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Improving Interprofessional Neurology Training Using Tele-Education
Improving Interprofessional Neurology Training Using Tele-Education
Neurologic disorders are major causes of death and disability. Globally, the burden of neurologic disorders continues to increase. The prevalence of disabling neurologic disorders significantly increases with age. As people live longer, health care systems will face increasing demands for treatment, rehabilitation, and support services for neurologic disorders. The scarcity of established modifiable risks for most of the neurologic burden demonstrates how new knowledge is required to develop effective prevention and treatment strategies.1
A single-center study for chronic headache at a rural institution found that, when combined with public education, clinician education not only can increase access to care but also reduce specialist overuse, hospitalizations, polypharmacy, and emergency department visits.2 A predicted shortage of neurologists has sparked increased interest in the field and individual neurology educators are helping fuel its popularity.3-5
TELE-EDUCATION
Educating the next generation of health professionals is 1 of 4 statutory missions of the US Department of Veterans Affairs (VA).6 Tele-education (also known as telelearning and distance learning) deviates from traditional in-person classroom settings, in which the lecture has been a core pedagogic method.7 Audio, video, and online technologies provide health education and can overcome geographic barriers for rural and remote clinicians.8 Recent technological improvements have allowed for inexpensive and efficient dissemination of educational materials, including video lectures, podcasts, online modules, assessment materials, and even entire curricula.9
There has been an increase in the awareness of the parallel curriculum involving self-directed and asynchronous learning opportunities. 10 Several studies report knowledge gained via tele-education is comparable to conventional classroom learning.11-13 A systematic review of e-learning perceptions among health care students suggested benefits (eg, learning flexibility, pedagogical design, online interactions, basic computer skills, and access to technology) and drawbacks (eg, limited acquisition of clinical skills, internet connection problems, and issues with using educational platforms).1
The COVID-19 pandemic forced an abrupt cessation of traditional in-person education, forcing educational institutions and medical organizations to transition to telelearning. Solutions in the education field appeared during the pandemic, such as videoconferencing, social media, and telemedicine, that effectively addressed the sudden cessation of in-person medical education.15
Graduate medical education in neurology residency programs served as an experimental set up for tele-education during the pandemic. Residents from neurology training programs outlined the benefits of a volunteer lecturer-based online didactic program that was established to meet this need, which included exposure to subspeciality topics, access to subspecialist experts not available within the department, exposure to different pedagogic methods, interaction with members of other educational institutions and training programs, career development opportunities, and the potential for forming a community of learning.16
Not all recent educational developments are technology-based. For example, instruction focused on specific patient experiences, and learning processes that emphasize problem solving and personal responsibility over specific knowledge have been successful in neurology.17,18 Departments and institutions must be creative in finding ways to fund continuing education, especially when budgets are limited.19
ANNUAL NEUROLOGY SEMINAR
An annual Veterans Health Administration (VHA) neurology seminar began in 2019 as a 1-day in-person event. Neurologists at the Michael E. DeBakey VA Medical Center in Houston presented in 50-minute sessions. Nonspecialist clinical personnel and neurology clinicians attended the event. Attendees requested making the presentations widely available and regularly repeating the seminar.
The second neurology seminar took place during the COVID-19 pandemic. It was conducted online and advertised across the Veterans Integrated Services Network (VISN) 16. The 1-day program had 204 participants who were primarily nurses (59%) and physicians (21%); 94% agreed with the program objectives (Table 1). Participants could earn CME credits for the 7 presentations primarily by VHA experts.
Based on feedback and a needs assessment, the program expanded in 2021 and 2022. With support from the national VHA neurology office and VHA Employee Education System (EES), the Institute for Learning, Education, and Development (ILEAD), the feedback identified topics that resonate with VHA clinicians. Neurological disorders in the fields of stroke, dementia, and headache were included since veterans with these disorders regularly visit primary care, geriatrics, mental health, and other clinical offices. Updates provided in the diagnosis and treatment of common neurological disorders were well received. Almost all speakers were VHA clinicians, which allowed them to focus on topics relevant to clinical practice at the VHA.
Attendance has increased annually. In 2021, 550 clinicians registered (52% nurses) and 433 completed the postseminar survey (Table 2). In 2022, 635 participants registered and 342 completed evaluations, including attendees from other federal agencies who were invited to participate via EES TRAIN (Training Finder Real-time Affiliate Integrated Network). Forty-seven participants from other federal agencies, including the US Department of Defense, National Institute of Health, and Centers for Disease Control and Prevention, completed the feedback evaluation via TRAIN (Table 3). Participants report high levels of satisfaction each year (mean of 4.5 on a 5-point scale). Respondents preferred conventional lecture presentation and case-based discussions for the teaching format and dementia was the most requested topic for future seminars (Table 4).
The content of each seminar was designed to include . 1 topic relevant to current clinical practice. The 2020 seminar covered topics of cerebrovascular complications of COVID- 19 and living well with neurodegenerative disease in the COVID-19 era. In 2021, the seminar included COVID-19 and neurologic manifestations. In 2022, topics included trends in stroke rehabilitation. In addition, ≥ 1 session addressed neurologic issues within the VHA. In 2020, the VA Deputy National Director of Neurology presented on the VHA stroke systems of care. In 2021, there was a presentation on traumatic brain injury (TBI) in the military. In 2022, sessions covered long term neurologic consequences of TBI and use of telemedicine for neurologic disorders. Feedback on the sessions were positive (eAppendix, available at doi:10.12788/fp.0545).
At the request of the participants, individual presentations were shared via email by the course director and speakers. In collaboration with the EES, each session was recorded and the 2022 seminar was made available to registrants in TMS and EES TRAIN and via the VHA Neurology SharePoint.
DISCUSSION
The annual VHA neurology seminar is a 1-day neurology conference that provides education to general neurologists and other clinicians caring for patients with neurologic disorders. It is the first of its kind neurology education program in the VHA covering most subspecialties in neurology and aims at improving neurologic patient care and access through education. Sessions have covered stroke, epilepsy, sleep, amyotrophic lateral sclerosis, neuropathy, dementia, movement disorders and Parkinson disease, headaches, multiple sclerosis, neurorehabilitation, and telehealth.
The seminar has transitioned from an inperson meeting to a virtual format, making neurology education more convenient and accessible. The virtual format provides the means to increase educational collaborations and share lecture platforms with other federal agencies. The program offers CME credits at no cost to government employees. Recorded lectures can also be asynchronously viewed from the Neurology SharePoint without the ability to earn CME credits. These recordings may be used to educate trainees as well.
The seminar aims to educate all health care professionals caring for patients with neurologic disorders. It aims to eliminate neurophobia, the fear of neural sciences and clinical neurology, and help general practitioners, especially in rural areas, take care of patients with neurologic disorders. The seminars introduce general practitioners to VHA neurology experts; the epilepsy, headache multiple sclerosis, and Parkinson disease centers of excellence; and the national programs for telestroke and teleneurology.
Education Support in the VHA
The EES/ILEAD provides a wide variety of learning opportunities to VHA employees on a broad range of topics, making it one of the largest medical education programs in the country. Pharmacists, social workers, psychologists, therapists, nurses, physician assistants, and physicians have access to certified training opportunities to gain knowledge and skills needed to provide high-quality, veteran-centered care.
A review of geriatrics learning activities through the EES found > 15,000 lectures from 1999 to 2009 for > 300,000 attendees.20 To our knowledge, a review of neurology-related learning activities offered by the EES/ILEAD has not been completed, but the study on geriatrics shows that a similar review would be feasible, given the integrated education system, and helpful in identifying what topics are covered, formats are used, and participants are engaged in neurology education at the VHA. This is a future project planned by the neurology education workgroup.
The EES/ILEAD arranged CME credit for the VHA Neurology Seminar and assisted in organizing an online event with > 500 attendees. Technology support and tools provided by EES during the virtual seminar, such as polling and chat features, kept the audience engaged. Other specialties may similarly value a virtual, all-day seminar format that is efficient and can encourage increased participation from practitioners, nurses, and clinicians.
Future Growth
We plan to increase future participation in the annual neurology seminar with primary care, geriatrics, neurology, and other specialties by instituting an improved and earlier marketing strategy. This includes working with the VHA neurology office to inform neurology practitioners as well as other program offices in the VHA. We intend to host the seminar the same day every year to make it easy for attendees to plan accordingly. In the future we may consider hybrid in-person and virtual modalities if feasible. We plan to focus on reaching out to other government agencies through platforms like TRAIN and the American Academy of Neurology government sections. Securing funding, administrative staff, and protected time in the future may help expand the program further.
Limitations
While a virtual format offers several advantages, using it removes the feel of an in-person meeting, which could be viewed by some attendees as a limitation. The other challenges and drawbacks of transitioning to the virtual platform for a national meeting are similar to those reported in the literature: time zone differences, internet issues, and participants having difficulty using certain online platforms. Attendance could also be limited by scheduling conflicts.16 Despite a large audience attending the seminar, many clinicians do not get protected time from their institutions. Institutional and leadership support at national and local levels will likely improve participation and help participants earn CME credits. While we are still doing a preliminary needs assessment, a formal needs assessment across federal governmental organizations will be helpful.
CONCLUSIONS
The annual VHA neurology seminar promotes interprofessional education, introduces neurology subspecialty centers of excellence, improves access to renowned neurology experts, and provides neurology-related updates through a VHA lens. The program not only provides educational updates to neurology clinicians, but also increases the confidence of non-neurology clinicians called to care for veterans with neurological disorders in their respective clinics.
- GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990- 2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-480. doi:10.1016/S1474-4422(18)30499-X
- Baker V, Hack N. Improving access to care for patients with migraine in a remote Pacific population. Neurol Clin Pract. 2020;10(5):444-448. doi:10.1212/CPJ.0000000000000774
- Gutmann L, Cahill C, Jordan JT, et al. Characteristics of graduating US allopathic medical students pursuing a career in neurology. Neurology. 2019;92(17):e2051-e2063. doi:10.1212/WNL.0000000000007369
- Jordan JT, Cahill C, Ostendorf T, et al. Attracting neurology’s next generation: a qualitative study of specialty choice and perceptions. Neurology. 2020;95(8):e1080- e1090. doi:10.1212/WNL.0000000000009461
- Minen MT, Kaplan K, Akter S, et al. Understanding how to strengthen the neurology pipeline with insights from undergraduate neuroscience students. Neurology 2022;98(8):314-323. doi:10.1212/WNL.0000000000013259
- US Department of Veterans Affairs, Office of Academic Affiliations. To Educate for VA and the Nation. Updated August 1, 2024. Accessed August 15, 2024. https://www.va.gov/oaa/
- Schaefer SM, Dominguez M, Moeller JJ. The future of the lecture in neurology education. Semin Neurol. 2018;38(4):418-427. doi:10.1055/s-0038-1667042
- Curran VR. Tele-education. J Telemed Telecare. 2006;12(2):57-63. doi:10.1258/135763306776084400
- Lau KHV, Lakhan SE, Achike F. New media, technology and neurology education. Semin Neurol. 2018;38(4):457- 464. doi:10.1055/s-0038-1666985
- Quirk M, Chumley H. The adaptive medical curriculum: a model for continuous improvement. Med Teach. 2018;40(8):786-790. doi:10.1080/0142159X.2018.1484896
- Brockfeld T, Müller B, de Laffolie J. Video versus live lecture courses: a comparative evaluation of lecture types and results. Med Educ Online. 2018;23(1):1555434. doi:10.1080/10872981.2018.1555434
- Davis J, Crabb S, Rogers E, Zamora J, Khan K. Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: a randomized controlled trial. Med Teach. 2008;30(3):302-307. doi:10.1080/01421590701784349
- Markova T, Roth LM, Monsur J. Synchronous distance learning as an effective and feasible method for delivering residency didactics. Fam Med. 2005;37(8):570-575.
- Naciri A, Radid M, Kharbach A, Chemsi G. E-learning in health professions education during the COVID-19 pandemic: a systematic review. J Educ Eval Health Prof. 2021;18:27. doi:10.3352/jeehp.2021.18.27
- Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In Vivo. 2020;34(3 Suppl):1603-1611. doi:10.21873/invivo.11950
- Weber DJ, Albert DVF, Aravamuthan BR, Bernson-Leung ME, Bhatti D, Milligan TA. Training in neurology: rapid implementation of cross-institutional neurology resident education in the time of COVID-19. Neurology. 2020;95(19):883-886. doi:10.1212/WNL.0000000000010753
- Frey J, Neeley B, Umer A, et al. Training in neurology: neuro day: an innovative curriculum connecting medical students with patients. Neurology. 2021;96(10):e1482- e1486. doi:10.1212/WNL.0000000000010859
- Schwartzstein RM, Dienstag JL, King RW, et al. The Harvard Medical School Pathways Curriculum: reimagining developmentally appropriate medical education for contemporary learners. Acad Med. 2020;95(11):1687-1695. doi:10.1097/ACM.0000000000003270
- Greer DM, Moeller J, Torres DR, et al. Funding the educational mission in neurology. Neurology. 2021;96(12):574- 582. doi:10.1212/WNL.0000000000011635
- Thielke S, Tumosa N, Lindenfeld R, Shay K. Geriatric focused educational offerings in the Department of Veterans Affairs from 1999 to 2009. Gerontol Geriatr Educ. 2011;32(1):38-53. doi:10.1080/02701960.2011.550214
Neurologic disorders are major causes of death and disability. Globally, the burden of neurologic disorders continues to increase. The prevalence of disabling neurologic disorders significantly increases with age. As people live longer, health care systems will face increasing demands for treatment, rehabilitation, and support services for neurologic disorders. The scarcity of established modifiable risks for most of the neurologic burden demonstrates how new knowledge is required to develop effective prevention and treatment strategies.1
A single-center study for chronic headache at a rural institution found that, when combined with public education, clinician education not only can increase access to care but also reduce specialist overuse, hospitalizations, polypharmacy, and emergency department visits.2 A predicted shortage of neurologists has sparked increased interest in the field and individual neurology educators are helping fuel its popularity.3-5
TELE-EDUCATION
Educating the next generation of health professionals is 1 of 4 statutory missions of the US Department of Veterans Affairs (VA).6 Tele-education (also known as telelearning and distance learning) deviates from traditional in-person classroom settings, in which the lecture has been a core pedagogic method.7 Audio, video, and online technologies provide health education and can overcome geographic barriers for rural and remote clinicians.8 Recent technological improvements have allowed for inexpensive and efficient dissemination of educational materials, including video lectures, podcasts, online modules, assessment materials, and even entire curricula.9
There has been an increase in the awareness of the parallel curriculum involving self-directed and asynchronous learning opportunities. 10 Several studies report knowledge gained via tele-education is comparable to conventional classroom learning.11-13 A systematic review of e-learning perceptions among health care students suggested benefits (eg, learning flexibility, pedagogical design, online interactions, basic computer skills, and access to technology) and drawbacks (eg, limited acquisition of clinical skills, internet connection problems, and issues with using educational platforms).1
The COVID-19 pandemic forced an abrupt cessation of traditional in-person education, forcing educational institutions and medical organizations to transition to telelearning. Solutions in the education field appeared during the pandemic, such as videoconferencing, social media, and telemedicine, that effectively addressed the sudden cessation of in-person medical education.15
Graduate medical education in neurology residency programs served as an experimental set up for tele-education during the pandemic. Residents from neurology training programs outlined the benefits of a volunteer lecturer-based online didactic program that was established to meet this need, which included exposure to subspeciality topics, access to subspecialist experts not available within the department, exposure to different pedagogic methods, interaction with members of other educational institutions and training programs, career development opportunities, and the potential for forming a community of learning.16
Not all recent educational developments are technology-based. For example, instruction focused on specific patient experiences, and learning processes that emphasize problem solving and personal responsibility over specific knowledge have been successful in neurology.17,18 Departments and institutions must be creative in finding ways to fund continuing education, especially when budgets are limited.19
ANNUAL NEUROLOGY SEMINAR
An annual Veterans Health Administration (VHA) neurology seminar began in 2019 as a 1-day in-person event. Neurologists at the Michael E. DeBakey VA Medical Center in Houston presented in 50-minute sessions. Nonspecialist clinical personnel and neurology clinicians attended the event. Attendees requested making the presentations widely available and regularly repeating the seminar.
The second neurology seminar took place during the COVID-19 pandemic. It was conducted online and advertised across the Veterans Integrated Services Network (VISN) 16. The 1-day program had 204 participants who were primarily nurses (59%) and physicians (21%); 94% agreed with the program objectives (Table 1). Participants could earn CME credits for the 7 presentations primarily by VHA experts.
Based on feedback and a needs assessment, the program expanded in 2021 and 2022. With support from the national VHA neurology office and VHA Employee Education System (EES), the Institute for Learning, Education, and Development (ILEAD), the feedback identified topics that resonate with VHA clinicians. Neurological disorders in the fields of stroke, dementia, and headache were included since veterans with these disorders regularly visit primary care, geriatrics, mental health, and other clinical offices. Updates provided in the diagnosis and treatment of common neurological disorders were well received. Almost all speakers were VHA clinicians, which allowed them to focus on topics relevant to clinical practice at the VHA.
Attendance has increased annually. In 2021, 550 clinicians registered (52% nurses) and 433 completed the postseminar survey (Table 2). In 2022, 635 participants registered and 342 completed evaluations, including attendees from other federal agencies who were invited to participate via EES TRAIN (Training Finder Real-time Affiliate Integrated Network). Forty-seven participants from other federal agencies, including the US Department of Defense, National Institute of Health, and Centers for Disease Control and Prevention, completed the feedback evaluation via TRAIN (Table 3). Participants report high levels of satisfaction each year (mean of 4.5 on a 5-point scale). Respondents preferred conventional lecture presentation and case-based discussions for the teaching format and dementia was the most requested topic for future seminars (Table 4).
The content of each seminar was designed to include . 1 topic relevant to current clinical practice. The 2020 seminar covered topics of cerebrovascular complications of COVID- 19 and living well with neurodegenerative disease in the COVID-19 era. In 2021, the seminar included COVID-19 and neurologic manifestations. In 2022, topics included trends in stroke rehabilitation. In addition, ≥ 1 session addressed neurologic issues within the VHA. In 2020, the VA Deputy National Director of Neurology presented on the VHA stroke systems of care. In 2021, there was a presentation on traumatic brain injury (TBI) in the military. In 2022, sessions covered long term neurologic consequences of TBI and use of telemedicine for neurologic disorders. Feedback on the sessions were positive (eAppendix, available at doi:10.12788/fp.0545).
At the request of the participants, individual presentations were shared via email by the course director and speakers. In collaboration with the EES, each session was recorded and the 2022 seminar was made available to registrants in TMS and EES TRAIN and via the VHA Neurology SharePoint.
DISCUSSION
The annual VHA neurology seminar is a 1-day neurology conference that provides education to general neurologists and other clinicians caring for patients with neurologic disorders. It is the first of its kind neurology education program in the VHA covering most subspecialties in neurology and aims at improving neurologic patient care and access through education. Sessions have covered stroke, epilepsy, sleep, amyotrophic lateral sclerosis, neuropathy, dementia, movement disorders and Parkinson disease, headaches, multiple sclerosis, neurorehabilitation, and telehealth.
The seminar has transitioned from an inperson meeting to a virtual format, making neurology education more convenient and accessible. The virtual format provides the means to increase educational collaborations and share lecture platforms with other federal agencies. The program offers CME credits at no cost to government employees. Recorded lectures can also be asynchronously viewed from the Neurology SharePoint without the ability to earn CME credits. These recordings may be used to educate trainees as well.
The seminar aims to educate all health care professionals caring for patients with neurologic disorders. It aims to eliminate neurophobia, the fear of neural sciences and clinical neurology, and help general practitioners, especially in rural areas, take care of patients with neurologic disorders. The seminars introduce general practitioners to VHA neurology experts; the epilepsy, headache multiple sclerosis, and Parkinson disease centers of excellence; and the national programs for telestroke and teleneurology.
Education Support in the VHA
The EES/ILEAD provides a wide variety of learning opportunities to VHA employees on a broad range of topics, making it one of the largest medical education programs in the country. Pharmacists, social workers, psychologists, therapists, nurses, physician assistants, and physicians have access to certified training opportunities to gain knowledge and skills needed to provide high-quality, veteran-centered care.
A review of geriatrics learning activities through the EES found > 15,000 lectures from 1999 to 2009 for > 300,000 attendees.20 To our knowledge, a review of neurology-related learning activities offered by the EES/ILEAD has not been completed, but the study on geriatrics shows that a similar review would be feasible, given the integrated education system, and helpful in identifying what topics are covered, formats are used, and participants are engaged in neurology education at the VHA. This is a future project planned by the neurology education workgroup.
The EES/ILEAD arranged CME credit for the VHA Neurology Seminar and assisted in organizing an online event with > 500 attendees. Technology support and tools provided by EES during the virtual seminar, such as polling and chat features, kept the audience engaged. Other specialties may similarly value a virtual, all-day seminar format that is efficient and can encourage increased participation from practitioners, nurses, and clinicians.
Future Growth
We plan to increase future participation in the annual neurology seminar with primary care, geriatrics, neurology, and other specialties by instituting an improved and earlier marketing strategy. This includes working with the VHA neurology office to inform neurology practitioners as well as other program offices in the VHA. We intend to host the seminar the same day every year to make it easy for attendees to plan accordingly. In the future we may consider hybrid in-person and virtual modalities if feasible. We plan to focus on reaching out to other government agencies through platforms like TRAIN and the American Academy of Neurology government sections. Securing funding, administrative staff, and protected time in the future may help expand the program further.
Limitations
While a virtual format offers several advantages, using it removes the feel of an in-person meeting, which could be viewed by some attendees as a limitation. The other challenges and drawbacks of transitioning to the virtual platform for a national meeting are similar to those reported in the literature: time zone differences, internet issues, and participants having difficulty using certain online platforms. Attendance could also be limited by scheduling conflicts.16 Despite a large audience attending the seminar, many clinicians do not get protected time from their institutions. Institutional and leadership support at national and local levels will likely improve participation and help participants earn CME credits. While we are still doing a preliminary needs assessment, a formal needs assessment across federal governmental organizations will be helpful.
CONCLUSIONS
The annual VHA neurology seminar promotes interprofessional education, introduces neurology subspecialty centers of excellence, improves access to renowned neurology experts, and provides neurology-related updates through a VHA lens. The program not only provides educational updates to neurology clinicians, but also increases the confidence of non-neurology clinicians called to care for veterans with neurological disorders in their respective clinics.
Neurologic disorders are major causes of death and disability. Globally, the burden of neurologic disorders continues to increase. The prevalence of disabling neurologic disorders significantly increases with age. As people live longer, health care systems will face increasing demands for treatment, rehabilitation, and support services for neurologic disorders. The scarcity of established modifiable risks for most of the neurologic burden demonstrates how new knowledge is required to develop effective prevention and treatment strategies.1
A single-center study for chronic headache at a rural institution found that, when combined with public education, clinician education not only can increase access to care but also reduce specialist overuse, hospitalizations, polypharmacy, and emergency department visits.2 A predicted shortage of neurologists has sparked increased interest in the field and individual neurology educators are helping fuel its popularity.3-5
TELE-EDUCATION
Educating the next generation of health professionals is 1 of 4 statutory missions of the US Department of Veterans Affairs (VA).6 Tele-education (also known as telelearning and distance learning) deviates from traditional in-person classroom settings, in which the lecture has been a core pedagogic method.7 Audio, video, and online technologies provide health education and can overcome geographic barriers for rural and remote clinicians.8 Recent technological improvements have allowed for inexpensive and efficient dissemination of educational materials, including video lectures, podcasts, online modules, assessment materials, and even entire curricula.9
There has been an increase in the awareness of the parallel curriculum involving self-directed and asynchronous learning opportunities. 10 Several studies report knowledge gained via tele-education is comparable to conventional classroom learning.11-13 A systematic review of e-learning perceptions among health care students suggested benefits (eg, learning flexibility, pedagogical design, online interactions, basic computer skills, and access to technology) and drawbacks (eg, limited acquisition of clinical skills, internet connection problems, and issues with using educational platforms).1
The COVID-19 pandemic forced an abrupt cessation of traditional in-person education, forcing educational institutions and medical organizations to transition to telelearning. Solutions in the education field appeared during the pandemic, such as videoconferencing, social media, and telemedicine, that effectively addressed the sudden cessation of in-person medical education.15
Graduate medical education in neurology residency programs served as an experimental set up for tele-education during the pandemic. Residents from neurology training programs outlined the benefits of a volunteer lecturer-based online didactic program that was established to meet this need, which included exposure to subspeciality topics, access to subspecialist experts not available within the department, exposure to different pedagogic methods, interaction with members of other educational institutions and training programs, career development opportunities, and the potential for forming a community of learning.16
Not all recent educational developments are technology-based. For example, instruction focused on specific patient experiences, and learning processes that emphasize problem solving and personal responsibility over specific knowledge have been successful in neurology.17,18 Departments and institutions must be creative in finding ways to fund continuing education, especially when budgets are limited.19
ANNUAL NEUROLOGY SEMINAR
An annual Veterans Health Administration (VHA) neurology seminar began in 2019 as a 1-day in-person event. Neurologists at the Michael E. DeBakey VA Medical Center in Houston presented in 50-minute sessions. Nonspecialist clinical personnel and neurology clinicians attended the event. Attendees requested making the presentations widely available and regularly repeating the seminar.
The second neurology seminar took place during the COVID-19 pandemic. It was conducted online and advertised across the Veterans Integrated Services Network (VISN) 16. The 1-day program had 204 participants who were primarily nurses (59%) and physicians (21%); 94% agreed with the program objectives (Table 1). Participants could earn CME credits for the 7 presentations primarily by VHA experts.
Based on feedback and a needs assessment, the program expanded in 2021 and 2022. With support from the national VHA neurology office and VHA Employee Education System (EES), the Institute for Learning, Education, and Development (ILEAD), the feedback identified topics that resonate with VHA clinicians. Neurological disorders in the fields of stroke, dementia, and headache were included since veterans with these disorders regularly visit primary care, geriatrics, mental health, and other clinical offices. Updates provided in the diagnosis and treatment of common neurological disorders were well received. Almost all speakers were VHA clinicians, which allowed them to focus on topics relevant to clinical practice at the VHA.
Attendance has increased annually. In 2021, 550 clinicians registered (52% nurses) and 433 completed the postseminar survey (Table 2). In 2022, 635 participants registered and 342 completed evaluations, including attendees from other federal agencies who were invited to participate via EES TRAIN (Training Finder Real-time Affiliate Integrated Network). Forty-seven participants from other federal agencies, including the US Department of Defense, National Institute of Health, and Centers for Disease Control and Prevention, completed the feedback evaluation via TRAIN (Table 3). Participants report high levels of satisfaction each year (mean of 4.5 on a 5-point scale). Respondents preferred conventional lecture presentation and case-based discussions for the teaching format and dementia was the most requested topic for future seminars (Table 4).
The content of each seminar was designed to include . 1 topic relevant to current clinical practice. The 2020 seminar covered topics of cerebrovascular complications of COVID- 19 and living well with neurodegenerative disease in the COVID-19 era. In 2021, the seminar included COVID-19 and neurologic manifestations. In 2022, topics included trends in stroke rehabilitation. In addition, ≥ 1 session addressed neurologic issues within the VHA. In 2020, the VA Deputy National Director of Neurology presented on the VHA stroke systems of care. In 2021, there was a presentation on traumatic brain injury (TBI) in the military. In 2022, sessions covered long term neurologic consequences of TBI and use of telemedicine for neurologic disorders. Feedback on the sessions were positive (eAppendix, available at doi:10.12788/fp.0545).
At the request of the participants, individual presentations were shared via email by the course director and speakers. In collaboration with the EES, each session was recorded and the 2022 seminar was made available to registrants in TMS and EES TRAIN and via the VHA Neurology SharePoint.
DISCUSSION
The annual VHA neurology seminar is a 1-day neurology conference that provides education to general neurologists and other clinicians caring for patients with neurologic disorders. It is the first of its kind neurology education program in the VHA covering most subspecialties in neurology and aims at improving neurologic patient care and access through education. Sessions have covered stroke, epilepsy, sleep, amyotrophic lateral sclerosis, neuropathy, dementia, movement disorders and Parkinson disease, headaches, multiple sclerosis, neurorehabilitation, and telehealth.
The seminar has transitioned from an inperson meeting to a virtual format, making neurology education more convenient and accessible. The virtual format provides the means to increase educational collaborations and share lecture platforms with other federal agencies. The program offers CME credits at no cost to government employees. Recorded lectures can also be asynchronously viewed from the Neurology SharePoint without the ability to earn CME credits. These recordings may be used to educate trainees as well.
The seminar aims to educate all health care professionals caring for patients with neurologic disorders. It aims to eliminate neurophobia, the fear of neural sciences and clinical neurology, and help general practitioners, especially in rural areas, take care of patients with neurologic disorders. The seminars introduce general practitioners to VHA neurology experts; the epilepsy, headache multiple sclerosis, and Parkinson disease centers of excellence; and the national programs for telestroke and teleneurology.
Education Support in the VHA
The EES/ILEAD provides a wide variety of learning opportunities to VHA employees on a broad range of topics, making it one of the largest medical education programs in the country. Pharmacists, social workers, psychologists, therapists, nurses, physician assistants, and physicians have access to certified training opportunities to gain knowledge and skills needed to provide high-quality, veteran-centered care.
A review of geriatrics learning activities through the EES found > 15,000 lectures from 1999 to 2009 for > 300,000 attendees.20 To our knowledge, a review of neurology-related learning activities offered by the EES/ILEAD has not been completed, but the study on geriatrics shows that a similar review would be feasible, given the integrated education system, and helpful in identifying what topics are covered, formats are used, and participants are engaged in neurology education at the VHA. This is a future project planned by the neurology education workgroup.
The EES/ILEAD arranged CME credit for the VHA Neurology Seminar and assisted in organizing an online event with > 500 attendees. Technology support and tools provided by EES during the virtual seminar, such as polling and chat features, kept the audience engaged. Other specialties may similarly value a virtual, all-day seminar format that is efficient and can encourage increased participation from practitioners, nurses, and clinicians.
Future Growth
We plan to increase future participation in the annual neurology seminar with primary care, geriatrics, neurology, and other specialties by instituting an improved and earlier marketing strategy. This includes working with the VHA neurology office to inform neurology practitioners as well as other program offices in the VHA. We intend to host the seminar the same day every year to make it easy for attendees to plan accordingly. In the future we may consider hybrid in-person and virtual modalities if feasible. We plan to focus on reaching out to other government agencies through platforms like TRAIN and the American Academy of Neurology government sections. Securing funding, administrative staff, and protected time in the future may help expand the program further.
Limitations
While a virtual format offers several advantages, using it removes the feel of an in-person meeting, which could be viewed by some attendees as a limitation. The other challenges and drawbacks of transitioning to the virtual platform for a national meeting are similar to those reported in the literature: time zone differences, internet issues, and participants having difficulty using certain online platforms. Attendance could also be limited by scheduling conflicts.16 Despite a large audience attending the seminar, many clinicians do not get protected time from their institutions. Institutional and leadership support at national and local levels will likely improve participation and help participants earn CME credits. While we are still doing a preliminary needs assessment, a formal needs assessment across federal governmental organizations will be helpful.
CONCLUSIONS
The annual VHA neurology seminar promotes interprofessional education, introduces neurology subspecialty centers of excellence, improves access to renowned neurology experts, and provides neurology-related updates through a VHA lens. The program not only provides educational updates to neurology clinicians, but also increases the confidence of non-neurology clinicians called to care for veterans with neurological disorders in their respective clinics.
- GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990- 2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-480. doi:10.1016/S1474-4422(18)30499-X
- Baker V, Hack N. Improving access to care for patients with migraine in a remote Pacific population. Neurol Clin Pract. 2020;10(5):444-448. doi:10.1212/CPJ.0000000000000774
- Gutmann L, Cahill C, Jordan JT, et al. Characteristics of graduating US allopathic medical students pursuing a career in neurology. Neurology. 2019;92(17):e2051-e2063. doi:10.1212/WNL.0000000000007369
- Jordan JT, Cahill C, Ostendorf T, et al. Attracting neurology’s next generation: a qualitative study of specialty choice and perceptions. Neurology. 2020;95(8):e1080- e1090. doi:10.1212/WNL.0000000000009461
- Minen MT, Kaplan K, Akter S, et al. Understanding how to strengthen the neurology pipeline with insights from undergraduate neuroscience students. Neurology 2022;98(8):314-323. doi:10.1212/WNL.0000000000013259
- US Department of Veterans Affairs, Office of Academic Affiliations. To Educate for VA and the Nation. Updated August 1, 2024. Accessed August 15, 2024. https://www.va.gov/oaa/
- Schaefer SM, Dominguez M, Moeller JJ. The future of the lecture in neurology education. Semin Neurol. 2018;38(4):418-427. doi:10.1055/s-0038-1667042
- Curran VR. Tele-education. J Telemed Telecare. 2006;12(2):57-63. doi:10.1258/135763306776084400
- Lau KHV, Lakhan SE, Achike F. New media, technology and neurology education. Semin Neurol. 2018;38(4):457- 464. doi:10.1055/s-0038-1666985
- Quirk M, Chumley H. The adaptive medical curriculum: a model for continuous improvement. Med Teach. 2018;40(8):786-790. doi:10.1080/0142159X.2018.1484896
- Brockfeld T, Müller B, de Laffolie J. Video versus live lecture courses: a comparative evaluation of lecture types and results. Med Educ Online. 2018;23(1):1555434. doi:10.1080/10872981.2018.1555434
- Davis J, Crabb S, Rogers E, Zamora J, Khan K. Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: a randomized controlled trial. Med Teach. 2008;30(3):302-307. doi:10.1080/01421590701784349
- Markova T, Roth LM, Monsur J. Synchronous distance learning as an effective and feasible method for delivering residency didactics. Fam Med. 2005;37(8):570-575.
- Naciri A, Radid M, Kharbach A, Chemsi G. E-learning in health professions education during the COVID-19 pandemic: a systematic review. J Educ Eval Health Prof. 2021;18:27. doi:10.3352/jeehp.2021.18.27
- Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In Vivo. 2020;34(3 Suppl):1603-1611. doi:10.21873/invivo.11950
- Weber DJ, Albert DVF, Aravamuthan BR, Bernson-Leung ME, Bhatti D, Milligan TA. Training in neurology: rapid implementation of cross-institutional neurology resident education in the time of COVID-19. Neurology. 2020;95(19):883-886. doi:10.1212/WNL.0000000000010753
- Frey J, Neeley B, Umer A, et al. Training in neurology: neuro day: an innovative curriculum connecting medical students with patients. Neurology. 2021;96(10):e1482- e1486. doi:10.1212/WNL.0000000000010859
- Schwartzstein RM, Dienstag JL, King RW, et al. The Harvard Medical School Pathways Curriculum: reimagining developmentally appropriate medical education for contemporary learners. Acad Med. 2020;95(11):1687-1695. doi:10.1097/ACM.0000000000003270
- Greer DM, Moeller J, Torres DR, et al. Funding the educational mission in neurology. Neurology. 2021;96(12):574- 582. doi:10.1212/WNL.0000000000011635
- Thielke S, Tumosa N, Lindenfeld R, Shay K. Geriatric focused educational offerings in the Department of Veterans Affairs from 1999 to 2009. Gerontol Geriatr Educ. 2011;32(1):38-53. doi:10.1080/02701960.2011.550214
- GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990- 2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-480. doi:10.1016/S1474-4422(18)30499-X
- Baker V, Hack N. Improving access to care for patients with migraine in a remote Pacific population. Neurol Clin Pract. 2020;10(5):444-448. doi:10.1212/CPJ.0000000000000774
- Gutmann L, Cahill C, Jordan JT, et al. Characteristics of graduating US allopathic medical students pursuing a career in neurology. Neurology. 2019;92(17):e2051-e2063. doi:10.1212/WNL.0000000000007369
- Jordan JT, Cahill C, Ostendorf T, et al. Attracting neurology’s next generation: a qualitative study of specialty choice and perceptions. Neurology. 2020;95(8):e1080- e1090. doi:10.1212/WNL.0000000000009461
- Minen MT, Kaplan K, Akter S, et al. Understanding how to strengthen the neurology pipeline with insights from undergraduate neuroscience students. Neurology 2022;98(8):314-323. doi:10.1212/WNL.0000000000013259
- US Department of Veterans Affairs, Office of Academic Affiliations. To Educate for VA and the Nation. Updated August 1, 2024. Accessed August 15, 2024. https://www.va.gov/oaa/
- Schaefer SM, Dominguez M, Moeller JJ. The future of the lecture in neurology education. Semin Neurol. 2018;38(4):418-427. doi:10.1055/s-0038-1667042
- Curran VR. Tele-education. J Telemed Telecare. 2006;12(2):57-63. doi:10.1258/135763306776084400
- Lau KHV, Lakhan SE, Achike F. New media, technology and neurology education. Semin Neurol. 2018;38(4):457- 464. doi:10.1055/s-0038-1666985
- Quirk M, Chumley H. The adaptive medical curriculum: a model for continuous improvement. Med Teach. 2018;40(8):786-790. doi:10.1080/0142159X.2018.1484896
- Brockfeld T, Müller B, de Laffolie J. Video versus live lecture courses: a comparative evaluation of lecture types and results. Med Educ Online. 2018;23(1):1555434. doi:10.1080/10872981.2018.1555434
- Davis J, Crabb S, Rogers E, Zamora J, Khan K. Computer-based teaching is as good as face to face lecture-based teaching of evidence based medicine: a randomized controlled trial. Med Teach. 2008;30(3):302-307. doi:10.1080/01421590701784349
- Markova T, Roth LM, Monsur J. Synchronous distance learning as an effective and feasible method for delivering residency didactics. Fam Med. 2005;37(8):570-575.
- Naciri A, Radid M, Kharbach A, Chemsi G. E-learning in health professions education during the COVID-19 pandemic: a systematic review. J Educ Eval Health Prof. 2021;18:27. doi:10.3352/jeehp.2021.18.27
- Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In Vivo. 2020;34(3 Suppl):1603-1611. doi:10.21873/invivo.11950
- Weber DJ, Albert DVF, Aravamuthan BR, Bernson-Leung ME, Bhatti D, Milligan TA. Training in neurology: rapid implementation of cross-institutional neurology resident education in the time of COVID-19. Neurology. 2020;95(19):883-886. doi:10.1212/WNL.0000000000010753
- Frey J, Neeley B, Umer A, et al. Training in neurology: neuro day: an innovative curriculum connecting medical students with patients. Neurology. 2021;96(10):e1482- e1486. doi:10.1212/WNL.0000000000010859
- Schwartzstein RM, Dienstag JL, King RW, et al. The Harvard Medical School Pathways Curriculum: reimagining developmentally appropriate medical education for contemporary learners. Acad Med. 2020;95(11):1687-1695. doi:10.1097/ACM.0000000000003270
- Greer DM, Moeller J, Torres DR, et al. Funding the educational mission in neurology. Neurology. 2021;96(12):574- 582. doi:10.1212/WNL.0000000000011635
- Thielke S, Tumosa N, Lindenfeld R, Shay K. Geriatric focused educational offerings in the Department of Veterans Affairs from 1999 to 2009. Gerontol Geriatr Educ. 2011;32(1):38-53. doi:10.1080/02701960.2011.550214
Improving Interprofessional Neurology Training Using Tele-Education
Improving Interprofessional Neurology Training Using Tele-Education