Ader Jeremy, Raymundo Isaac, Galinsky Adam D, Akinola Modupe, Bell Michelle
Department of Neurology, NYU Grossman School of Medicine, New York, NY.
Management Division, Columbia Business School, New York, NY; and.
Neurol Educ. 2025 Apr 9;4(2):e200216. doi: 10.1212/NE9.0000000000200216. eCollection 2025 Jun.
"Brain-writing" is a technique in which group members write down ideas individually, before a group discussion, to improve idea generation and individual engagement in group discussions. We assessed the feasibility of studying the impact of brain-writing on diagnostic quality and educational experience among neurology residents in a small case-based learning environment.
We conducted a repeated-measures study, conducted over 6 sessions consisting of groups of 3 to 5 neurology residents from different years of training. During each session, 3 cases were treated as control, "brainstorming," cases, and 3 were intervention, "brain-writing," cases, in which the group wrote down possible diagnoses and tests before engaging in a group discussion. Tests and diagnoses from the brain-writing exercise and group discussion as well as a post case survey on participant experience were recorded through a Qualtrics survey, and video recordings were reviewed to determine speaking order and number of tests and diagnoses verbalized by each member. Feasibility was determined by recruitment and ability to complete the study procedures in a pragmatic fashion that incorporated resident education. The primary outcome was accuracy of diagnoses, and secondary outcomes included number of tests and diagnoses generated, percent of "can't miss diagnoses mentioned," speaking order and psychological reactions of group members.
Twenty-five (9 PGY-2, 8 PGY-3, and 8 PGY-4) of 29 eligible residents participated in the sessions. There was no significant difference in accuracy of diagnosis between the brain-writing and brainstorming cases (mean = 73% vs 72%, = 0.51). Brainstorming cases listed significantly more tests (mean = 11.9 vs 9.6, = 0.001) but not more diagnoses (mean = 9.60 vs 9.12, = 0.07). Junior residents spoke later and verbalized significantly fewer diagnoses and tests than senior residents in both brainstorming and brain-writing groups. There was no statistically significant difference in psychological outcomes of junior and senior residents in each group.
It is feasible to examine the impact of a behavioral-based intervention among medical trainees in a small case-based learning environment. This study, limited by a small sample size, did not find that brain-writing improved decision quality.
“头脑写作”是一种让小组成员在小组讨论前各自写下想法的技巧，以提高想法的产生数量以及个人在小组讨论中的参与度。我们评估了在基于病例的小型学习环境中研究头脑写作对神经科住院医师诊断质量和教育体验影响的可行性。
我们进行了一项重复测量研究，共开展6次课程，每次课程由3至5名来自不同培训年份的神经科住院医师组成小组。在每次课程中，3个病例作为对照“头脑风暴”病例，另外3个作为干预“头脑写作”病例，即小组成员在进行小组讨论前写下可能的诊断和检查项目。通过Qualtrics调查记录头脑写作练习和小组讨论中的检查项目、诊断结果以及关于参与者体验的病例后调查情况，并查看视频记录以确定发言顺序以及每位成员说出的检查项目和诊断结果数量。可行性通过招募情况以及以兼顾住院医师教育的务实方式完成研究程序的能力来确定。主要结果是诊断的准确性，次要结果包括产生的检查项目和诊断结果数量、提及的“必查诊断”百分比、发言顺序以及小组成员的心理反应。
29名符合条件的住院医师中有25名（9名二年级住院医师、8名三年级住院医师和8名四年级住院医师）参加了课程。头脑写作病例和头脑风暴病例在诊断准确性方面没有显著差异（平均值分别为73%和72%，P = 0.51）。头脑风暴病例列出的检查项目显著更多（平均值分别为11.9项和9.6项，P = 0.001），但诊断结果数量没有显著差异（平均值分别为9.60项和9.12项，P = 0.07）。在头脑风暴组和头脑写作组中，低年资住院医师发言较晚，说出的诊断结果和检查项目明显少于高年资住院医师。每组中低年资和高年资住院医师的心理结果没有统计学显著差异。
在基于病例的小型学习环境中研究基于行为的干预措施对医学实习生的影响是可行的。本研究受样本量小的限制，未发现头脑写作能提高决策质量。
