Abstract Details

Patients with neurological symptoms are often first assessed by general medical providers. However, many internal medicine residencies lack formal neurology education and IMRs endorse low confidence in evaluating neurological patients.

To describe the design, implementation, and evaluation of a trainee-led inpatient bedside rounding teaching program that aims to improve internal medicine residents’ (IMRs) confidence with assessing neurological patients, including obtaining a focused history and performing a neurological exam.

The BRAINs program pairs neurology trainees (residents/fellows) with teams of IMRs for a 45-minute structured bedside teaching session bi-monthly. Neurology instructors demonstrate a focused history and exam at the bedside for a patient admitted with a neurological complaint. IMRs then practice a hands-on exam with real-time feedback and the opportunity to ask questions. We evaluated BRAINs with a mixed quantitative-qualitative post-session survey. IMR participants rated to what extent the session achieved its objectives and their confidence with the neurological history and exam.

40 IMRs participated and completed the survey (31 PGY-1, 6 PGY-2, 3 PGY-3). Participants agreed that BRAINs met the learning objectives of developing an approach to obtaining a neurological history (31/40, 77.5%) and performing a neurological exam (38/40, 95%). IMRs also felt more confident in taking a focused history (34/40, 85%) and performing an exam (39/40, 97.5%) after the session. 95% (38/40) thought bedside teaching was more effective than traditional didactics.

The BRAINs program offers a scalable and adaptable structured teaching session that accommodates learners at various levels and promotes near-peer teaching in the clinical setting. The program is not resource intensive and can scale to different services, populations of learners, and hospitals. The BRAINs program is an educational innovation that supports cross-departmental comradery, empowers near-peer teachers, and equips IMRs—who are often the first to assess neurological patients—with increased confidence in neurological knowledge and skills.