Gheihman Galina, Rajarajan Prashanth, Sotiropoulos Marinos G, Conway Sarah Esther
Department of Neurology, Mass General Brigham, Boston, MA.
Harvard Medical School, Boston, MA; and.
Neurol Educ. 2025 Mar 19;4(2):e200209. doi: 10.1212/NE9.0000000000200209. eCollection 2025 Jun.
Patients with neurologic symptoms are often first assessed by general medical providers, many of whom endorse low confidence and knowledge in evaluating neurologic patients. To address this gap, we designed, implemented, and evaluated the Bedside Rounding Alliance for Internal Medicine & Neurology Residents (BRAINs) Program.
Program objectives for internal medicine residents (IMRs) were to develop an approach to obtaining a focused neurologic history and to performing a focused physical examination. Objectives for neurology instructors were to demonstrate a focused neurologic history and examination and practice observing learners examining patients and providing specific feedback.
BRAINs paired neurology trainees (residents and fellows) with teams of 4-5 IMRs and subinterns for a 45-minute structured bedside teaching session bimonthly. Neurology instructors demonstrated a focused history and examination at the bedside for a patient admitted with a neurologic concern. IMRs then practiced a hands-on examination with real-time feedback. We evaluated the BRAINs program using a mixed quantitative-qualitative postsession survey. Neurology educators were surveyed on their teaching experiences.
Seventy-four IMRs participated and completed the survey since 2022. Participants agreed that BRAINs met the learning objectives of developing an approach to obtaining a neurologic history (69/74, 84%) and performing a neurologic examination (71/74, 96%). IMRs felt more confident in taking a focused history (62/74, 85%) and performing an examination (69/74, 93%) after the session. Ninety-five percent felt that bedside teaching was more effective than traditional didactics. Eighteen neurology educators completed the survey. One hundred percent reported that BRAINs was an effective way to practice near-peer teaching, and 89% reported that it was more effective than traditional didactics. Feedback from IMRs and educators helped iteratively improve the initiative.
The BRAINs program offered 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 be scaled to different specialties, populations of learners, and hospitals. The BRAINs program is an educational innovation that supports cross-departmental camaraderie, empowers near-peer educators, and equips IMRs with increased confidence in neurologic knowledge and skills.
出现神经症状的患者通常首先由普通内科医生进行评估，其中许多医生表示在评估神经科患者时信心不足且知识有限。为了弥补这一差距，我们设计、实施并评估了内科与神经科住院医师床边查房联盟（BRAINs）项目。
内科住院医师（IMR）的项目目标是制定一种获取重点神经病史并进行重点体格检查的方法。神经科教员的目标是展示重点神经病史和检查，并练习观察学员检查患者并提供具体反馈。
BRAINs项目每两个月为一组4至5名内科住院医师和实习医生安排一次45分钟的结构化床边教学课程，将神经科实习生（住院医师和研究员）与他们配对。神经科教员在床边为一名因神经问题入院的患者展示重点病史和检查。然后，内科住院医师在实时反馈下进行实际操作检查。我们使用定量与定性相结合的课后调查问卷对BRAINs项目进行评估。对神经科教育工作者的教学经验进行了调查。
自2022年以来，74名内科住院医师参与并完成了调查。参与者一致认为，BRAINs项目实现了制定获取神经病史方法（69/74，84%）和进行神经科检查（71/74，96%）的学习目标。课程结束后，内科住院医师在获取重点病史（62/74，85%）和进行检查（69/74，93%）方面更有信心。95%的人认为床边教学比传统教学更有效。18名神经科教育工作者完成了调查。100%的人报告说，BRAINs项目是一种有效的近伴教学方式，89%的人报告说它比传统教学更有效。内科住院医师和教育工作者的反馈有助于不断改进该项目。
BRAINs项目提供了一种可扩展且适应性强的结构化教学课程，可适应不同水平的学习者，并在临床环境中促进近伴教学。该项目不需要大量资源，可以扩展到不同专业、不同学习者群体和不同医院。BRAINs项目是一项教育创新，它支持跨部门的友谊，增强近伴教育者的能力，并使内科住院医师对神经科知识和技能更有信心。
