Objective:

Background:

Case-based sessions covering eight subspecialties were developed to replace mandatory traditional didactics for neurology clerks, ensuring consistency of education across rotation sites and adherence to the AAN-recommended curriculum. Conducted via Zoom by subspecialty experts, the sessions used a structured question-and-answer format to promote student discussion. Preceptors received general instructions to maximize interactivity. 

Design/Methods:

To establish baseline measurements, we analyzed preceptor speaking times by processing automated transcripts of recorded sessions from 2021 to 2024 using custom MATLAB software. Lecturing was defined as preceptors speaking for more than 90% of the session. A survey captured their perceived and ideal speaking times for an “interactive” session, which were compared to actual measured times. Students were surveyed at the clerkship conclusion. 

Results:

345 sessions led by 13 different preceptors were analyzed. 61.5% were male, and 69% at assistant professor level. Preceptors spoke for an average of 73% of the total session time (SD 10.9), and only 7.8% of sessions met lecture criteria. Preceptors only interjected between student comments for an average of 32.17 seconds (IQR 16.0), most commonly to revise discussion questions or clarify students' responses. Most preceptors underestimated their speaking time and identified a lower target, between 50-70% of the session, as the ideal amount. 70% of preceptors were satisfied or very satisfied with the sessions. 99.5% of students reported increased knowledge of common neurological disorders, and 71% believed the sessions should remain mandatory.  

Conclusions:

While preceptors were the primary speakers, the short duration of preceptor interjections did not suggest a fallback towards lecturing. Most preceptors preferred further minimizing their speaking time. Measures such as percent speaking time and mean interjection duration may serve as indicators of interactivity and merit further study.