ANSWER: A Multi-modal Teaching Intervention for Neurology Undergraduate Medical Education: A Randomized Cross-over Control Trial
Liah McElligott1, Muirne Spooner2, Diane Gillan3, Catriona Cahir4, Mohammad Hijaz Adenan5, Grainne Mulkerrins6, Daire Lee2, Claire Hevican7, Susan Byrne8, Norman Delanty1, Jan Illing9, John Flood2, Arnold DK Hill7, Noel G McElvaney2, Eavan McGovern1
1Department of Neurology, Beaumont Hospital, RCSI School of Medicine, 2RCSI School of Medicine, Beaumont Hospital, 3Department of Neuropsychology, Beaumont Hospital, 4Department of Research and Statistics, RCSI, 5Department of Neurology, King's College Hospital, 6Department of Neurology, Beaumont Hospital, 7Department of Surgery, RCSI School of Medicine, Beaumont Hospital, 8Department of Pediatric Neurology and Genetics, RCSI, CHI, 9Health Professions Education Centre, RCSI
Objective:

Examine the effect of ANSWER (Analogy, Switch to clinical, Embody the signs and Recall learning), a multi-modal undergraduate neurology teaching intervention, on knowledge acquisition and attitudes towards neurology in final year medical students.

Background:
Novel approaches to neurology undergraduate education can improve undergraduate knowledge and attitudes towards clinical neurology.
Design/Methods:

Final year medical students were randomly distributed into two groups; an intervention group (ANSWER teaching) and a control group (usual teaching). A crossover design was used. Baseline test and trait anxiety measured using validated State-Trait Anxiety Inventory (STAIT-5) and Test Anxiety Inventory (TAI-5). Knowledge was assessed via multiple-choice-question examination (MCQE). Neurophobia (fear of neurology) was assessed via a validated scale Neuro-Combined Measure (NCM). 

Results:

Seventy-seven final-year medical students participated. In the intervention arm,  post-intervention MCQE scores (M =13.7, SD = 2.6) were significantly higher than baseline (M =11.4, SD = 2.5) (Z = 4.818 , p = 0.000). There was a significant reduction in median NCM score from baseline (m = 30, IQR = 26, 33) to post-intervention (m = 26, IQR = 24, 31) ( Z = -2.869, p = 0.004). Both MCQE (Z = 3.508, p = 0.005and NCM (Z = -3.637, p = 0.003) changes were maintained post washout period in the intervention arm. In the control arm, there was no significant change in MCQE  pre (M = 11.4, SD = 3.3) and post-usual teaching (M = 12.3, SD =3.3) (Z = 1.782, p = 0.074) or NCM pre (m = 28.5, IQR 25,33) and post usual teaching (m = 28.5, IQR 25,31) (Z = -1.098 , p = 0.272). 

 

Conclusions:
ANSWER teaching technique improved knowledge acquisition and reduced neurophobia in final year medical students. Students reported ANSWER improved their understanding of neurology and preparedness for examinations, making it a promising tool for teaching neurology.
10.1212/WNL.0000000000205673