Work-up and Counseling for First Evaluation of Cognitive Decline: A Simulation-based Educational Tool and Embedded Learning Results
Dina Dass, MD1, Ndubisi Chikwem, MD1, Radhika Jagannathan, MD, PhD1, James M. Noble, MD, MS1, Michelle Bell, MD1, Karen Marder, MD, MPH1, Shivani Ghoshal, MD1
1Columbia University Irving Medical Center
Objective:
We created a simulation-based educational tool to identify post-graduate year 2 (PGY-2) neurology residents' knowledge gaps pertaining to behavioral neurology.
Background:
Cognitive aging disorders are common, with upwards of 15% of persons >65 years having mild cognitive impairment or dementia. Work-up and counseling for dementia are core milestones in ACGME neurology resident education
, though methods for competency assessment in these areas are limited.
Design/Methods:
Following IRB approval, simulations were conducted at our center in April 2023. Simulation case framework and critical action checklists were adapted from Form B9 (Clinician Judgment of Symptoms), Uniform Data Set v3 from the National Alzheimer’s Coordinating Center (NACC), an extensively used tool in diverse nationwide aging cohorts. Finalized checklists were developed through a Delphi expert consensus among institutional UCNS certified behavioral neurologists. The 25-minute simulation presented a patient for first neurologic evaluation for dementia, scored by the critical action checklist, followed by 25 minutes of structured debriefing.
Results:
Seven PGY-2 neurology residents participated in the simulation. From critical action checklist data, residents were attentive to screening motor domains (6/7), independent activities of daily living (6/7), sleep (6/7), and time-course of symptoms (7/7). Assessment of hallucinations (3/7) and attention (2/7) were variable. Conceptual differentiation between mild cognitive impairment and dementia, and counseling regarding advanced diagnostics (lumbar puncture, biomarker-based PET scans), were knowledge gaps for all participating residents. Post-simulation, all residents reported improved learning and confidence for initial evaluation of dementia.
Conclusions:
This pilot study identified cognitive aging skills gaps in neurology residents and a possible means to address them. Using a standardized semi-structured interview instrument (NACC B9), the simulation was feasible and effective for highlighting common knowledge gaps among junior neurology trainees in behavioral neurology. This training is increasingly important in the emerging era of new diagnostic and treatment paradigms. Six-month follow-up evaluations of trainees are ongoing.