCE, how useful it was, how they rated their performance, and how much they learned from the activity via a Likert scale from 1 (worst) to 5 (best) and free text response. The SP completed a behavioral anchored checklist to assess the residents' ability to gather information, develop a relationship, provide education and counseling, present bad news, and maintain professionalism.
RESULT(S): 57 third and fourth year neurology residents completed the case from 2018-2020, 54 (95%) of whom completed the post-OSCE survey. Residents reported feeling moderately prepared (mean Likert score 3.7/5) and rated their performance as average (3.4/5). Overall they found the case to be very helpful (4.6/5). Several reported difficultly with 1) addressing a complex medical case in a limited amount of time 2) reacting appropriately to an emotional family member and 3) avoiding medical jargon. The SP reported that residents performed well in the realms of non-verbal behavior enriched communication, being non-judgmental, not interrupting, acknowledging emotion, and avoiding medical jargon. Areas in which there was room for improvement included collaborating with the SP to decide upon next steps, identifying a support system, and asking "what is going through your mind right now?".
CONCLUSION(S): OSCE cases can be used to teach clinicians how to discuss prognosis and break bad news. Feedback about this simulation was positive, however its efficacy has yet to be evaluated
Identifying and Addressing Struggling Colleagues in the Era of Physician Burnout
The psychosocial implications of COVID-19 for a neurology program in a pandemic epicenter
OBJECTIVE:We discuss the psychosocial implications of the COVID-19 pandemic as self-reported by housestaff and faculty in the NYU Langone Health Department of Neurology, and summarize how our program is responding to these ongoing challenges. METHODS:During the period of May 1-4, 2020, we administered an anonymous electronic survey to all neurology faculty and housestaff to assess the potential psychosocial impacts of COVID-19. The survey also addressed how our institution and department are responding to these challenges. This report outlines the psychosocial concerns of neurology faculty and housestaff and the multifaceted support services that our department and institution are offering in response. Faculty and housestaff cohorts were compared with regard to frequencies of binary responses (yes/ no) using the Fisher's exact test. RESULTS:Among 130 total survey respondents (91/191 faculty [48%] and 37/62 housestaff [60%]), substantial proportions of both groups self-reported having increased fear (79%), anxiety (83%) and depression (38%) during the COVID-19 pandemic. These proportions were not significantly different between the faculty and housestaff groups. Most respondents reported that the institution had provided adequate counseling and support services (91%) and that the department had rendered adequate emotional support (92%). Participants offered helpful suggestions regarding additional resources that would be helpful during the COVID-19 pandemic. CONCLUSION/CONCLUSIONS:COVID-19 has affected the lives and minds of faculty and housestaff in our neurology department at the epicenter of the pandemic. Efforts to support these providers during this evolving crisis are imperative for promoting the resilience necessary to care for our patients and colleagues.
Rapid implementation of virtual neurology in response to the COVID-19 pandemic
The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies.We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types.We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurological examinations that are clinically meaningful, and how we document, code and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.
Training in neurology: Flexibility and adaptability of a neurology training program at the epicenter of COVID-19
OBJECTIVE:To outline changes made to a neurology residency program in response to coronavirus disease 2019 (COVID-19). METHODS:In early March 2020, the first cases of COVID-19 were announced in the United States. New York City quickly became the epicenter of a global pandemic, and our training program needed to rapidly adapt to the increasing number of inpatient cases while being mindful of protecting providers and continuing education. Many of these changes unfolded over days, including removing residents from outpatient services, minimizing the number of residents on inpatient services, deploying residents to medicine services and medical intensive care units, converting continuity clinic patient visits to virtual options, transforming didactics to online platforms only, and maintaining connectedness in an era of social distancing. We have been able to accomplish this through daily virtual meetings among leadership, faculty, and residents. RESULTS:Over time, our program has successfully rolled out initiatives to service the growing number of COVID-related inpatients while maintaining neurologic care for those in need and continuing our neurologic education curriculum. CONCLUSION/CONCLUSIONS:It has been necessary and feasible for our residency training program to undergo rapid structural changes to adapt to a medical crisis. The key ingredients in doing this successfully have been flexibility and teamwork. We suspect that many of the implemented changes will persist long after the COVID-19 crisis has passed and will change the approach to neurologic and medical training.
Education Research: Teaching and assessing communication and professionalism in neurology residency with simulation
Sleep-Deprived Residents and Rapid Picture Naming Performance Using the Mobile Universal Lexicon Evaluation System (MULES) Test [Meeting Abstract]
Assessing and Enhancing Non-Neurology Resident Education on Acute Stroke Identification and Intervention [Meeting Abstract]