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de Liège A, Carle G, Hingray C, Lehn A, Autier L, Degos B, Garcin B. Functional Neurological Disorders in the medical education: An urgent need to fill the gaps. Rev Neurol (Paris) 2022; 178:788-795. [PMID: 35863918 DOI: 10.1016/j.neurol.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/21/2022] [Accepted: 03/03/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND FND is a disabling disease that accounts for 5 to 10% of the reason for consultation in neurology. However, young physicians often say they have little or no training in their management. AIM The aim of the present study was to assess whether French junior neurologists, psychiatrists and physical and rehabilitation medicine (PRM) specialists received teaching on FND during their medical studies, including the residency, and to evaluate their knowledge and perception of the disorder. METHODS The survey was distributed by the means of a Google form questionnaire to specialist registrars and young specialists with the help of resident's organizations. RESULTS 568 respondents from the 3 specialties were included in the study. Most respondents (72.4%) were specialists registrars. Almost half of the respondents (45.5%) answered they never received any teaching on FND, and only 20.5% of them knew the Hoover's sign, a positive sign specific of functional weakness. A large majority of respondents felt they were not sufficiently trained in FND (87.9%), and they did not have sufficient knowledge of these disorders (85.3%). DISCUSSION Better training would allow clinicians to make a diagnosis earlier, to better explain it to patients, and to limit the costs associated with diagnosis delays. A better training of clinicians about FND would also improve the prognosis of patients, as early diagnosis and good explanation is associated with a better prognosis. CONCLUSION This survey shows that there is a gap about FND in the training programs in the medical studies and during the specialization training of young doctors in France.
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Affiliation(s)
- A de Liège
- Service de Neurologie, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France
| | - G Carle
- Consultation-Liaison Psychiatry and Psychiatric Emergency Department, Toulouse University Hospital, Toulouse, France
| | - C Hingray
- Pole de psychiatrie universitaire du grand Nancy, Centre Psychothérapeutique de Nancy, Laxou, France
| | - A Lehn
- Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - L Autier
- ANAINF (Association Nationale des Assistants et Internes de Neurologie de France), France
| | - B Degos
- Service de Neurologie, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France; Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, College de France, CNRS UMR7241/INSERM U1050, Université PSL, 75005 Paris, France
| | - B Garcin
- Service de Neurologie, AP-HP, Hôpital Avicenne, Université Sorbonne Paris Nord, Bobigny, France; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France.
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Nicholson TR, Carson A, Edwards MJ, Goldstein LH, Hallett M, Mildon B, Nielsen G, Nicholson C, Perez DL, Pick S, Stone J, Aybek S, Baslet G, Bloem BR, Brown RJ, Chalder T, Damianova M, David AS, Epstein S, Espay AJ, Garcin B, Jankovic J, Joyce E, Kanaan RA, Kozlowska K, LaFaver K, LaFrance WC, Lang AE, Lehn A, Lidstone S, Maurer C, Morgante F, Myers L, Reuber M, Rommelfanger K, Schwingenshuh P, Serranova T, Shotbolt P, Stebbins G, Tijssen MAJ, Tinazzi M. Outcome Measures for Functional Neurological Disorder: A Review of the Theoretical Complexities. J Neuropsychiatry Clin Neurosci 2020; 32:33-42. [PMID: 31865871 DOI: 10.1176/appi.neuropsych.19060128] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.
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Affiliation(s)
- Timothy R Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Alan Carson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark J Edwards
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Laura H Goldstein
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark Hallett
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Bridget Mildon
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Glenn Nielsen
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Clare Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - David L Perez
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Susannah Pick
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Jon Stone
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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Garcin B, Mariani LL, Méneret A, Mongin M, Delorme C, Cormier F, Renaud MC, Roze E, Degos B. The "Neurological Hat Game": A fun way to learn the neurological semiology. Rev Neurol (Paris) 2019; 175:528-533. [PMID: 31076136 DOI: 10.1016/j.neurol.2019.01.395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In-class courses are deserted by medical students who tend to find it more beneficial to study in books and through online material. New interactive teaching methods, such as serious games increase both performance and motivation. We developed and assessed a new teaching method for neurological semiology using the "Hat Game" as a basis. METHODS In this game, two teams of second-year medical students are playing against one another. The game is played with a deck of cards. A neurological symptom or sign is written on each card. Each team gets a predefined period of time to guess as many words as possible. One member is the clue-giver and the others are the guessers. There are three rounds: during the first round, the clue-giver uses any descriptive term he wants and as many as he wants to make his team guess the maximum number of words within the allocated time. During the second round, the clue-giver can only choose one clue-word and, during the third round, he mimes the symptom or sign. The team that has guessed the most cards wins the game. To assess the efficacy of this learning procedure, multiple choices questions (MCQs) were asked before and after the game. Exam results of second-year students on their final university Neurology exam were analyzed. A satisfaction survey was proposed to all participating students. RESULTS Among 373 students, 121 volunteers (32.4%) were enrolled in the "Neurology Hat Game" and 112 attended the game. One hundred and seven of the 112 students completed the MCQs with a significant improvement in their responses after the game (P<0.001). The 112 students who completed the satisfaction self-administered questionnaire were very satisfied with this funny new teaching method. CONCLUSIONS Teaching neurological semiology via the "Hat Game" is an interesting method because it is student-centered, playful and complementary to the lecturer-centered courses. A randomized controlled study would be necessary to confirm these preliminary results.
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Affiliation(s)
- B Garcin
- Service de Neurologie, hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint-Denis, AP-HP, 93000 Bobigny, France; Sorbonne universités, UPMC université Paris 6 UMR S 1127, Inserm U 1127, CNRS UMR 722, institut du cerveau et de la moelle épinière, 75013 Paris, France.
| | - L L Mariani
- Département de Neurologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, Sorbonne universités, université Pierre-et-Marie-Curie (UPMC), 91, boulevard de l'hôpital, 75013 Paris, France
| | - A Méneret
- Département de Neurologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, Sorbonne universités, université Pierre-et-Marie-Curie (UPMC), 91, boulevard de l'hôpital, 75013 Paris, France
| | - M Mongin
- Service de Neurologie, hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint-Denis, AP-HP, 93000 Bobigny, France; Faculté de médecine, Sorbonne universités, université Pierre-et-Marie-Curie (UPMC), 91, boulevard de l'hôpital, 75013 Paris, France
| | - C Delorme
- Département de Neurologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, Sorbonne universités, université Pierre-et-Marie-Curie (UPMC), 91, boulevard de l'hôpital, 75013 Paris, France
| | - F Cormier
- Département de Neurologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, Sorbonne universités, université Pierre-et-Marie-Curie (UPMC), 91, boulevard de l'hôpital, 75013 Paris, France
| | - M-C Renaud
- Faculté de médecine, Sorbonne universités, université Pierre-et-Marie-Curie (UPMC), 91, boulevard de l'hôpital, 75013 Paris, France
| | - E Roze
- Service de Neurologie, hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint-Denis, AP-HP, 93000 Bobigny, France; Département de Neurologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Faculté de médecine, Sorbonne universités, université Pierre-et-Marie-Curie (UPMC), 91, boulevard de l'hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 6 UMR S 1127, Inserm U 1127, CNRS UMR 722, institut du cerveau et de la moelle épinière, 75013 Paris, France
| | - B Degos
- Service de Neurologie, hôpital Avicenne, hôpitaux universitaires de Paris-Seine Saint-Denis, AP-HP, 93000 Bobigny, France; UMR CNRS 7241/Inserm U1050, Center for Interdisciplinary Research in Biology (CIRB), collège de France, 75005 Paris, France
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