Curriculum Innovations: A Comprehensive Teleneurology Curriculum for Neurology Trainees

Abstract

Introduction and problem statement: As the role of teleneurology expands, it is important to prepare trainees to perform virtual encounters proficiently.

Objectives: We created a comprehensive multimodality teleneurology curriculum for residents to teach key aspects of telehealth encounters including the virtual examination and skill development across several environments.

Methods and curriculum description: We developed and implemented a teleneurology curriculum focused on teaching the virtual neurologic examination, measuring teleneurology competency, and providing opportunities for trainees to perform telehealth encounters in multiple settings. Residents (N = 22) were first surveyed on what methods would be most helpful to learn teleneurology. Trainees observed a faculty member conducting a teleneurology visit with another faculty member playing a patient. Residents then practiced a teleneurology encounter during a 10-minute objective structured clinical examination (OSCE) at a simulation center. After positive feedback from the fall of 2020, we adapted the OSCE to be completely remote in the spring of 2021 for senior residents. Trainees then performed teleneurology visits during their continuity clinics and subspecialty clinic rotations.

Results and assessment data: All neurology residents from adult and child neurology and neuropsychiatry programs at New York University Grossman School of Medicine participated in the curriculum. Residents identified a variety of teaching modalities that would help them learn teleneurology: didactics with slides (25%), live demonstration (25%), simulated experience (23%), starting with live patients (23%), and articles/reading material (4%). To date, 68 trainees participated in the OSCE. Trainees who completed on-site and remote simulations reported increased comfort (p < 0.05) and interest in teleneurology (p < 0.05) and requested more access to simulations during training. Sensorimotor assessment and adequate visualization of the affected limb were identified as areas for improvement.

Discussion and lessons learned: Our multimodal 3-year teleneurology curriculum provides opportunities for residents to learn and apply teleneurology. Survey tools helped strengthen the curriculum to optimize educational potential. We implemented a teleneurology simulation with and without the use of a simulation center. We plan to expand our teleneurology clinical and simulation experiences to trainees based on our data and further developments in teleneurology and to track the progress of teleneurology skills as residents advance through training.

Figure 1. Overview of the Teleneurology Curriculum and the Participants

This schematic summarizes the details of the curriculum and the timing of the curricular activities. (A) Exhibits the major teleneurology-related activities at specific training years. (B) Summarizes major learning goals of these teleneurology-related activities, the relevant assessment tools, as well as the participant demographics. OSCE = objective structured clinical examination.

Figure 2. Major Findings From the Precurricular Survey of the Trainees

This needs assessment was completed by the trainees anonymously prior to the start of the curriculum. Many trainees felt comfortable taking a history virtually but did not feel confident performing a neurologic examination virtually. The trainees felt that a variety of teaching modalities would be helpful in learning teleneurology. HPI = history of the present illness.

Figure 3. Trainees' Interest in and Comfort With Teleneurology Pre- and Postsimulation

This comparison of interest in and comfort with teleneurology were reported by the trainees after the OSCE. Both levels of interest in and comfort with teleneurology increased postsimulation in on-site and remote settings.

Figure 4. Trainee Performance on Completing Telemedicine Tasks During the OSCE

Trainee performance on completing telemedicine tasks was assessed by the SP and categorized into “not done”, “partially done” or “well done” based on a predetermined criteria. Most of the trainees scored “well done” or “partially done” on the telemedicine tasks. OSCE = objective structured clinical examination; SP = standardized patient.

Figure 5. Trainee Performance on Completing Examination During the OSCE

Trainee performance on completing telemedicine tasks was assessed by the faculty observer and categorized into “not done”, “partially done”, or “well done” based on a predetermined criteria. Many components of the neurologic exam were “not done” or “partially done”. OSCE = objective structured clinical examination.