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Seminars in Neurology

Arielle M Kurzweil, Steven L Galetta
Struggling trainees exist in all residency programs across all fields. Remediation, the act of improving deficiencies in struggling trainees, is necessary to promote the graduation of competent physicians. Deficiencies may be primarily cognitive or behavioral, and occasionally physical limitations do arise during residency. Remediation is challenging for all parties involved, and there is a paucity of literature to help guide the most effective process. In this review, we outline key principles of effective remediation of a struggling trainee in the modern era of medical education...
August 2018: Seminars in Neurology
Darya Khazanova, Joseph E Safdieh
Continuing medical education (CME) is designed to keep physicians up-to-date on ever-changing practices and guidelines to provide patients with high quality care. CME is especially important in the field of neurology due to rapidly evolving knowledge and medical advances, and is a required element of maintenance of certification. CME itself has evolved from a passive, didactic approach to a learner-centered approach which utilizes new technologies, online learning, and simulations. CME improves knowledge, skills, and, to a lesser extent, patient outcomes, with multimodal, interactive interventions found to be most effective in teaching health care professionals...
August 2018: Seminars in Neurology
Lyell K Jones
Neurology trainee assessment is a required component of the education feedback loop, allowing programs and trainees to measure their progress toward established educational goals. In the era of competency-based medical education, assessment systems should be designed to inform decisions about each trainee's acquisition of the many competencies required for independent clinical neurology practice. In addition to the need to inform trainees and programs regarding trainee performance, assessment systems must be equipped to satisfy requirements established by accrediting bodies...
August 2018: Seminars in Neurology
Eelco F M Wijdicks, Sara E Hocker
Acute neurologic (and potentially disability prone) conditions are rarely taught and, if so, at the bedside and usually after the fact. Simulation training offers a realistic environment to teach rapid-fire decision making, how to take charge, and how best to approach a deteriorating, acutely ill neurologic patient.Simulating acute neurology is a newly emerging educational program. Proven principles of simulation, which may include teaching technical skills, can be applied to acute neurology (and neurointensive care)...
August 2018: Seminars in Neurology
K H Vincent Lau, Shaheen E Lakhan, Francis Achike
The use of technology in neurology education has revolutionized many aspects of medical teaching, addressing some important challenges of modern education such as information overload and the unique needs of millennial learners. However, it also has inherent problems, such as depersonalization and high development costs. Due to the heterogeneity of different applications, it is difficult to establish general principles to guide front line educators, but it may be possible to describe "minimum" best practice elements...
August 2018: Seminars in Neurology
Douglas P Larsen
Educational systems are rarely designed for long-term retention of information. Strong evidence has emerged from cognitive psychology and applied education studies that repeated retrieval of information significantly improves retention compared to repeated studying. This effect likely emerges from the processes of memory consolidation and reconsolidation. Consolidation and reconsolidation are the means by which memories are organized into associational networks or schemas that are created and recreated as memories are formed and recalled...
August 2018: Seminars in Neurology
Jeffrey J Dewey, Tracey A Cho
The patient's bedside offers an ideal venue for teaching the art of clinical neurology and modeling humanism and professionalism. However, bedside teaching is underutilized in modern medical education, despite evidence that learners desire more. Logistical challenges and lack of teacher confidence are commonly cited reasons, but both can be mitigated with a deliberate approach and sufficient experience. Well-executed bedside teaching can provide lasting lessons for learners while enhancing the patient experience, without affecting the efficiency or quality care delivery...
August 2018: Seminars in Neurology
James M Hillis, Tracey A Milligan
The neurological examination remains the essence of neurology. It allows symptoms to be assessed, diagnoses to be made, and dynamic functions to be followed. Skill in the neurological examination has faced increasing challenges from the encroachment of diagnostic imaging, but has maintained its clinical utility. It has also encountered the battle for the precious time within a medical curriculum. This review considers how the neurological examination can best be taught into the future. It does so by considering factors related to the examination, the learner, the teacher, and the modern clinical environment...
August 2018: Seminars in Neurology
Sara M Schaefer, Moises Dominguez, Jeremy J Moeller
The lecture has been a core pedagogical method since the early days of formal medical education. Although approaches to formal lectures have evolved over the years, there has been ongoing debate about the role that lectures should play in modern medical education. Arguably, traditional lectures do not align well with modern learning theory, and do not take full advantage of our current knowledge of how people learn. In many modern medical curricula, lectures have been replaced by self-study activities, including video-based lectures, computer-based learning modules, and other self-directed learning...
August 2018: Seminars in Neurology
José-Rafael Zuzuarregui, Connie Wu, Anna DePold Hohler
Research in neurological disorders is expanding at a phenomenal pace, and the need for neurologists is increasing as the population ages. This results in a critical requirement for medical students entering the neurology pipeline. Mentoring, whether formal or informal, ensures that students are inspired and supported to enter the field of neurology. Students should also receive structured mentoring throughout their longitudinal curriculum. Informal mentoring programs enable expanded opportunities for collaborations in education, research, and outreach...
August 2018: Seminars in Neurology
Christopher G Tarolli, Ralph F Józefowicz
Neurophobia was defined more than two decades ago as a "fear of neural sciences and clinical neurology" among medical students. Despite recognition of the ailment and research into underlying causes, medical students and neurological educators continue to struggle with neurophobia today. At our institution, we have been successful at mitigating neurophobia. Here, we define the underlying drivers of neurophobia, based on the relevant literature. We also describe our strategies for battling neurophobia in the preclinical and clinical years by (1) establishing a continuum of neurological education; (2) incorporating active and observed learning throughout neurological education; and (3) enhancing socialization into neurology...
August 2018: Seminars in Neurology
Jeremy J Moeller
No abstract text is available yet for this article.
August 2018: Seminars in Neurology
David M Greer
No abstract text is available yet for this article.
August 2018: Seminars in Neurology
A Sebastian López-Chiriboga, Eoin P Flanagan
The field of autoimmune neurology is evolving rapidly. The discovery of autoantibodies that target neural antigens has expanded swiftly in the last decade. Recognition of the clinical syndromes associated with autoimmune neurologic disorders, and our understanding of the pathophysiology, has progressed significantly. Radiographic, electrophysiological, and laboratory testing (particularly neural autoantibody testing) are fundamental in the diagnosis of autoimmune neurological disorders and in the exclusion of mimics...
June 2018: Seminars in Neurology
Amanda L Piquet, Stacey L Clardy
When patients present with neurological syndromes, such as encephalopathy/encephalitis, meningitis, and/or myelopathy/myelitis, the differential diagnosis is often broad, including infectious, inflammatory, autoimmune, vascular, and neoplastic etiologies. Just with inflammatory and autoimmune etiologies alone, there are numerous causative diseases. A comprehensive history and physical examination investigating for extraneurologic manifestations of immune-mediated disease is often necessary. Moreover, evaluating for an underlying infection and/or immunodeficiency becomes a critical aspect to the workup...
June 2018: Seminars in Neurology
Jenny J Linnoila
Autoimmune disorders are becoming increasingly recognized within the broader field of neurology. The discovery of multiple, novel, neutrally targeted autoantibodies over the past decade and their translation into commercially available testing, in particular, has aided in the more rapid diagnosis of these disorders. When considering imaging in autoimmune neurologic disorders, it is important, when possible, to visualize the autoimmune process itself, as well as to make sure that the patient does not have an associated malignancy driving the overall process...
June 2018: Seminars in Neurology
Michael Sweeney
Autoimmune diseases of the nervous system in children are composed of a heterogeneous group of rare disorders that can affect the central or peripheral nervous system at any level. Presentations may occur in children of any age and are typically acute or subacute in onset. Consideration of an autoimmune process as the etiology of neurologic diseases in children is important, as it may lead to early initiation of immunotherapy and an improvement in long-term neurologic outcomes. The developing nervous and immune systems in children create unique challenges in diagnosis and treatment of these rare diseases...
June 2018: Seminars in Neurology
Hakan Cetin, Angela Vincent
Autoimmune myasthenic syndromes are antibody-mediated disorders of the neuromuscular junction. Common antigenic targets are the acetylcholine receptor or muscle specific kinase (MuSK) in myasthenia gravis (MG) and the voltage-gated calcium channel in Lambert-Eaton myasthenic syndrome. There is evidence that antibodies directed against other antigens such as low-density lipoprotein receptor-related protein 4 (LRP4) are also involved in MG. The mechanisms by which various antibodies exert their pathogenic effect depend on the IgG subclass and also the epitope location on the antigens...
June 2018: Seminars in Neurology
Michael J Bradshaw, Jenny J Linnoila
The understanding of the manifestations, mechanisms, and management of autoimmune encephalitis has expanded dramatically in recent decades. Immune-mediated encephalitides are comparable in incidence and prevalence to infectious etiologies, and are associated with significant morbidity, especially when there is a delay in recognition and treatment. As such, clinicians from many specialties must develop a functional understanding of these disorders. Herein we provide an overview of the autoimmune and paraneoplastic encephalitides, including those associated with either intracellular or cell surface/synaptic neuronal autoantibodies...
June 2018: Seminars in Neurology
Conor Fearon, Orna O'Toole
Autoimmune movement disorders are rare but potentially treatable entities. They can present with an excess or paucity of movement and may have other associated neurological symptoms. These disorders were originally recognized by their classic clinical presentations and the cancers associated with them. Recent emphasis has been targeted on associated, and sometimes causative, antibodies. Although some disorders have stereotypical presentations, the spectrum of abnormalities reported in association with antibodies is widening...
June 2018: Seminars in Neurology
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