Objective:

To develop and implement an OSCE on the delivery of a FND and to evaluate differences in neurology residents’ attitudes toward working with patients with FNDs.

Background:

FNDs present as motor and sensory symptoms originating from functional rather than structural causes. Delivering this diagnosis requires balance between communicating medical information and providing emotional support. Neurologists often encounter challenges in delivering FND diagnoses, likely due to inadequate training in this area.

Design/Methods:

Eight third-year neurology residents participated in a 12-minute OSCE station, followed by 6-minutes of debrief. During the OSCE, they performed focused motor exams, including eliciting a Hoover sign, and delivered a FND diagnosis. Residents were emailed an article that discussed how to deliver a FND diagnosis prior to the OSCE. Using a Likert scale ranging from (1) strongly agree to (5) strongly disagree, participants completed pre- and post-OSCE surveys indicating their attitudes toward working with FND patients and the helpfulness of the OSCE in practicing delivering the diagnosis.

Results:

Resident satisfaction working with FND patients increased after the OSCE (pre mean = 2.75 vs. post 1.88, p = 0.052), though did not reach statistical significance. Perceived difficulty working with patients with FNDs did not change (pre mean 2.63 vs. post 2.38, p = 0.54). Overall, they strongly felt the OSCE was beneficial for developing communication skills (mean = 1.50) and recommended annual continuation (mean = 1.38).

Conclusions:

Although the limited sample size precluded statistical significance, the study revealed a positive trend in residents’ attitudes toward working with patients with FNDs. They found structured practice helpful and supported its integration into the resident curriculum. OSCEs offer an innovative approach for teaching the delivery of a diagnosis of a FND.