371 third-year McGovern Medical School (MMS) students rotating through their core four-week neurology clerkship between May 2017 and October 2019 were asked to participate in this study. 234 (63%) students completed the surveys. Participants completed two anonymous online surveys regarding their perceptions of neurology and their overall experience during the clerkship. Surveys were completed before and immediately after completing the clerkship. The Qualtrics© online forum was used for the administration of the surveys (https://www.qualtrics.com/). The study overview is highlighted in figure 1.
The neurology residents underwent a one-time interactive hour-long workshop on small group teaching strategies led by a Ph.D. educator from the Office of Educational Programs at MMS. The objective of the workshop was to introduce effective teaching strategies and improve residents’ teaching skills. It included topics such as how learners process information, use of questioning skills, and the one-minute preceptor model. There was no assessment of residents’ teaching skills before and after the workshop.
Pre-rotation and post-rotation questionnaires included students’ level of interest in pursuing neurology as a career (scale: 1=not interested at all, 2=undecided, 3=slightly interested, 4=very interested) and confidence in managing neurological conditions (scale: 1=not confident at all, 2=not confident, 3=somewhat confident, 4=extremely confident). Post-rotation questionnaire also included students’ perception of the adequacy of time residents took to teach (scale: 1=no teaching at all, 2=not a lot of time spent on teaching, 3=limited time, 4=adequate time), the effectiveness of resident teaching (scale: 1= extremely ineffective, 2=somewhat ineffective, 3=effective, 4=very effective), the impact of residents on overall rotation experience (scale: 1=very negative, 2=negative, 3=positive, 4=very positive), overall value of the rotation (1=not valuable at all, 2=not valuable, 3=somewhat valuable, 4=very valuable) and residents’ bedside manner and professionalism (scale: 1=definitely no, 2=no, 3=yes, 4=definitely yes). See the appendix for the internally generated survey.
Descriptive statistics and the Mann Whitney U test were used to analyze the change in the students’ interest in neurology along with their confidence level in neurology before and after the rotation. The pre-/post rotation data is collected from the same students, as were collected anonymously. As the data was gathered using Likert scales, ordinal regression analysis was used to determine the correlates of students’ overall experience during their clerkship, residents’ impact on their experience, their interest in neurology, and confidence in managing neurological conditions. We created four univariate regression models for the regression analyses. In the first model, the overall value of the clerkship was the dependent variable, and the time the residents spent teaching, the residents’ teaching effectiveness, and residents’ professionalism and bedside manner were independent variables. In the second model, the residents’ impact on the students’ neurology experience was treated as the dependent variable, and the time the residents spent teaching, the residents’ teaching effectiveness, and residents’ professionalism and bedside manner were independent variables. In the third and fourth models, the students’ interest in neurology and confidence in managing neurological conditions were the dependent variables respectively, and the time the residents spent teaching, the residents’ teaching effectiveness, residents’ professionalism and bedside manner, residents’ impact on students’ neurology experience and students’ overall experience were the independent variables. The students rated residents’ teaching effectiveness before and after the teaching workshop. The residents’ teaching effectiveness and impact on students’ rotation experience was assessed by students who rotated through the neurology clerkship and interacted with the residents before the resident workshop (n=58) and after the workshop (n=176) using the Mann Whitney U Test. The means of residents' teaching effectiveness and their impact on students’ rotation experience rated by the students were compared.
We also collected site specific information from a subset of our students (n=149). A group of students only rotated on inpatient sites (n=50), and the other group rotated in both inpatient and outpatient sites (n=99). We compared their overall experience of neurology, the perceived resident teaching effectiveness, the impact of residents’ teaching on students’ rotation experience, students’ interest, and perceived confidence in neurology. False discovery rate (FDR) of 10% was performed for the correction of multiple comparison analyses, and R statistical software (https://www.r-project.org/) was used for statistical analyses.