A medical education initiative for internal medicine residents and medical students that offers instruction on assessing common neurologic conditions boosted trainees' confidence in caring for neurology patients and could help address the US neurologist shortage, a new report suggested.
Bedside Rounding Alliance for Internal Medicine and Neurology Residents (BRAINs) moves training from the lecture hall to the bedside, offering instruction on obtaining a focused neurologic history and performing a focused neurologic physical exam for common neurologic symptoms.
Almost 100% of trainees surveyed gave the program a favorable rating, citing patient exposure and bedside training from neurology educators as keys to its success.
As internal medicine providers are often "the first to lay eyes" on patients with a neurology complaint, it's important they "have a basic level of comfort" in addressing patients' common questions and concerns, study author Prashanth Rajarajan, MD, PhD, a resident in the Department of Neurology at Brigham and Women's Hospital, Boston, told Medscape Medical News.
The findings were presented on April 17 at the American Academy of Neurology (AAN) 2024 Annual Meeting.
Addressing 'Neurophobia'
Neurology is often viewed by medical trainees as the most difficult subspecialty, Rajarajan said. Many have what he calls "neurophobia," which he defines as "a discomfort with assessing and treating neurologic complaints."
A survey at his institution showed 62% of internal medicine residents lacked the confidence to diagnose and treat neurologic diseases, he reported.
BRAINs is a structured neurology trainee-led, inpatient bedside teaching session for internal medicine residents, medical students, and others that aims to increase trainees' confidence in assessing patients with common neurologic symptoms.
The program includes a biweekly 45-minute session. Most of the session is spent at the bedside and involves demonstrations and practice of a focused neurologic history and physical exam.
Participants receive feedback from educators, typically neurology residents or fellows in epilepsy, stroke, or some other neurology subspecialty. It also includes a short discussion on pertinent diagnostics, management, and other topics.
Surveys evaluating the program and teaching skill development were completed by 59 residents and 15 neurology educators who participated in BRAINs between 2022 and 2024.
Over 90% (54) of trainees agreed BRAINs sessions met the program's objective (five were neutral); 49 agreed it increased confidence in taking a neuro history (nine were neutral and one disagreed); 56 felt it boosted their confidence in doing a neuro exam (three were neutral); and 56 said BRAINs is more effective than traditional lecture-based didactics (three were neutral).
All the residents rated the material covered as appropriate for their level of training; 88% considered the 45-minute session length appropriate; and 98% had a favorable impression of the program as a whole.
When asked to identify the most helpful aspect of the program, 82% cited more patient exposure and 81% more bedside teaching.
All educators reported that the sessions were an effective way to practice near-peer teaching skills. Most (87%) felt the experience was more effective at accomplishing learning objectives than preparing and giving traditional didactic lectures, and 80% agreed it also gave them an opportunity to get to know their medical colleagues.
Use It or Lose It
Rajarajan noted that the program doesn't require significant planning or extra staff, is not resource-intensive, and can be adapted to different services such as emergency departments and to other learner populations.
But time will tell if the newfound confidence of those taking the program actually lasts.
"You have to keep using it," he said. "You use it or lose it when comes to these skills."
Commenting on the initiative for Medscape Medical News, Denney Zimmerman, DO, Neurocritical Care Faculty, Blount Memorial Hospital, Maryville, Tennessee, and co-chair of the AAN session featuring the study, called the program a good example of one way to counteract "neurophobia" and address the widespread neurologist shortage in the United States.
A 2019 AAN report showed that by 2025, almost every state in the United States will have a mismatch between the number of practicing neurologists and the demand from patients with neurologic conditions. The report offered several ways to address the shortage, including more neurology-focused training for internal medicine doctors during their residency.
"They're usually on the front line, both in the hospital and in the clinics, and can help expedite patients who need to be seen by neurology sooner rather than later," Zimmerman said.
Zimmerman noted the study assessed how well participants perceived the program but not whether it improved their skills.
He also pointed out that different groups may assess different diseases during their training session. "I think it's important to ensure you're hitting all the major topics."
The study received funding from MGB Centers of Expertise Education Grant. Rajarajan and Zimmerman reported no relevant conflicts of interest.