Characteristics of graduating US allopathic medical students pursuing a career in neurology

High-Yield, Case-Based, Interactive Workshop on Telehealth and Teleneurology With Pediatric Resident Physicians

Introduction

Increasing prevalence of neurologic disorders with an aging global population and limited availability of neurologists may lead to worse patient outcomes. As a result of the COVID-19 pandemic, telehealth services surged, and despite easing public health measures, the demand has remained. Telehealth technology has the potential to close the physical gaps in expanding the reach of care. This academic half-day workshop sought to provide a learning opportunity in response to these concerns.

Methods

The workshop consisted of small- and large-group case discussions among pediatric resident physicians (PGY 1-PGY 3) moderated by two child neurology faculty physicians over Zoom. Participants received a learner document with prereading articles and questions for each case. PowerPoint presentations with video demonstrations were used to introduce the cases and guide discussions.

Results

Of the 25 attendees, 14 (56% response rate) answered a nonmandatory postsession survey. Eighty-six percent of the respondents were very or extremely satisfied with the content covered and were similarly satisfied with the effectiveness of content delivery. Seventy-nine percent of the respondents found the content helpful or very helpful in preparation for the board, and 93% anticipated applying the content covered occasionally or frequently in their clinical practice.

Discussion

Small-group discussions with video demonstrations are helpful in increasing proficiency with telehealth technology and in examining board-relevant cases on pediatric patients. There is strong interest in subsequent telehealth half-day workshops that incorporate teaching through group discussions on relevant patient case scenarios.

Neurology Education in 2035: The Neurology Future Forecasting Series

In the past decade, there have been dramatic changes in all aspects of neurologic care, and along with this, neurology education has transformed. These changes have affected all aspects of education across the educational continuum, including learners, teachers, educators, content, delivery methods, assessments, and outcomes. Health systems science, health humanities, diversity, equity, and inclusion and health disparities are becoming core components of neurology curricula, and, in the future, will be integrated into every aspect of our educational mission. The ways in which material is taught and learned have been influenced by technologic innovations and a growing understanding of the science of learning. We forecast that this trend will continue, with learners choosing from an array of electronic resources to engage with fundamental topics, allowing front-line clinical teachers to spend more time supporting critical reasoning and teaching students how to learn. There has been a growing differentiation of educational roles (i.e., teachers, educators, and scholars). We forecast that these roles will become more distinct, each with an individualized pattern of support and expectations. Assessment has become more aligned with the work of the learners, and there are growing calls to focus more on the impact of educational programs on patient care. We forecast that there will be an increased emphasis on educational outcomes and public accountability for training programs. In this article, we reflect on the history of medical education in neurology and explore the current state to forecast the future of neurology education and discuss ways in which we can prepare.

The Neurology Fellowship Application Conundrum: Finding Common Ground

For many neurologic subspecialties, the fellowship application process begins early in the first half of the second year of neurology-specific training (PGY3 for adult neurology residents and PGY4 for child neurology residents). In 2019, the American Academy of Neurology (AAN) published a position statement recommending communication between fellowship candidates and training programs begin no sooner than March 1 of the penultimate year of training and that programs offer fellowship positions no sooner than August 1 of the final year of training. A few pilot subspecialties adopted this timeline for 2021 recruitment for positions beginning in 2022. All United States-based AAN-affiliated neurology and child neurology residents who recently completed the fellowship application process received a survey about their fellowship application experience. Of the 291 residents who responded to the survey, 96% agree that applications should not be submitted before March 1 of the penultimate year of training and 72% believe that August 1 of the final year is a reasonable time to begin offering positions. Nearly half (49%) of residents believe that there is too little time for subspecialty/clinical exposure before applying for fellowship and 88% feel the current process and timeline are stressful. Residents who applied to programs in pilot subspecialties report more time to choose, less stress, and a lower number of time-pressured offers. A large majority of residents (89%) prefer to submit a single application through a centralized system. The survey results suggest that residents who just completed the fellowship application process agree with the AAN recommended timeline for all subspecialties and that all neurology subspecialties should consider adopting a fellowship match. Programs can help facilitate a better fellowship application experience by providing earlier exposure to a broad range of neurologic subspecialties and ensure that residents are given opportunities to attend national meetings and participate in appropriately scoped scholarly endeavors.

Understanding How to Strengthen the Neurology Pipeline With Insights From Undergraduate Neuroscience Students

Despite increased neuroscience interest at the undergraduate level, a significant shortage of neurologists in the United States exists. To better understand how to generate more interest in neurology, specifically at the undergraduate level, we conducted an anonymous cross-sectional online survey comprising 1,085 undergraduates in either neuroscience courses or majoring/minoring in neuroscience from across the United States to better understand their clinical neurology experiences and perspectives. The survey quantitatively and qualitatively assessed students' clinical neurology exposure inside and outside of the classroom, research experiences, and career goals. Students were from a broad spectrum of undergraduate institutions (public research university [40.8%], liberal arts college [29.7%], and private research university [29.0%]). Most students (89.9%) were looking to pursue graduate studies; 56.9% reported wanting to be a physician, and 17.8% expressed interest in obtaining an MD/PhD. Of importance, students reported first exposure to neuroscience at age 16 years but felt that they could be exposed to neuroscience as early as 13 years. Half (50.5%) decided to major in neuroscience before college, and a quarter (25.6%) decided to major in their first year of college. Despite high interest in clinical neurology exposure, less than one-third of students had spoken with or shadowed a neurologist, and only 13.6% had interacted with clinical neurology populations. Only 20.8% of students felt volunteer and internship opportunities were sufficiently available. Qualitative results include student perspectives from those who did and did not work with a neurologist, describing how they were or were not able to obtain such opportunities. We discuss translating the survey findings into actionable results with opportunities to target the undergraduate neuroscience interest to improve the neurology pipeline. We describe existing programs that could be integrated into everyday neurology practices and new approaches to learning and training to help leverage the significant undergraduate neuroscience interest. We also raise questions for further research, including exploring (1) how students learn of neurologic conditions/expand their knowledge about additional neurologic conditions, (2) whether qualitative investigation of the experiences of neuroscience undergraduates at specific institutions might provide an additional insight, and (3) systems to maintain interest in neuroscience/neurology as students enter medical school.

Longitudinal Qualitative Study of Career Decision-making of First-Year Medical Students: Why Neurology (or Not)?

Objective

The growing shortage of neurologists is in part due to suboptimal recruitment. Little is known about students' decision making regarding a career in neurology, particularly early in training. Using a longitudinal qualitative approach, we aimed to understand factors that influence first-year medical students' decisions about neurology.

Methods

We conducted 1-on-1 semistructured interviews with 15 first-year medical students at 1 institution before and after the preclinical neurology course (2018-2019). In the first interview, we asked about career intentions, factors likely to influence specialty choice, and perceptions of neurology. In the second interview, we asked about changes in students' views over the year. Using thematic analysis, we generated codes and clustered coded data into themes.

Results

The 2 most prominent factors influencing career choice in general were lifestyle and personal interest. No students expressed concerns about lifestyle in neurology. Most students were neutral about neurology or had a positive personal interest, which typically increased after the neurology course. Students frequently worried about content difficulty and the curative potential of neurology.

Conclusions

Interventions should include early education about the factors important to students in determining specialty choice, including lifestyle, and address potentially negative perceptions of neurology. Increasing time allotment to the preclinical neurology course may combat perception of the content as difficult.

Trends in Demographics of Neurology House Staff in the United States

Background The lack of an adequate number of neurologists is a worldwide problem. As populations age, the prevalence of neurological disorders will likely increase, thereby increasing the demand for neurologists. In addition to the growing demand, inadequate diversity in the neurology healthcare workforce still exists. The purpose of this study is to examine the demographic characteristics of neurology residents and fellows. Methodology This cross-sectional study used data from the following publicly available databases: Accreditation Council for Graduate Medical Education, Association of American Medical Colleges, and the United States Census Bureau. Trends (from 2007 to 2018) in demographic characteristics were assessed using the slope and the associated p-value of a simple linear regression model, with the year as the independent variable. All p-values of <0.05 were considered significant. Results From 2007 through 2018, the percentage of US medical school graduates in neurology residency decreased from 58% to 55% (slope = -0.25; p = 0.0004), while the percentage of international medical graduates (IMGs) decreased from 36% to 32% (slope = -0.29; p = 0.0141) and doctor of osteopathy (DO) graduates increased from 6% to 13% (slope = 0.58; p < 0.0001). Although the percentage of female neurology residents increased from 39.5% in 2007 to 43.1% in 2018 (slope = 0.03; p = 0.8659), female physicians were underrepresented in vascular neurology fellowship (34% in 2018). Collectively, the percentage of underrepresented minorities in neurology residencies was low and increased only slightly over time (from 8% in 2011 to 9% in 2018; slope = 0.17; p = 0.0788). In 2018, the proportion of underrepresented minorities was smaller in neurology fellowships (5.5% neurophysiology, 12.5% epilepsy, 10.4% neuromuscular, and 12.4% vascular) compared to the population as a whole (31.3%). Conclusions IMGs still play an important role in filling a significant portion of the neurology residencies and fellowships. DO graduates have slowly increased in neurology residencies and fellowships. Members of several racial/ethnic minority groups and women are underrepresented in neurology house staff and efforts need to be taken to increase diversity.

Neurological interest and career exploration among black medical students: Perceptions and solutions for the pipeline

PURPOSE

The goal of this study was to identify factors that influence the selection of Neurology as a career choice for Black medical students.

METHODS

Survey data was collected from attendees at a national educational conference and at a large academic medical school. Two proportion z-tests were used to assess responses among students of different racial/ethnic backgrounds.

RESULTS

199 students participated in the survey. Compared to their Asian and White counterparts, Black students were significantly less likely to choose or consider a career in Neurology. In addition, we found that these students relied more heavily on their pre-clinical experiences to make this determination, citing preference for another specialty, lack of exposure, a preference for a different patient population, and a lack of racial/ethnic diversity as key reasons to not choose a career in Neurology.

CONCLUSIONS

Neurological disorders are important contributors to morbidity and mortality. It is imperative that the field attract medical students toward careers in Neurology, particularly those students from traditionally and persistently underrepresented backgrounds. Our findings suggest that Black medical students consider Neurology as a specialty choice less frequently than their counterparts do, and this decision may be made prior to training. We conclude that a multifaceted approach is best to improve the racial/ethnic diversity within the neurological workforce, which should include targeted interventions prior to and after matriculation to medical school.

A Shortage of Neurologists - We Must Act Now: A Report From the AAN 2019 Transforming Leaders Program

In nearly every US state, a large mismatch exists between the need for neurologists and neurologic services and the availability of neurologists to provide these services. Patients with neurologic disorders are rising in prevalence and require access to high-level care to reduce disability. The current neurology mismatch reduces access to care, worsens patient outcomes, and erodes career satisfaction and quality of life for neurologists as they face increasingly insurmountable demands. As a community, we must address this mismatch in the demand and supply of neurologic care in an aggressive and sustained manner to ensure the future health of our patients and our specialty. The American Academy of Neurology has multiple ongoing initiatives to help reduce and resolve the existing mismatch. With the intent of raising awareness and widening the debate nationally, we present a strategic plan that the Academy could implement to coordinate and expand existing efforts. We characterize the suggested strategies as shaping the demand, enhancing the workforce, and advocating for neurologist value. The proposed framework is based on available data and expert opinion when data were lacking. Prioritization of strategies will vary by geography, practice setting, and local resources. The time to act is now to allow concerted effort and targeted interventions to avert this looming public health crisis.

The impact of student debt on neurological practice

The median cost of attending medical school is rising annually, and with it, student debt. Neurology residents have stepped up during the pandemic to answer the call of a health system at its breaking point. In this article, we outline how this escalating problem of student debt affects the neurology pipeline, the wellbeing and career decisions of current neurology trainees and practicing neurologists and through it, and the gap in healthcare. We describe currently available options for loan repayment and call for advocacy and legislation to address this mounting burden as a means to improve neurological care in the United States.

Career choice and influential factors among medical students majoring in psychiatry in China

BACKGROUND

The undergraduate program of psychiatry has been widely established in recent years to improve the education and recruitment of psychiatrists in China. We aim to investigate the career choice of medical students majoring in psychiatry in China and the influential factors.

METHOD

This multicenter study was conducted in 26 medical schools in China from May to October of 2019. Participants included 4610 medical students majoring in psychiatry and 3857 medical students majoring in clinical medicine. Multivariable logistic regression was used to investigate the influential factors of students' choices of psychiatry at matriculation and as a career.

RESULTS

44.08% of psychiatry majored students gave psychiatry as a first choice at matriculation, and 56.67% of them would choose psychiatry as a career, which was in sharp contrast to the proportion of clinical medicine majored students who would choose psychiatry as a career (0.69%). Personal interest (59.61%), suggestions from family members (27.96%), and experiencing mental problems (23.19%) were main reasons for choosing psychiatry major at matriculation. Personal interest (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.87-2.40), experiencing a psychiatry clerkship (OR = 1.99, 95% CI = 1.28-3.08), being female (OR = 1.50, 95% CI = 1.30-1.68), experiencing mental problems (OR = 1.33, 95% CI = 1.28-1.56), and suggestions from family members (OR = 1.25, 95% CI = 1.08-1.46) correlated positively with students' choice of psychiatry as career. Students who lacked psychiatry knowledge (OR = 0.49, 95% CI = 0.29-0.85) or chose psychiatry because of lower admission scores (OR = 0.80, 95% CI = 0.63-0.97) were less likely to choose psychiatry as a career.

CONCLUSION

More than half of psychiatry majored medical school students planned to choose psychiatry as their career, whereas very few students in the clinic medicine major would make this choice. Increasing students' interest in psychiatry, strengthening psychiatry clerkships, and popularizing psychiatric knowledge are modifiable factors to increase the psychiatry career intention. The extent to which medical students' attitudes toward psychiatry can be changed through medical school education and greater exposure to psychiatry will need further investigation.

Educational Research: Why Medical Students Choose Neurology: A Computational Linguistics Analysis of Personal Statements

OBJECTIVE

To understand medical students' motivations for choosing neurology and how applicants conceptualize the field, as this information can be used to enhance interest in neurology and develop educational programs to help identify, support, and recruit future neurologists.

BACKGROUND

Applicants to neurology residencies submit personal statements describing themselves and their motivations. Textual analysis of personal statements has been performed in internal medicine and general surgery, but never before in neurology. We hypothesized that specific words and themes would be mentioned in residency personal statements with high frequencies indicating students' motivations.

METHODS

We used computational linguistics software to assess key words and thereby study motivations, expectations, and themes present among neurology applicants. A total of 2,405 personal statements submitted over 5 years to our institution were de-identified and compiled into a database for evaluation through 3 computational linguistics software programs. We performed calculations of term frequencies (TF) and TF-inverse document frequencies and performed K-means clustering to identify unique words and common themes.

RESULTS

Specific disease states were discussed. For example, stroke (TF 2,178), epilepsy (TF 970), and dementia (TF 944) were referenced more often than amyotrophic lateral sclerosis (TF 220) and carpal tunnel (TF 10). The most common proper names cited were Oliver Sacks (TF 94) and Sherlock Holmes (TF 41). Common themes included fascination with the brain, interest in research, desire to help patients, early interests in neurology, continued pursuit of learning, appreciation for time with patients, family history with neurologic illness, and intellectual curiosity.

CONCLUSIONS

This first computational linguistic analysis of neurology personal statements provides understanding into medical students' motivations and interests. Ongoing subgroup and thematic analyses may inform educational strategies and enhance recruitment to our field.

Building the Neurology Pipeline With Undergraduate Students in Research and Clinical Practice

There is currently a shortage of neurologists in the United States. Multiple efforts are underway to increase the strength of the neurology workforce. One potential approach is early exposure to neurology research and clinical care to pique interest and promote the specialty as a career choice. This study details the rewarding experience of working with undergraduate students, both in clinical research and clinical care. The logistics, benefits to students, and positive aspects for neurologists are outlined. Examples provided by undergraduate students who have participated in neurology research and clinical care are presented. The ultimate goals of this work are to encourage and inspire academic neurologists to involve undergraduate students in research and clinical care, to facilitate this process by outlining the steps needed to make this pairing successful, and to ultimately promote a pathway to build the neurology pipeline.

Neurologist Attitudes on Practicing in Hawai'i

There is a shortage of neurologists nationwide, and the demand for neurologists is expected to increase in the upcoming years while the pool of practicing neurologists dwindles. Per Hawai'i Neurological Society, there were 44 practicing neurologists in the state of Hawai'i in 2019, representing a shortage of approximately 28 neurologists. Considering that Hawai'i is geographically, demographically, and culturally distinct compared to other states, a concern is that practicing neurology in Hawai'i poses unique challenges that may contribute to the low numbers of neurologists. An anonymous online survey was sent via email to all members of the Hawai'i Neurological Society from February 2019 to June 2019, inquiring about aspects of their practice they considered unique to Hawai'i. Twenty-three neurologists completed the survey, representing 52% of Hawai'i's neurology workforce. One neurologist completed a portion of the survey. Twenty-five percent of participants were born and raised or completed their medical education in Hawai'i. Self-reported reasons for practicing in Hawai'i included family, lifestyle, and patient population despite financial challenges and limited resources and opportunities. Participants suggested introducing a mandatory neurology rotation for Hawai'i medical students and creating an instate neurology residency program to combat the growing neurologist shortfall in Hawai'i. This survey identified local strengths and challenges in the field of neurology, potential ways to improve the practice environment in Hawai'i, and neurologists' perspectives on ways to address the neurology shortage.

Attracting neurology's next generation

Objectives

To better understand the reasons medical students select or avoid a career in neurology by using a qualitative methodology to explore these factors, with the long-term objective of attracting more graduates to the field.

Methods

In 2017, 27 medical students and 15 residents participated in 5 focus groups, and 33 fourth-year medical students participated in semistructured individual interviews. Participants were asked predefined open-ended questions about specialty choice, experiences in their basic neuroscience course and neurology clerkship, and perceptions about the field. Interviews were audio recorded and transcribed. We used a flexible coding methodology to generate themes across groups and interviews.

Results

Four main analytical themes emerged: (1) early and broad clinical exposure allows students to “try on” neurology and experience the variety of career options; (2) preclerkship experiences and a strong neuroscience curriculum lay the foundation for interest in the field; (3) personal interactions with neurology providers may attract or deter students from considering the specialty; and (4) persistent stereotypes about neurologists, neurology patients, and treatment options harm student perceptions of neurology.

Conclusion

Efforts to draw more students to neurology may benefit from focusing on clinical correlations during preclerkship neuroscience courses and offering earlier and more diverse clinical experiences, including hands-on responsibilities whenever possible. Finally, optimizing student interactions with faculty and residents and reinforcing the many positive aspects of neurology are likely to favorably affect student perceptions.