Objective:

Improve the phenomenology description and diagnosis recognition of hyper and hypokinetic movement disorders amongst neurology residents.

Background:

ACGME competencies require neurology residents to demonstrate knowledge in movement disorders and apply it to patient care. However, there are no specific movement disorder lecture guidelines and the curricula delivered during protected didactics are determined by each program. Furthermore, clinical and educational exposure to movement disorders often depends on individual interests and institutional resources. Standardizing exposure to movement disorders during training may positively impact independent clinical practice.

Design/Methods:

We performed a needs assessment by reviewing consult notes for chief complaint of Parkinson’s disease, tremor and tic disorder to identify inconsistencies in description and knowledge gaps. The team developed a video-based lecture series on hyperkinetic (tremor, tics, chorea, myoclonus, dystonia, ataxia, extrapyramidal syndromes) and hypokinetic (atypical parkinsonism, Parkinson’s Disease) disorders with emphasis on phenomenology recognition. Four sessions were held during an academic half-day with pre- and post-tests administered two weeks apart. During the evaluations, residents reported confidence diagnosing movement disorders, observed ten unique patient videos, wrote a short description of their phenomenology and reached a diagnosis via multiple choice.

Results:

Ten residents completed pre-test and post-test (3 PGY-2, 4 PGY-3, 3 PGY-4). Correct responses increased in all movement disorders and across PGY classes after the lecture series (reported as N pre-test; N post-test). Dystonia (5;10), atypical parkinsonism (5;9), left hemiballismus (3;10), myoclonus (1;8) and severe essential tremor (1;7) had a substantial improvement. Pathologies like tic disorder (7;10), Parkinson’s Disease (7;8), ataxia (6;7) and functional movement disorder (7;9) were often identified correctly at baseline but they also saw an increase in diagnosis recognition. The phenomenology description (e.g. from “full body shaking” to “fast jerky movements”) and confidence improved as well.

Conclusions:

The video-based lecture series improved diagnostic recognition, accuracy of phenomenology description, and trainee confidence in identifying movement disorders.