Education Research: The Landscape of Adult Neurology Residency Didactic Curricula in the United States

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Abstract
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. 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. 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. 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.

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