Miller Richard, Lidstone Sarah, Perez David L, Albert Dara V F
Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital/The Ohio State University, Columbus.
Integrated Movement Disorders Program, University Health Network, Toronto, Canada.
Neurol Educ. 2025 Sep 5;4(3):e200239. doi: 10.1212/NE9.0000000000200239. eCollection 2025 Sep.
The objective of this study was to improve functional neurologic disorder (FND) education by identifying knowledge gaps among providers who registered for an online course on FND. The field of FND is rapidly evolving with new frameworks for understanding the diagnosis, pathophysiology, and treatment. This leads to the potential for knowledge gaps among clinicians who care for patients with FND. The shift away from terminologies such as "psychogenic" or "conversion" disorders underscores advances in how FND is conceptualized. Yet, gaps in the assimilation of this new knowledge among medical providers have been consistently found in surveys. This study is a qualitative analysis, allowing participants to state their specific knowledge gaps and identify content areas most in need of additional education.
Providers from various disciplines including neurologists and other physicians, psychologists, and physical therapists enrolled in a virtual course containing 9 asynchronous lectures on various FND topics followed by 2 live webinars (fndsociety.org/fnd-education/virtual-education-course). Participants were invited to optionally submit questions for the live webinars to the expert panel about the care of FND in various treatment settings. A qualitative descriptive research design was used, with conventional content analysis applied to identify themes from participant questions.
One hundred ninety-one responses were collected from 268 participants over 2 months for a 71% response rate. Participant responses clustered on specific clinical presentations (e.g., functional seizures [FSs]), communication challenges with patients and other providers, inpatient challenges (e.g., when admission might be warranted), and outpatient challenges, such as limited access to multidisciplinary teams. Some participants explicitly stated outdated attitudes about FND.
Qualitative analysis of the participant responses revealed priority areas of knowledge gaps, indicating potential underexplored avenues for high-impact education on FND. These areas include diagnostic uncertainty, such as the presence of comorbid medical illness, FSs, and tools to help the patient when best practice models are not available. Developing case-based learning to better foster illness scripts and modules on psychoeducation and psychological treatments for the nontherapist FND provider would enhance existing educational tools to allow providers in every setting to better care for patients with FND.
本研究的目的是通过识别注册参加功能性神经障碍（FND）在线课程的医疗服务提供者之间的知识差距，来改进FND教育。FND领域正在迅速发展，出现了用于理解诊断、病理生理学和治疗的新框架。这导致了在照顾FND患者的临床医生中存在知识差距的可能性。从诸如“心因性”或“转换性”障碍等术语的转变突出了FND概念化方面的进展。然而，在调查中一直发现医疗服务提供者在吸收这些新知识方面存在差距。本研究是一项定性分析，允许参与者陈述他们具体的知识差距，并确定最需要额外教育的内容领域。
来自不同学科的医疗服务提供者，包括神经科医生和其他内科医生、心理学家和物理治疗师，参加了一个虚拟课程，该课程包含9个关于各种FND主题的异步讲座，随后是2次现场网络研讨会（fndsociety.org/fnd-education/virtual-education-course）。参与者被邀请选择向专家小组提交关于在各种治疗环境中FND护理的问题，以供现场网络研讨会讨论。采用定性描述性研究设计，应用传统内容分析法从参与者的问题中识别主题。
在2个月内，从268名参与者中收集到191份回复，回复率为71%。参与者的回复集中在特定的临床表现（如功能性癫痫发作[FSs]）、与患者及其他医疗服务提供者的沟通挑战、住院挑战（如何时可能需要住院）以及门诊挑战，如难以获得多学科团队的服务。一些参与者明确表示对FND存在过时的态度。
对参与者回复的定性分析揭示了知识差距的优先领域，表明在FND的高影响力教育方面可能存在未充分探索的途径。这些领域包括诊断的不确定性，如合并内科疾病的存在、FSs，以及在没有最佳实践模式时帮助患者的工具。开发基于案例的学习，以更好地培养疾病脚本，并为非治疗师FND医疗服务提供者提供关于心理教育和心理治疗的模块，将增强现有的教育工具，使每个环境中的医疗服务提供者都能更好地照顾FND患者。
