Education Research: The current state of neurophysiology education in selected neurology residency programs
Objective Prior research has illustrated there is a knowledge gap in neurology residents' neurophysiology education (EEG and EMG), and we sought to understand whether this is still an issue and to recognize the barriers in order to create solutions and improve education. Methods Surveys were developed for adult neurology residents and one for program directors asking about confidence in neurophysiology knowledge, percent of graduates reaching level 4 ACGME (American Council of Graduate Medical Education) milestones in EEG and EMG, methods of learning used, interest in the subjects, and suggestions for improvements. Results Twenty-six program directors (19% responder rate) and 55 residents (from at least 16 different programs) completed the survey. Program directors thought that 85% of graduating residents met level 4 milestones in EEG and only 75% in EMG. Structured rotations and more time allocated to education of these topics were frequent barriers mentioned. Postgraduate year 4 residents were 60% and 67% confident in EEG and 64%, 59%, and 62.3% in EMG level 4 milestones. Learning to read EEGs was considered important throughout residents' training; however, this interest and value decreased over time with EMG. Conclusion In our study, program directors suspect up to a quarter of residents may graduate not meeting level 4 ACGME milestones, and residents expressed lack of confidence in these areas. The educational methods used to instruct residents in EEG and EMG were similar as were the barriers they face across programs. This information hopefully will help fuel curriculum design and interest in these important neurology techniques.
The new Swiss postgraduate training (residency program) in neurology
Following the creation of the first university chair for neurology (Zurich 1894), the Swiss Neurological Society (SNG) was founded in 1908.. In 1932, neurology was recognized in Switzerland as an independent specialty and included in the medical (undergraduate) curriculum. The postgraduate training (residency program) in neurology lasted first 4 years (including 1 year of internal medicine, 0.5 years of psychiatry and 2.5 years of clinical neurology as mandatory rotations). In 1985, it grew to 5 years, and in 1996 to 6 years (including 1 year of internal medicine, 3 years of clinical neurology, and 1 year of clinical neurophysiology). Considering the results of a survey among young neurologists and “landscape changes” such as the increasing subspecialization, economic pressure, requirements for research, number of foreign doctors, and restrictions of working hours, the SNG undertook a revision which was approved in 2016. Today, the Swiss neurology postgraduate training includes 1 year of internal medicine, a “common trunk” of 3 years of general neurology (with 1 year of clinical neurophysiology including sleep), and 2 years of “fellowships” with rotations in different subspecialties and up to 12 months of research.
Use of the USMLE to select residents
Many studies have examined the relationships between students' performances on the National Board of Medical Examiners (NBME) Part I and Part II examinations and their postgraduate clinical performances. Most studies have found a positive relationship between students' NBME examination scores and the ratings of residents' clinical performances and/or scores on specialty board certification examinations. Surveys of residency directors have also shown that NBME scores are used as part of the process for selecting residents, although other data and other selection criteria are considered more useful than the NBME scores. One area of continued concern is that a large body of data on the United States Medical Licensing Examination (USMLE) is not yet available. However, the predictive validity of the NBME scores supports the use of USMLE scores as part of the review process to screen potential residents. Residency directors should continue to use a variety of criteria in their final selection decisions and are encouraged to use their own program-specific data to establish and monitor particular cutoff scores for screening applicants.