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Exposing Trainees to Headache Medicine Improves Knowledge and Test Scores

‚ÄčNeurology residents who took a series of courses dedicated to the treatment and diagnosis of headache performed significantly better on tests after attending the sessions, researchers reported at the virtual annual scientific meeting of the American Headache Society.

The research team reported improvements in mean scores between the pre-test and post-test assessments of knowledge of headache therapy and medications, in general, and more specifically, on providing nerve blocks and onabotulinumtoxinA injections.

In their pre-quiz evaluations, neurology residents achieved a score of 6.89, but by the time they had finished the sessions their mean score was 7.83, a statistically significant improvement (p=0.005), reported Candice Todd-Aziz, MD, MSc, a fourth year adult neurology resident at the University of Toronto.

The residents, both in neurology and others who participated in the educational sessions, had positive scores in a variety of components of the testing, Dr. Todd-Aziz told Neurology Today At the Meetings.

Dr. Todd-Aziz said that the results are preliminary, however. Thus far, a total of 59 residents have consented to participate in the study and of these, 31 (52.5 percent) completed all surveys.  "Preliminary results show that 100 percent of residents believed that they improved their clinical approach to headache patients post-rotation and 73.9 percent felt that their interest in headache medicine changed following the rotation."

The quality improvement study was conducted at the Centre of Headache at Women's College Hospital in Toronto. Recruitment for the study began in 2018, and included all residents rotating, including those in adult and pediatric neurology, family medicine, and anesthesia.

Only the neurology residents took the pre-test and post-tests. More than half the residents who participated in the program were in their second post-graduate year of training. Sixty percent of the participants completed five or more sessions. About half the residents performed nerve blocks and administration of onabotulinumtoxinA as part of the program.

"We are still going through the data but when we look at each question there is a lot of variability in resident answers," said Dr. Todd-Aziz. "Some of the questions show statistical significance and some do not," she said in her oral presentation.

"COVID-19 has obviously impacted our ability to recruit residents into the study," Dr. Todd-Aziz continued. "All of us have been redeployed to hospital service and we have not been in the outpatient clinics. Our program is slowly returning to clinics in person and once we do we will continue recruitment."

Dr. Todd-Aziz said her goal was to encourage universities in Canada to include a aanmandatory headache curriculum in their neurology programs. "I really believe that headache is undervalued and the whole purpose of this study is to show that we need this teaching and that in fact residents want this teaching experience as well," she said.

Commenting on the study, Mia Minen, MD, a headache specialist and associate professor of neurology and population health at NYU Langone Health, said: "These authors are doing important work in having residents gain exposure to headache and reflect on their own exposure to headache in training. There is a huge need to expose trainees to headache medicine, especially at the residency level so that residents can learn about headache medicine as a specialty. Moreover, even if residents choose not to pursue headache medicine, it is important for them to learn about headache medicine from experts because headache is one of the most common complaints in the primary care setting."

"We need more headache specialists," Dr. Minen said. 

Disclosures: Drs. Todd-Aziz and Minen had no disclosures.

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AHS Abstract: Todd-Aziz-CM. Trainee headache and education management (THEME) study.