S. Andrew Josephson

A combination of MRI perfusion and metabolic biomarkers significantly improved diffusion reversal prediction performance and refined ischemic core volume estimation in patients with acute ischemic stroke for whom reperfusion was successful.

While academic centers have traditionally valued faculty research and educational accomplishments, clinical excellence is often assumed or underappreciated. Accordingly, neurology residency programs frequently offer structured pathways for aspiring clinician-scientists or educators, but few offer dedicated training to launch residents into academic careers focused on clinical mastery. Guided by self-regulated learning principles and the Master Adaptive Learner framework, the aim of this curriculum was to equip neurology postgraduate year (PGY)-4 residents with the foundational skills of the master clinician by advancing the following: (1) clinical acumen and diagnostic reasoning; (2) a scholarly and evidence-informed approach to their work; (3) outstanding communication, professionalism, and humanism; and (4) effective navigation and leadership within complex health care systems. Using the Kern six-step curriculum design framework, we developed a 6-month Master Clinician track that included didactics, customized clinical rotations, reflective patient portfolios, and a scholarly project. Didactics addressed topics such as cognitive bias, adaptive expertise, communication, and clinical uncertainty. Clinical rotations were learning-focused experiences tailored to resident interests. Track residents maintained 2 patient portfolios: one for in-depth case analysis (“depth” portfolio) and another to track diagnostic accuracy (“breadth” portfolio). The scholarly project reinforced a reflective approach to patient care and promoted academic inquiry skills. Assessments of the track included an exit survey on completion, patient portfolio audits, and post-track surveys for 3 years after graduation from residency. Five residents completed the track in the first 5 years (2017–2022). Baseline residency milestone ratings were similar between participants and nonparticipants. Track components received high ratings (≥4.6 on a 5-point scale), with didactics on cognitive bias and teaching skills rated highest. Portfolios averaged 32 cases (breadth) and 8 cases (depth). Residents highlighted clinical uncertainty, communication, and cognitive bias as the most relevant sessions for patient care. Over 3 years of follow-up, high satisfaction with the track persisted and most enrollees elected academic clinical or clinician-educator careers. A residency track that used didactics, customized clinical experiences, case-tracking, and reflective practices to foster clinical excellence was well received by residents. Neurology programs should consider similar tracks to develop academic clinicians focused on excellence in patient care.

Pressures on academic physician educators to generate clinical revenue or research grants may threaten faculty engagement as teachers. Neurology has historically prized its outstanding educators, but programs that provide financial support for teaching are lacking. We developed an opt-in, financial, teaching incentive program in an academic neurology department and evaluated its impact on faculty experience, motivation, and identity. We applied a change management framework and conducted a National and local needs assessment before designing an education value unit (EVU) system using time-based metrics and rates reflecting impact on clinical revenue. Activities essential for graduation of students and residents that reduced clinical revenue generation were included. Faculty self-reported teaching through an online platform and received an incentive payment at the end of each year. Following a 6-month pilot, faculty participated in a 3-year implementation phase followed by an evaluation through faculty survey and semistructured interviews. In the first 3 years of the program, 42, 56, and 54 faculty enrolled, representing 28% of faculty by year 3. Faculty reported an average of 1,488 hours of teaching annually, drew from 13 divisions, and included all ranks (51% assistant, 29% associate, and 20% full). Fifty-five percent of participating faculty (N = 30) completed a survey to evaluate the incentive program. The majority agreed or somewhat agreed that the program had met its goals (80%–92%), reduced barriers to teaching (56%), and the department highly valued teaching (93%). Semistructured interviews with 11 participating faculty identified 5 themes regarding the impact of the program on faculty experience, including (1) supporting the choice of faculty to teach even when time is scarce, (2) making teaching visible to oneself and others, (3) directing faculty toward eligible teaching opportunities, (4) communicating the department's commitment to education, and (5) reinforcing educator identity and sense of belonging. The development of a teaching incentive program at an academic neurology center is feasible with benefits extending beyond the incentive payment itself. Although EVU programs are not without limitations, faculty experienced the program as reflective of the department valuing its educators, which reinforced their educator identity and engagement in teaching.

Objective: Training clinician–scientists is a primary objective of many academic neurology departments, as these individuals are uniquely positioned to perform insightful clinical or laboratory‐based research informed both by clinical knowledge and their own experiences caring for patients. Despite its importance, training clinician–scientists has perhaps never been so challenging. The National Institute of Neurologic Disorders and Stroke (NINDS) R25 program was designed in an attempt to support these individuals, decrease the time needed to obtain National Institutes of Health K awards, and to help educate a cohort of trainees preparing for a career in academic neurology. We endeavored to describe the structure and features of the program while examining its outcomes.Methods: R25 outcome data from 2009 to 2024 were reviewed. Statistical comparisons were made using 2‐sided Mann–Whitney U testing.Results: A total of 67% of adult neurologists who received an R25 had a successful application for a National Institutes of Health K award compared with 45% of adult neurologists who had not received R25 support (p < 0.0001). Among child neurologists, 73% who applied went on to receive K funding after R25 support, compared with 45% who had not been part of the R25 program (p < 0.001). The average time between completion of residency and obtaining a K award for R25 participants was decreased by 26 months among those with an MD/PhD degree, and 32 months for those with an MD degree compared with non‐R25 individuals.Interpretation: The R25 program has been successful in achieving its training goals, but stands as only one component of support for aspiring clinician–scientists. Investments and commitments made by academic neurology departments are key to supporting this success. ANN NEUROL 2024;96:625–632

As we turn the page on 2023, we here at JAMA Neurology want to once again thank all of our readers, authors, and peer reviewers (who are listed elsewhere) for t

We are pleased to announce that JAMA Neurology is offering a 1-year editorial fellowship position for a qualified individual. The fellow will receive hands-on training in the editorial processes and policies of a neurology journal and will be well prepared to take an editorial role in a peer-reviewed publication at the end of the fellowship. The JAMA Neurology editorial fellowship is open to neurologists who are no more than 10 years from their completion of residency/clinical fellowship. Current residents and fellows are encouraged to apply. Applicants should have or be planning to have an academic position. Research experience is encouraged. We encourage neurologists from various underrepresented backgrounds in medicine to apply for this fellowship.

We describe a case of a 41-year-old male with a history of end-stage renal disease, hypertension, epilepsy, ischemic stroke, and traumatic brain injury transferred to our tertiary care center for subacute, progressive cognitive impairment. He was found to have disproportionate brain atrophy, focal seizures, and refractory hypertension. Given suspicion for an underlying genetic etiology, a genetic panel for progressive renal disease was sent, revealing two known pathogenic variants in a gene for a cobalamin metabolism disorder, Cobalamin C deficiency. He was started on targeted metabolic supplementation with subsequent improvement in his cognition. Our case highlights the crucial need to expand diagnostic workup to include genetic and metabolic causes in patients with neurologic disease, atypical features, relevant family history and multi-organ dysfunction.

Reflecting on the last 12 months here at JAMA Neurology, I am struck by just how much the journal continues to thrive, thanks in large part to all of you. While

Objective: In 2017, the American Academy of Neurology (AAN) convened the AAN Quality Measurement Set working group to define the improvement and maintenance of quality of life (QOL) as a key outcome measure in epilepsy clinical practice. A core outcome set (COS), defined as an accepted, standardized set of outcomes that should be minimally measured and reported in an area of health care research and practice, has not previously been defined for QOL in adult epilepsy.Methods: A cross‐sectional Delphi consensus study was employed to attain consensus from patients and caregivers on the QOL outcomes that should be minimally measured and reported in epilepsy clinical practice. Candidate items were compiled from QOL scales recommended by the AAN 2017 Quality Measurement Set. Inclusion criteria to participate in the Delphi study were adults with drug‐resistant epilepsy diagnosed by a physician, no prior diagnosis of psychogenic nonepileptic seizures or a cognitive and/or developmental disability, or caregivers of patients meeting these criteria.Results: A total of 109 people satisfied inclusion/exclusion criteria and took part in Delphi Round 1 (patients, n = 95, 87.2%; caregivers, n = 14, 12.8%), and 55 people from Round 1 completed Round 2 (patients, n = 43, 78.2%; caregivers, n = 12, 21.8%). One hundred three people took part in the final consensus round. Consensus was attained by patients/caregivers on a set of 36 outcomes that should minimally be included in the QOL COS. Of these, 32 of the 36 outcomes (88.8%) pertained to areas outside of seizure frequency and severity.Significance: Using patient‐centered Delphi methodology, this study defines the first COS for QOL measurement in clinical practice for adults with drug‐resistant epilepsy. This set highlights the diversity of factors beyond seizure frequency and severity that impact QOL in epilepsy.