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For many neurologic subspecialties, the fellowship application process begins early in the first half of the second year of neurology-specific training (PGY3 for adult neurology residents and PGY4 for child neurology residents). In 2019, the American Academy of Neurology (AAN) published a position statement recommending communication between fellowship candidates and training programs begin no sooner than March 1 of the penultimate year of training and that programs offer fellowship positions no sooner than August 1 of the final year of training. A few pilot subspecialties adopted this timeline for 2021 recruitment for positions beginning in 2022. All United States–based AAN-affiliated neurology and child neurology residents who recently completed the fellowship application process received a survey about their fellowship application experience. Of the 291 residents who responded to the survey, 96% agree that applications should not be submitted before March 1 of the penultimate year of training and 72% believe that August 1 of the final year is a reasonable time to begin offering positions. Nearly half (49%) of residents believe that there is too little time for subspecialty/clinical exposure before applying for fellowship and 88% feel the current process and timeline are stressful. Residents who applied to programs in pilot subspecialties report more time to choose, less stress, and a lower number of time-pressured offers. A large majority of residents (89%) prefer to submit a single application through a centralized system. The survey results suggest that residents who just completed the fellowship application process agree with the AAN recommended timeline for all subspecialties and that all neurology subspecialties should consider adopting a fellowship match. Programs can help facilitate a better fellowship application experience by providing earlier exposure to a broad range of neurologic subspecialties and ensure that residents are given opportunities to attend national meetings and participate in appropriately scoped scholarly endeavors.

Background Despite increasing awareness of inequities in healthcare in neurology, health equity is not a core competency of neurology training. To meet this need, we implemented a health equities curriculum for neurology residents at the Hospital of the University of Pennsylvania. Methods A seven-lecture health equities curriculum was implemented during the 2019-2020 academic year. Surveys were distributed pre-and post-curriculum to assess resident demographics, previous training in health equities, curriculum effectiveness addressing health equities topics, and resident appraisal of the curriculum. Results On average, residents attended 2-3 lectures. Most of the residents who participated were White-Non Latinx women. Residents who did not participate in the curriculum listed clinical responsibilities as the main reason for absenteeism. Residents who participated felt the curriculum was at least somewhat effective in addressing health disparities, cultural competency, and implicit bias. 64% of the residents felt the curriculum was effective in improving their preparedness in caring for underserved patients. Conclusion Implementing a health equities curriculum in neurology residency programs is feasible and well-received by residents. Given inconsistent attendance and a small sample size, we are unable to assess its true effectiveness. Nonetheless, residents felt it prepared them in addressing disparities in neurological care. A longer curriculum will help in assessing the effectiveness of this curriculum intervention. A standard health equities curriculum should be implemented across neurology residency programs, and health equities should be considered a core competency topic for the American Board of Psychiatry and Neurology (ABPN) certification.

BACKGROUND Nonemergent communications between nursing staff and residents often occur randomly throughout the workday at teaching institutions, resulting in inefficiency and interruptions of scheduled resident educational conferences or periods of overnight rest. OBJECTIVE The aim of this study was to determine whether a quality improvement communication strategy can reduce interruptive notifications during scheduled resident didactic sessions. METHODS We conducted a prospective, mixed-methods trial of a communication strategy between nurses and residents in 3 neurology units of an academic institution. We measured content and volume of notifications from nurses to residents during scheduled conferences and overnight and categorized these notifications according to levels of urgency. We implemented an intervention requiring multidisciplinary evening work rounds between the on-call resident and charge nurse and batching of nonemergent communications. Survey data were collected. RESULTS The total census during the 6-month study period was 728 patients. Of the 704 resident-reported nursing notifications, 50% could be safely deferred until change of shift. After the intervention, there was a 52% decrement of notifications (0.52 vs 0.25 notifications per patient, P < .01). The preintervention survey response rate was 65% for nurses (46/71) and 100% for residents (26/26), whereas postintervention response rates were 51% for nurses (36/71) and 96% for residents (24/25). Both nurses and residents responded more favorable in the postintervention period across multiple items that addressed patient safety, utility, and satisfaction (P < .01 for comparisons). CONCLUSIONS A scheduled nurse-resident communication system reduced interruptive calls during educational conferences and overnight by half. This intervention was perceived as safe and effective and resulted in higher satisfaction among participants.

Background: Non-emergent communications between nursing staff and covering providers often occur randomly throughout the workday at teaching institutions, resulting in inefficiency and interruptions of scheduled resident educational conferences or periods of overnight rest. Methods: We conducted a prospective, mixed-methods, crossover trial of a communication strategy between nurses and residents in 3 neurology units of a single academic institution. We measured content and volume of notifications from nurses to residents during scheduled conferences and overnight, and categorized these notifications according to levels of urgency. We implemented an intervention requiring evening work rounds between the on-call provider and charge nurse, and batching of non-emergent communications. Survey data were collected to determine perceived safety, utility, and satisfaction of the intervention. Results: The total census during the 6-month study period was 728 patients with a mean case-mix index of 1.86 (indicating moderate disease complexity). Of the total 704 provider-reported nursing notifications, there was a 56.3% decrement of notifications in the post-intervention period. Of the total 299 nurse-reported notifications, there was a 46.9% decrement in the post-intervention period. Both nurses and residents provided more favorable survey responses in the post-intervention period across multiple items that addressed patient safety, utility, and satisfaction (p Conclusions: A scheduled nurse-resident communication system reduced interruptive calls during educational conferences and overnight by half. This intervention was safe, effective, and resulted in higher satisfaction among nurses and residents.

Objective: Effective stroke care does not end with acute treatment during hospitalization, but extends through Objective: Effective stroke care does not end with acute treatment during hospitalization, but extends through rehabilitation and secondary stroke prevention. In transitions across care environments, stroke patients are vulnerable to errors in communication of diagnosis and treatment. This study aimed to demonstrate that formalized communication between the neurology team and the rehabilitation medicine team would promote secondary stroke prevention and minimize interruptions during rehabilitation. Methods: The intervention was a standardized verbal handoff by phone between the discharging neurology resident and the admitting rehabilitation resident regarding each patient at transfer. This retrospective cohort study compared a pre-intervention control group (September 2012- February 2013) and a post-intervention group transferred with the handoff (September 2013- January 2014). The outcomes measured included errors in communication of stroke severity, stroke mechanism, medications, and recommended follow-up (appointments and tests) as well as emergent brain imaging, return to the acute care facility, and readmission. Results: The pre- and post-intervention groups were similar with respect to number of patients (50 vs. 52) and demographics including gender (52% vs. 54% female), age (65.8 vs. 64.0 years), severity of illness as measured by the NIHSS (10 vs. 6.5), and stroke type (84% vs. 77% ischemic). Implementation of the handoff decreased errors in communication of diagnosis (NIHSS 92% vs. 74%, p=0.02; stroke mechanism 54% vs. 30%, p=0.02). Furthermore, the handoff decreased the proportion with errors in reconciliation of critical medications (42% vs. 23%, p=0.04). However, the intervention did not significantly reduce interruptions of the rehabilitation program, such as emergent brain imaging (8% vs. 12%, p=0.55) or transfers back to the acute care hospital (26% vs. 21%, p=0.56). Conclusions: Standardized handoffs decreased errors in communication of diagnosis and critical medications for secondary stroke prevention.

The incidence of neurologic complications from bariatric surgery is rising with the prevalence of obesity and the increasing number of bariatric surgeries. We report a 25-year-old woman who developed subacute progressive weakness and areflexia followed by confusion, ophthalmoplegia, and nystagmus following bariatric surgery. While the differential of generalized weakness with altered mental status is broad, vitamin deficiency should be routinely suspected after bariatric surgery to prevent permanent neurological injury. Multifocal neurological dysfunction in our patient represented beriberi and Wernicke's encephalopathy related to vitamin B1 deficiency.

Patient nonattendance in neurology and other subspecialty clinics is closely linked to longer waiting times for appointments. We developed a new scheduling system for residents' clinic that reduced average waiting times from4 months toor =3 weeks. The purpose of this study was to compare nonattendance for clinics scheduled using the new model (termed "rapid access") vs those scheduled using the traditional system.In the rapid access system, nonestablished (new) patients are scheduled on a first-come, first-served basis for appointments that must occur within 2 weeks of their telephone request. Nonattendance for new patient appointments (cancellations plus no-shows) was compared for patients scheduled under the traditional vs the rapid access scheduling systems. Nonattendance was compared for periods of 6, 12, and 18 months following change in scheduling system using the chi2 test and logistic regression.Compared to the traditional scheduling system, the rapid access system was associated with a 50% reduction in nonattendance over 18 months (64% [812/1,261 scheduled visits] vs 31% [326/1,059 scheduled visits], p0.0001). In logistic regression models, appointment waiting time was a major factor in the relation between rapid access scheduling and nonattendance. Demographics, diagnoses, and likelihood of scheduling follow-up visits were similar between the 2 systems.A new scheduling system that minimizes waiting times for new patient appointments has been effective in substantially reducing nonattendance in our neurology residents' clinic. This rapid access system should be considered for implementation and will likely enhance the outpatient educational experience for trainees in neurology.