Neurological Exam Round-robin: Advancing Neurological Examination Skills for Advanced Practice Providers Through an Interactive, Hands-on, Skills-based Workshop
Alexandra Balshi1, Galina Gheihman2, Margaret Naclerio3, Christopher Doughty2, Shannon Anderson4, Michael Bowley5, Manali Sheth6, Andrea Thurler5, Jennifer Cheng5, Ariel Nowicki2, Denis Balaban5, Lisa Townsend5, Haatem Reda5
1Harvard Medical School, 2Brigham & Women's Hospital, 3Brigham and Women's Hospital, 4Oregon Health & Science University, 5Massachusetts General Hospital, 6Mass General Brigham
Objective:

To evaluate an interactive, hands-on, skills-based round-robin workshop in which advance practice provider (APP) participants rotate through multiple stations to practice the neurological exam.

Background:

Although an increasing number of APPs are entering neurology practice, they have limited neurological education during training. Fewer than 20% of PA and 10% of NP students complete elective neurology rotations. Prior studies report APP discomfort with neurological localization and performing and interpreting the neurological exam.

Design/Methods:

We designed a hands-on, interactive, skills-based workshop in which APPs rotated among 4-6 stations taught by APP and physician faculty focused on an aspect of the neurological exam (45-60 minutes each). Stations involved live demonstration and hands-on practice with feedback from faculty. The workshop was held twice nationally at the American Academy of Neurology conference (2024-25) and locally at one academic medical center. We assessed participant confidence (Likert scale 1-10) in performing the neurological exam using a simultaneous pre-post survey. Student’s t-test for paired samples evaluated workshop efficacy for each station. Analysis of open responses identified key learnings and feedback for workshop improvement.

Results:

Workshop participants included 48 and 85 APPs on the national and local levels, respectively. Mean self-reported confidence increased across all topics (p<0.0001): weakness (national: 6.2 to 7.8; local: 5.0 to 7.2), headache (national: 6.5 to 8.1; local: 5.6 to 7.2), sensory change (national: 6.0 to 7.7; local: 3.9 to 6.9), dizziness (national: 5.5 to 7.8; local: 5.5 to 7.5), altered mental status (national: 7.1 to 8.4, local: 4.8 to 6.9), and gait (national: 5.2 to 7.3). Participants stated their intention to change their practice after this workshop, including completing a comprehensive exam and adapting specific maneuvers.

Conclusions:

A hands-on, interactive, skills-based round-robin style workshop introduced APPs to neurological exam skills and increased  self-confidence through deliberate practice and focused feedback. Our results may be generalizable to other settings/learner populations.

10.1212/WNL.0000000000217585
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.