By Daniel B. Hier, MD, MBA, FAAN, Education Editor for AAN.com
The journal Neurology® is universally recognized for its excellence in publication. This column inaugurates an ongoing feature that will highlight some of the best articles published in Neurology with an emphasis on neurologic education. Each month I will provide article highlights and hyperlinks to the original articles.
Readers should note that some articles have appeared in both the print and online versions of Neurology, while others appeared only in the online version. When a page number is preceded by an "E," this indicates that the article is available only in the online edition of Neurology (e.g., "E43").
In the March 3 issue of Neurology, Joel C. Morgenlander, MD, FAAN, and Cheryl Bushnell, MD, MHS, of Duke University examine the problem of the Neurology Continuity Clinic for neurology residents (Neurology continuity clinic: Improving the timing of the experience. Neurology 2009;72:9;E43). In a pilot study approved by the Neurology Review Committee (NRC), Duke randomized five residents to either a traditional rotation with weekly continuity of care clinics during inpatient and outpatient rotations or a modified schedule in which residents did twice weekly sessions during outpatient rotations and reduced clinics during Neuro ICU and Consultation rotations. The goal was to reduce the stress of doing continuity of care clinics during demanding inpatient rotations. The new schedule was favored by three of five residents and 13 of the 15 faculty. The authors conclude that the Neurology Review Committee should consider allowing neurology programs to submit alternative schedules for continuity of care clinics for their residents.
In the March 10 issue, K. M. Kash, PhD, et al. from Thomas Jefferson University report on a web-based set of five clinical case simulations to meet Accreditation Council for Graduate Medical Education (ACGME) competencies in neurology (ACGME competencies in neurology: Web-based objective simulated computerized clinical encounters. Neurology 2009;72:893-898). The American Headache Society developed five web-based clinical case simulations to teach both headache diagnosis and treatment as well as ACGME-mandated core competencies. The five case simulations were thunderclap headache, migraine, cluster headache, chronic daily headache, and CADASIL. Residents took a 50-question pre-test and a 50-question post-test before and after completing the web-based computerized case simulations. Ninety-two residents in 40 neurology programs completed the web-based simulations. The mean score on the pretest was 30.08 rising to 34.79 on the post-test. This innovative web-based case simulation demonstrated the possibilities for web-based education for neurology residents.
In the March 10 issue, Theodore L. Munsat, MD, FAAN, et al. discuss the educational efforts of the World Federation of Neurology (WFN) in countries with limited medical resources (Educational programs of the World Federation of Neurology. Neurology 2009;72:10;E46-E49). The WFN supports development of neurology societies and indigenous neurology education programs when feasible. In a joint program with the AAN, the WFN has brought the Continuum: Lifelong Learning in Neurology® program to 42 countries including Brazil, India, Jordan, Kenya, and Zambia. The WFN has begun to help start these programs in countries lacking neurology training programs. Programs have been started in Nicaragua, Mexico, and Guatemala with WFN assistance. The WFN also has a certification program for neurology programs, an Africa initiative, and a program for countries with little or no neurology resources.
In the March 31 issue, Uzma Usman, MD, FCPS, describes the state of neurology training in Pakistan, a country of 150 million with only 85 consultant neurologists (Neurology training in Pakistan: my experience as a neurology resident, Neurology 2009;72:13;E58-E60). Usman describes training at the Aga Khan University Hospital in Karachi, and encounters with a wide spectrum of neurologic diseases during training, including stroke, epilepsy, movement disorders, CNS infections, and CNS tuberculosis. Usman describes the challenges facing neurology education in Pakistan, including the risk of losing new trainees to more resource-rich countries.
Each issue of Neurology offers a Resident and Fellow Section, which provides valuable teaching images.
Noteworthy contributions in March included images of the MRI and EEG of an eight-year-old boy with frontal seizures that mimicked psychogenic seizures (Neurology 2009;72:12;E56); images of the brain including CT, MR and autopsy of emboli from a rare fistula between the esophagus and left atrium due to esophageal carcinoma (Neurology 2009;72:12;E54-E55); MRI images of the so-called "Panda face" in a case of Wilson's disease (Neurology 2009;71:11;E50); and CT and angiographic images from a case of hereditary hemorrhagic telangiectasia or Osler-Weber-Rendu syndrome (Neurology 2009;72:10;E45).
Within the past 24 months, Dr. Hier received personal compensation for medical legal consulting and consulting to legal firms regarding medical malpractice issues. In that period he also served as editor for MDnetguide, and has given expert testimony, prepared a deposition, and/or acted as a witness or consultant in medical malpractice cases. Dr. Hier has received personal compensation in an editorial capacity for AAN.com.