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.
Reader response: Education research: The current state of neurophysiology education in selected neurology residency programs
I read with interest the Resident & Fellow Education Research article by Daniello and Weber1 on the current state of neurophysiology education in neurology residency programs. The authors found that the majority of residents graduate without meeting level 4 Accreditation Council for Graduate Medical Education (ACGME) milestones in EEG and EMG (EMG > EEG). Inpatient service demands and time constraints on residents were reported as the major cause of resident failure to meet ACGME milestones. The last few decades have witnessed a knowledge explosion in neurology. Somehow, the knowledge explosion and knowledge divide needs to be bridged, especially by residents in training. The 80-hour work week restriction placed by ACGME needs to be relaxed so that residents can be exposed to various neurology subspecialties, or we risk having many of our patients with epilepsy and neuromuscular disorders receive suboptimal care from these doctors in the future.
Training the future neurology workforce
Objective: To address training demands on future neurologists, the American Academy of Neurology (AAN) surveyed its US members as to their views about training the future neurology workforce. Methods: The survey was mailed to 575 US neurologists and 425 residents/fellows. Respondents (54%) were asked about their perceptions of current and future educational programs and settings needed to improve practice competence; issues related to subspecialization; and the role of non-neurologists in providing neurologic care. Views of neurologists were compared with those of neurology residents/fellows. Results: Most respondents support additional training in outpatient, community, and staff model health maintenance organization settings. The majority of respondents oppose a required fifth year of training or a yearly competency examination, but neurologists who have a subspecialty interest and residents/fellows favor elective certification and higher fees by subspecialists. General neurologists oppose these ideas. Most neurologists feel that primary care physicians, nurse practitioners, and physician assistants can manage uncomplicated neurologic problems, although residents/fellows are less willing to accept the role of nonphysician providers for neurologic services. Conclusions: Neurology educational programs should consider addressing deficiencies that today’s practitioners perceive. Increasing subspecialization, although favored by most neurologists, creates a challenge for the neurologic community as neurologists without subspecialty training see this trend as a threat to their livelihood.