Jeremy J. Moeller

Establishing a foundation of outpatient knowledge is key for child neurology residents as they prepare for careers shaped by evolving diagnostics and treatments. Although national recommendations define core didactic content, strategies for implementation vary widely. To address this gap, educators developed the ABCs of Child Neurology (ABCs), an asynchronous, article-based curriculum grounded in the Master Adaptive Learner framework. On participation, learners will (1) develop competency in outpatient child neurology foundational principles and (2) cultivate self-directed learning behaviors through an asynchronous curriculum. ABCs is mirrored after the American Board of Psychiatry and Neurology (ABPN) Article-Based Continuing Certification program. It comprises 40 modules across 8 core outpatient topics, each featuring a high-yield clinical article and 5-item assessment. The curriculum was implemented during the 2024–2025 academic year for child neurology residents (PGY3–PGY5) at a single institution. Learner expectations include completing 1 module per month and scoring ≥80% on the assessment to receive credit. Evaluation follows the New World Kirkpatrick model, evaluating learner reaction and knowledge growth. Outcomes include module completion rates, aggregate performance on module assessments, and postmodule and postintervention surveys. Descriptive statistics and subgroup analyses by postgraduate year were performed. Ten residents (100%) participated in the pilot. Overall completion rate was 97%, with individual rates ranging from 75% to 107%. Of 129 completed modules, 116 (89.9%) were passed on the first attempt. Mean assessment score was 4.4/5 (SD = 0.8), and median completion time was 43 minutes (IQR-17-470 minutes). Patient care was the most common motivator (41.9%). Postmodule survey ratings revealed 95.7% (mean = 4.5/5; SD = 0.6) of content as essential to practice and 94% (mean = 4.5/5; SD = 0.6) reporting likelihood to apply material. Ratings increased across training levels—PGY-3 = 4.0 (SD = 1.1), PGY-4 = 4.4 (SD = 0.8), and PGY-5 = 4.7 (SD = 0.6) (p = 0.008). Postintervention surveys indicated strong endorsement of the curriculum to colleagues (4.5/5; SD = 0.7; 90% rating 4 or 5). Early work at a single institution supports the feasibility and quality of an asynchronous, article-based curriculum for outpatient child neurology education. Key lessons from the pilot included prioritizing usability to support sustained engagement and aligning content with clinical responsibilities. Future work will evaluate scalability across multiple institutions and explore qualitative insights to optimize integration of asynchronous curricula.

Strokes in the right temporal lobe are known to cause acquired amusia, or deficits in music processing, which can be formally assessed using the online version of the Montreal Battery of Evaluation of Amusia (MBEA). Patients with acquired amusia most often present with not only amusia but also other neurologic symptoms, such as aphasia, neglect, or memory issues. We report a case of a 39-year-old man who initially presented for follow-up after a single seizure episode. Two years before the seizure, the patient experienced an episode of headache, nausea, and vomiting, after which he developed difficulty appreciating music and carrying a tune, something he had never experienced before as a competent trumpet player and singer. An MRI scan performed after his seizure revealed encephalomalacia and gliosis within the right lateral temporal lobe with areas of hemosiderin deposition, suggesting that the episode 2 years ago was a stroke. His standard neurologic examination was normal including a score of 30/30 on the Montreal Cognitive Assessment. On the online version of the MBEA, he scored 66.7% on the off-tune test, 87.5% on the off-beat test, and 70.8% on the out-of-key test, consistent with a diagnosis of amusia. This case highlights the importance of eliciting less common isolated neurologic symptoms in patients with an otherwise normal examination, including musical symptoms. We also highlight the utility of tools such as the MBEA to document the severity of amusia and potentially to follow patients' progress as they recover.

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.

Microlearning is the acquisition of knowledge or skills in small units, commonly delivered by digital technology. NeuroBytes (NB) and Question of the Day (QOD) are 2 microinstructional programs in neurology. NB programs are brief, video-based mini-courses on clinical topics (microteaching); QODs are daily multiple-choice questions (microassessment). The aim of this study was to understand how neurologists use NB and QOD and to explore their influence on clinical practice, education, and lifelong learning. Purposive sampling was used to recruit neurologists or trainees who completed at least 1 NB program or 25 QODs within the past 3 months. Individual semistructured interviews were conducted to explore participants' use of NB/QOD, what they perceived as gained from the product, how learning influenced their practice, and how this influenced lifelong learning. Thematic analysis was conducted to generate codes and describe themes emerging from the data. A total of 28 participants were interviewed. Neurologists were enthusiastic to use NB and QOD. Three themes were identified. NB and QOD were used to (1) enhance teaching, (2) influence clinical care, and (3) facilitate lifelong learning. Enhancing teaching: Interviewees used knowledge gained from NB/QOD in their own instruction and used NB/QOD with students. QOD was a model for writing their own assessments. Patient care: Respondents kept their knowledge current and reinforced concepts already known. QOD had less impact on patient care because it was used for identifying knowledge gaps, often outside the subspecialty niche. Lifelong learning: QOD was used to identify gaps in knowledge while NB filled educational gaps already recognized. NB and QOD were viewed as timesaving and could be completed on the fly. However, they were considered supplemental to other learning sources because they lacked depth. NB and QOD are convenient supplemental resources for teaching, learning, and augmenting clinical practice. Microteaching and microassessment delivered through these programs fulfilled different learning needs and have complementary educational roles.

As the concept of a clinician-educator (CE) evolves and the multiple competencies of the role become better defined, there seems to be a growing need for targeted training for clinicians pursuing a career in medical education. This study aims to describe the current state of CE tracks in adult neurology residency programs and to identify the barriers to implementation, potential solutions, and program goals and outcomes. We characterized CE tracks using 2 methods. First, we reviewed the websites of all US adult neurology residency programs to determine the availability of a CE track and its characteristics. Second, we administered a 20-item survey to program directors (PDs) of all US neurology residency programs, with questions focused on track availability, characteristics, perceived benefits of CE tracks on resident career development, barriers to implementation, and ideas for national initiatives that may facilitate track development or improvement. Fifty-eight of 177 (33%) PDs responded to the survey. Combining the results of the website reviews and surveys, we found that 34 of 179 (19%) programs have CE tracks. Seventy percent of PDs felt that CE tracks are very impactful or impactful for participating residents' careers, a perception more common among PDs of programs with tracks. The greatest perceived benefit was in preparing residents for educational leadership roles. The greatest barriers to implementation were a lack of teaching faculty, a lack of resources, and limited resident time. The highest ranked idea for a national initiative that can facilitate track development was live and recorded lectures on medical education topics. Although most PDs surveyed agreed that CE tracks are impactful for preparing residents as teachers and education leaders, such tracks are available in only 19% of adult neurology residency programs. PDs report that the benefits of CE tracks extend beyond the participants, with implications for the health of the residency program and the neurology department. While some programs have significant barriers to implementation, national initiatives may help reduce the resource burden on individual programs. Future areas of study include assessing the development and outcomes of national initiatives and analyzing the outcomes associated with CE tracks.

Residents are responsible for much of the formal and informal teaching of neurology clerkship medical students. High-quality resident teachers can enhance clerkship satisfaction, decrease neurophobia, and increase specialty interest. To train such residents, some institutions have developed resident as teacher (RAT) curricula. Existing RAT curricula are highly variable, partly because of our limited understanding of medical student attitudes and expectations regarding the qualities and skills of effective resident teachers. We sought to identify important themes in resident teaching, based on qualitative analysis of written evaluations by students, to better inform future RAT curricula in neurology. Clerkship student evaluations of residents from 2012 to 2023 at a single institution were collected and anonymized. The narrative comments were thematically coded using conventional content analysis in an iterative process of reconciliation and recoding. Randomly selected evaluations were analyzed in batches of 50 at a time until thematic saturation was achieved. A total of 200 evaluations yielded 6 themes with 27 subthemes: (1) Work-based learning, teaching and assessment: "sets expectations," "student involvement in care," "student autonomy over care," "helps students prepare/practice," "gives feedback," "mentorship and coaching," and "challenges students"; (2) Attitudes as teacher: "likes to teach," "made time to teach," "inspirational/fun," "patience," "approachability," and "learner-centric"; (3) Learning environment: "safety" and "clear communication"; (4) Role modeling: "knowledge," "skills," "attitudes," and "leadership"; (5) Content of teaching: "clinical skills," "medical knowledge," "nonmedical topics," and "directed to further learning"; and (6) Context of teaching: "bedside/in exam room," "attending rounds," "in workflow," and "break for teaching." The most prevalent subthemes were "student involvement in care," "gives feedback," "safety," "made time to teach," and "approachability." In their written evaluations of neurology residents, medical students identified many attributes, skills, and methods that led to a positive learning experience. Many of these themes highlighted the importance of residents facilitating work-based learning, cultivating the learning environment, and serving as role models rather than formal teaching activities alone. We provide recommendations for further RAT curricular development informed by these results. Using these findings, we further illustrate how residents influence the tripartite interaction between the learner, their subject, and their environment seen in existing learning theories.

Introduction and Problem Statement There is a need for structured EEG education opportunities to enhance neurology resident education. To address this need, the American Epilepsy Society (AES) supported the development and implementation of both synchronous and asynchronous EEG courses. Objectives To produce EEG curricula that enhance resident EEG learning, increase interest in EEG and improve participants9 knowledge, and to ensure that courses were highly used and available to the broadest range of learners. Methods and Curriculum Description A multi-institutional group of EEG educators developed both courses. The synchronous curriculum consisted of a mixture of brief “mini-lectures” and interactive small group activities with self-assessment quizzes at the start and end of the course. The online asynchronous EEG curriculum consisted of self-directed slide sets, multiple-choice self-assessment quizzes and a structured EEG self-assessment tool. Courses were evaluated using postcourse surveys, analysis of pretest and posttest data, and analysis of user data from the asynchronous curriculum. Results and Assessment Data Between 2019 and 2021, 56 residents participated in the synchronous EEG courses. On the resident survey, mean Likert scores for course design, planning, and learning outcomes ranged from 4.6 to 5.0 for the in-person courses and from 3.9 to 4.5 for the virtual course. On the 24-item pretests and posttests, overall median scores increased from 60% (14.5/24) to 75% (18/24; p < 0.001). More than 2,300 learners completed the first submodule of the asynchronous curriculum, but only 164 completed all sections. Most of those who completed the asynchronous curriculum reported that it was effective and appropriate for resident-level learning. Discussion and Lessons Learned The AES EEG courses provide EEG learning opportunities for neurology residents beyond what is available at their home institutions. There is evidence for the effectiveness of the synchronous course, but the scope is limited to a small number of attendees. The asynchronous curriculum is more broadly available, but very few learners completed all elements. Future steps will include expansion of the in-person synchronous course and providing guidance to learners about the core and optional components of the asynchronous curriculum to increase the impact of both educational offerings.