Scoping Review: Innovations in Clinical Neurology Education

Abstract

Advances in adult learning theory and instructional technologies provide opportunities to improve neurology knowledge acquisition. This scoping review aimed to survey the emerging landscape of educational innovation in clinical neurology. With the assistance of a research librarian, we conducted a literature search on November 4, 2021, using the following databases: PubMed, Embase, Scopus, Cochrane Library, Education Resources Information Center, and PsycINFO. We included studies of innovative teaching methods for medical students through attending physician-level learners and excluded interventions for undergraduate students and established methods of teaching, as well as those published before 2010. Two authors independently reviewed all abstracts and full-text articles to determine inclusion. In the case of disagreement, a third author acted as arbiter. Study evaluation consisted of grading level of outcomes using the Kirkpatrick model, assessing for the presence of key components of education innovation literature, and applying an author-driven global innovation rating. Among 3,830 identified publications, 350 (175 full texts and 175 abstracts) studies were selected for analysis. Only 13 studies were included from 2010 to 2011, with 98 from 2020 to 2021. The most common innovations were simulation (142), eLearning, including web-based software and video-based learning (78), 3-dimensional modeling/printing (34), virtual/augmented reality (26) podcasts/smartphone applications/social media (24), team-based learning (17), flipped classroom (17), problem-based learning (10), and gamification (9). Ninety-eight (28.0%) articles included a study design with a comparison group, but only 23 of those randomized learners to an intervention. Most studies relied on Kirkpatrick Level 1 and 2 outcomes-the perceptions of training by learners and acquisition of knowledge. The sustainability of the innovation, transferability of the innovation to a new context, and the explanation of the novel nature of the innovations were some of the least represented features. We rated most innovations as only slightly innovative. There has been an explosion of reports on educational methods in clinical neurology over the last decade, especially in simulation and eLearning. Unfortunately, most reports lack adequate assessment of the validity and effect of the respective innovation's merits, as well as details regarding sustainability and transferability to new contexts.

Figure 1. PRISMA-ScR Flowchart of Study Inclusion

Flowchart of article inclusion phases. A total of 930 studies were included in full-text analysis and assessed by 2 screening authors, with 350 studies included in data extraction. PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

Figure 2. Defining Features of Education Innovation

Audit of all 175 full-text studies for the presence of Colbert-Gert et al. defined 12 key features of education innovation articles, represented in percentages.

Figure 3. Top Education Innovation Study Trends Over Past Decade

Most studied neurology educational innovations and their prevalence per year since 2010. A total of 4 studies published in 2010 included, with an increase to 54 published in 2021. Total studies included for each innovation: simulation (142 studies), eLearning (78 studies), 3D modeling/printing (34), virtual reality (26), and podcasts/smartphone app/social media (24). 3D = 3 dimensional.

Figure 4. Kirkpatrick Training Evaluation Outcomes per Innovation

Kirkpatrick training evaluation grades by level in total for each education innovation. There were 5 Level 3 studies and only 3 Level 4 studies. 3D = 3 dimensional; N/A = not applicable.

Figure 5. Clinical Content Areas (by Study)

Total number of studies focused on each clinical content area represented in the entire 350 studies included in the scoping review.

Figure 6. Study Design per Innovation

Number of total studies with study design details including full-text publications, comparative group design, medical student participation, and participant randomization for each innovation. 3D = 3 dimensional.