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Emergency Neurology Oral Cases for Trainee Assessment and Education

Loochtan, Aaron I., DO*; Spector, Andrew R., MD*; Sinha, Saurabh R., MD, PhD*; Lerner, David P., MD

doi: 10.1097/NRL.0000000000000217
Original Articles

Objectives: Neurological emergencies comprise much of neurology residency, but there may be a lack of clinical experience. For our program, oral examinations have been used to assess resident readiness for additional clinical independence. In this study, we examined the perceptions of learners and examiners of oral case examinations.

Methods: Six attending physicians administered case-based oral examinations to 8 trainees. Each case involved a chief complaint and progressed through a clinical encounter. Following the examination, each attending physician and trainee completed an online 5-point Likert scale survey of content and educational value. Statistical analysis of point assignment based on Likert scale responses was performed.

Results: Six attendings (100% response) and 7 trainees (87.5% response) completed the assessment. The trainees assessed all 6 cases. Residents had negative responses for 3 cases with specific concern in “feedback” and “learning experience.” Residents responded with less positive response than attendings for “The case is easy to understand and progressed in a logical fashion” (3.90 for residents vs. 4.83 attendings; P=0.015) and “The case complexity is appropriate for level of training” (4.14 vs. 4.83; P=0.033). Attendings noted better understanding of trainees thought processes following oral examinations. Trainees noted feedback as the most useful component of case-based assessments.

Conclusions: Case-based assessment in neurology training allows for rapid evaluation of trainees’ abilities to critically think. There is general agreement from attendings and trainees that case-based assessment is a useful and positive learning tool. The responses from this survey are being used to modify the cases for future examinations.

*Department of Neurology, Duke University Medical Center, Durham, NC

Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA

A.I.L. and D.P.L.: drafted and revised both the questionnaire and manuscript. A.I.L., A.R.S., S.R.S., and D.P.L.: have read and reviewed the manuscript and is responsible for the overall content of the article. A.R.S.: conducted the survey and reviewed the results. A.R.S. and S.R.S.: revised both the questionnaire and manuscript. D.P.L.: He completed the statistical analysis of the survey results.

The authors declare no conflict of interest.

Correspondence to: David P. Lerner, MD, Department of Neurology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805. E-mail:

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