2025 American Academy of Neurology Abstract Website

Daniel Harrison¹, Margaret Naclerio², Kathryn Swider³, Joel Morgenlander⁴, Shannon Anderson⁵, Calli Cook⁶, Deena Rodney⁷, Megan Kennelly⁸, Elyse Doherty², Cassie Meffert⁹, Alexander King¹⁰, Scott Friedenberg¹¹, Nathaniel Robbins¹², Ariel Nowicki², Fnu Alfandy¹³, Kasser Saba¹⁴, Pavan Vaswani¹⁵, Allison Hennigan¹⁶, Holly Bischof¹⁵, Abigail Taylor¹⁷, Jason Johns¹⁸, Shivani Ghoshal¹⁹, Alyssa Bautista¹⁹, John Emmett²⁰, Christopher Doughty²
¹Boston Medical Center, ²Brigham and Women's Hospital, ³Lahey Hospital and Medical Center, ⁴Duke University Medical Center, ⁵Oregon Health & Science University, ⁶Emory Healthcare, ⁷Neurology Associates, PA, ⁸Sharp HealthCare, ⁹UW Health, ¹⁰UVA Health, ¹¹Geisinger Medical Center, ¹²Mass General Brigham, ¹³Stanford Health Care, ¹⁴Atrium Health, ¹⁵University of Pennsylvania, ¹⁶UT Tyler School of Medicine, ¹⁷Mayo Clinic Hopsital, ¹⁸Dartmouth-Hitchcock Medical Center, ¹⁹Columbia University Medical Center, ²⁰IU Health Physicians

Objective:

To describe typical longitudinal development of self-efficacy and entrustment of new neurology advanced practice providers (APPs) over their first year of practice.

Background:

APPs are key contributers to neurology teams. However, APP degree programs offer limited clinical neurology education. On-the-job training is critical for ensuring success in neurologic practice, but data to inform best practices are limited.

Design/Methods:

This was a prospective, multi-center, longitudinal survey-based study. Participants were APPs in their first year of neurology practice across the United States. We developed a survey instrument to evaluate participant training activities, self-efficacy, and entrustment. The survey was administered at 0-, 1-, 3-, 6-, and 12-months post-start date.

Results:

Through one year, 26 participants (14 outpatient, 8 inpatient, 2 hybrid; 14 physician assistants, 12 nurse practitioners) have been enrolled, completeing 65 individual surveys. A neurology APP fellowship was previously completed by 5 participants. Participants reported engaging in 4-5 hours of reading per week in the first 3 months but only reported 1-1.5 hours of didactic time per week throughout the first year. Only one participant reported any simulation training at any time point. Compared with other diseases, participants reported highest self-efficacy in headache management (62.0-82.4, 100-point self-efficacy scale) and lowest self-efficacy in brain tumor management (26.3-39.9) throughout the study. Self-efficacy in epilepsy management increased most (39.9-69.1). By month 3, most participants reported typically taking a history (11/14) and performing an exam (13/14) without a supervisor immediately available. By 6 months, only 5/10 participants reported most often recommending and interpreting diagnostic testing without a supervisor immediately available.

Conclusions:

Training activities for new neurology APPs are mostly self-directed. Neuro-oncology and recommending and interpreting diagnostic testing may be unique educational needs for these clinicians. Enrollment of additional participants will facilitate between group comparisons to determine which educational strategies most effectively foster entrustment and self-efficacy among new neurology APPs.