好色先生

好色先生

Explore the latest content from across our publications
Join The AAN

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Diagnostic Accuracy Among Neurology Residents: Six-year Data from the Close the Loop Resident Clinical Acumen Assessment Project
Research Methodology, 好色先生, and History
S39 - 好色先生 Research and Research Methodology (3:41 PM-3:52 PM)
002
The Close the Loop Project at Mount Sinai characterizes cases presented by on-call neurology residents, including the accuracy of their initial diagnostic impressions.
To evaluate neurology resident diagnostic patterns to identify individual and systemic educational needs. 
From July 2010 to June 2016 all patients independently assessed by on-call junior residents and presented in daily morning report were captured in a caselog. We recorded basic encounter data and resident's initial diagnostic impression; we “closed the loop” by revisiting each case after reviewing final diagnosis. We categorized initial impression and final diagnosis as neurological or non-neurological. Neurological cases were then localized as CNS/PNS, and further cataloged etiologically. We compared residents' initial impression to the final diagnosis to assess whether the initial impression was accurate, partially accurate, or wrong, and characterized the types of errors made. Two raters evaluated the entries (>95% interrater agreement).  
 1301 cases were presented and analyzed for resident accuracy; of these, 920 (70.7%) were ultimately deemed neurological.  Of these neurological cases, 775 (84.2%) localized to the CNS; the most common were ischemic stroke (25.8%) and seizure (16.5%).  Of the 381 non-neurological cases, 64.0% were medical, 26.0% psychiatric and 2.6% ophthalmological. Residents’ overall initial diagnoses were accurate in 64.0% of cases, and wrong in 31.1%. Accuracy was higher for neurological cases (67.5%) than for non-neurological (55.6%).  Accuracy was similar between CNS (67.8%) and PNS (65.5%) localizations. Neurological cases were appropriately identified in 94.7%, whereas non-neurological cases were inappropriately deemed neurological in 40.6% of cases.  
We present the first analyses of our complete dataset from this educational initiative to assess and improve neurology resident clinical acumen. Residents displayed higher diagnostic accuracy when recognizing neurological disease compared with non-neurological disease, with a tendency to over-diagnose neurological illness. Future analyses will explore subgroups and more specific misdiagnosis patterns. 
Authors/Disclosures
Emily Schorr, MD (UCSD)
PRESENTER 		No disclosure on file
Rachel Brandstadter, MD (University of Pennsylvania) Dr. Brandstadter has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Peter Jin, MD (University of Maryland School of Medicine) Dr. Jin has nothing to disclose.
Christine Stahl, MD (Atlantic Neuroscience Institue) Dr. Stahl has nothing to disclose.
Stephen Krieger, MD, FAAN (Mount Sinai Dept of Neurology) Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Expert Witness. The institution of Dr. Krieger has received research support from Novartis. The institution of Dr. Krieger has received research support from Bristol Myers Squibb. The institution of Dr. Krieger has received research support from Biogen.