Neurology for internal medicine residents: Working towards a national Canadian curriculum consensus

Figures & data

Table

Practice points

Internal medicine residents self-perceived competency in neurology is low both before and after neurology rotations. Learning objectives chosen by program directors for residents closely match residents’ perceived needs. A consensus neurology curriculum tailored for off-service internal medicine residents was achieved and will lay the groundwork for improved education at our institution.

Table 1.  Resident demographics

Post-graduate year	Number (%)
1	10 (31.3)
2	6 (18.8)
3	14 (43.8)
4	2 (6.3)
5	0 (0)

Table 2.  Internal medicine resident's self-perceived competency in neurology

	Before neurology rotation (%)	After neurology rotation (%)
Best	0	0
Above average	7.1	18.5
Average	42.9	62.1
Below average	48.3	18.5
Worst	0	0

Table 3.  Top 20 neurology topics

Rank	Topics
1	Ischemic stroke
2	Interpretation of patterns of weakness
3	Headache
4	Encephalitis/meningitis
5	Epilepsy
6	Dizziness & vertigo
7	Movement disorders (especially Parkinson's disease)
8	Structural neuroimaging
9	Dementia
10	Aphasia
11	Disorders of consciousness (e.g., prognosis of coma, persistent vegetative state (PVS); brain death determination)
12	Intracerebral hemorrhage
13	Multiple sclerosis and other inflammatory demyelinating diseases of the central nervous system (CNS)
14	Disorders of peripheral nerves
15	Acute spinal cord injury
16	Delirium
17	Neurological complications in critically ill patients
18	Deficiency diseases of the nervous system
19	Disorders of neuromuscular transmission
20	Neurological manifestations of human immunodeficiency virus infection

Table S1 Rank order list of neurology topics after the first iteration of the survey

Rank^a	Topics^b	Staff	Residents
		Rating average^c
1	Ischemic cerebrovascular disease	5.00	4.9
1	Acute ischemic stroke	5.00	4.9
1	Stroke in the young	4.91	4.1
1	Neurological complications of hypertension	4.82	4.58
2	Interpretation of patterns of weakness: e.g., proximal, distal, generalized weakness	5.00	4.77
2	Hemiplegia and monoplegia	5.00	4.29
2	Paraplegia	4.91	4.06
3	Bacterial meningitis	5.00	4.65
3	Viral encephalitis	4.91	4.65
3	Bacterial infections	4.82	4.45
3	Viral infections	4.82	4.45
4	Intracerebral hemorrhage	5.00	4.65
4	Intracranial aneurysms and subarachnoid hemorrhage	4.73	4.58
4	Subarachnoid hemorrhage	4.64	4.42
5	Dizziness & vertigo	5.00	4.55
5	Acute dizziness	4.82	4.55
6	Aphasia	5.00	4.42
7	Multiple sclerosis and other inflammatory demyelinating diseases of the CNS	4.91	4.74
8	Headache	4.91	4.71
8	Headache and other craniofacial pain	4.91	4.42
8	Temporal arteritis	4.91	4.45
9	Delirium and confusional states	4.91	4.55
9	Toxic and metabolic encephalopathies	4.73	4.48
10	Anoxic-ischemic encephalopathy	4.91	4.13
10	Neurological complications of cardiac arrest	4.82	4.45
11	Epilepsy	4.91	4.71
11	Status epilepticus	4.91	4.74
11	Episodic impairment of consciousness	4.82	4.13
12	Structural neuroimaging (magnetic resonance imaging, MRI; computed tomography, CT)	4.82	4.81
13	Movement disorders – Parkinsonism	4.82	4.74
13	Movement disorders – tremor	4.73	4.39
13	Movement disorders	4.73	4.52
14	Stupor and coma	4.82	4.61
14	Unexplained coma	4.82	4.77
14	The neurology of disorders of consciousness (e.g., prognosis of coma, PVS; brain death determination)	4.82	4.35
15	Dementia	4.82	4.45
16	Acute visual loss	4.82	4.45
16	Vision loss	4.73	4.23
17	Neurological complications in critically ill patients	4.82	4.42
18	Disorders of peripheral nerves	4.82	4.39
18	Neurological disorders associated with diabetes	5.00	4.45
19	Neurological manifestations of human immunodeficiency virus infection	4.82	4.39
20	Disorders of neuromuscular transmission (including myasthenia gravis)	4.82	4.35
21	Deficiency diseases of the nervous system (e.g., vitamin deficiencies)	4.82	4.16
22	Cranial neuropathies	4.82	4.19
22	Dysarthria	4.64	4.39
22	Diplopia	4.64	4.52
23	Pupillary and eyelid abnormalities	4.82	3.87
24	Acute spinal cord or cauda equina compression	4.73	4.68
24	Other Spinal cord syndromes (Brown-Sequard, central cord)	4.55	3.97
25	Neurological manifestations of electrolyte disturbances	4.73	4.32
26	Neurological manifestations of acquired cardiac disease and arrhythmias	4.73	4.03
26	Neurological manifestations of infective endocarditis	4.73	4.16
27	Limb ataxia	4.64	3.9
27	Disorders of the cerebellum, including the degenerative ataxias	4.55	4.29
27	Gait disorders	4.55	4.35
28	Neurological disorders associated with connective tissue diseases and vasculitis	4.64	4.29
28	CNS vasculitis	4.64	4.26
29	Nervous system metastases	4.64	3.9
30	Increased intracranial pressure	4.64	4.55
31	Sensory abnormalities of the limbs, trunk, and face	4.55	4.1
32	Paraneoplastic disorders	4.55	3.97
33	Neurological complications of substance abuse	4.55	3.81
34	Neurological manifestations of hematological disorders	4.55	4.19
35	Neurological disorders associated with sarcoidosis	4.55	3.97
36	Acute generalized weakness	4.45	4.45
37	Falls and drop attacks	4.45	4.42
38	Disorders of upper and lower motor neurons (e.g., amyotrophic lateral sclerosis)	4.45	4.29
39	Neurological disorders associated with thyroid disease	4.45	4.13
40	Disorders of the autonomic nervous system	4.45	4.1
41	Neurological complications of cardiovascular surgery	4.45	3.74
42	Fungal infections	4.36	4.19
43	Disorders of nerve roots and plexuses	4.36	4.16
44	Drug-induced disorders of the nervous system	4.36	3.97
45	Neurological complications of chemotherapy and radiation therapy	4.36	3.58
46	Neurological problems of pregnancy	4.36	3.16
47	Cardiac manifestations of acute neurological lesions	4.27	4.19
48	Brain edema and disorders of cerebrospinal fluid circulation	4.27	4.1
49	Dix-Hallpike maneuver	4.27	4.03
50	Vascular malformations	4.27	3.77
51	Otoneurological manifestations of otological disease (e.g., benign paraxysmal positional vertigo, Meneire's disease)	4.27	3.77
52	Neurological complications of organ transplantation and immunosuppressive agents	4.27	3.45
53	Nystagmus	4.18	4.29
54	Angiography by CT and MRI	4.18	4.26
55	Neurological disorders associated with gastrointestinal, liver, or pancreatic diseases (e.g., celiac disease)	4.18	4.06
56	Sleep disorders	4.18	3.48
57	Acute dystonia	4.09	4.35
58	Movement disorders – chorea and atheosis	4.09	4.1
59	Parasitic infections	4.09	4.06
60	Neurological disorders associated with kidney disease	4.09	4.06
61	Intellectual and memory impairments	4.09	3.97
62	Agnosias including neglect	4.09	3.94
63	Head trauma	4.09	3.94
64	Particle repositioning maneuver (Epley's maneuver)	4.09	3.71
65	Disorders of skeletal muscle	4.09	3.65
66	Visual field testing	4.09	3.58
67	Psychogenic neurological disorders	4.09	3.13
68	Neurological causes of bladder, bowel, and sexual dysfunction	4.00	4.06
69	Neurogenic dysphagia	4.00	4.03
70	Primary nervous system tumors in adults	4.00	3.97
71	Prion diseases	4.00	3.94
72	Spinal cord vascular disease	4.00	3.87
73	Other endocrinopathies and the nervous system (e.g., pituitary, parathyroid, and adrenal glands)	4.00	3.87
74	Neurological disorders associated with bone and joint disease (e.g., spinal stenosis, Paget's disease)	3.91	3.74
75	Muscle pain and cramps	3.91	3.71
76	Effects of occupational toxins of the nervous system	3.91	3.35
77	Neurological complications of anesthesia	3.91	3.19
78	Ultrasound imaging of cerebral vasculature	3.91	2.77
79	Peripheral nerve trauma	3.82	3.97
80	Movement disorders – dystonia	3.73	4
81	Sex hormones and the nervous system	3.73	3.23
82	Arm and neck pain	3.64	3.68
83	Movement disorders – tics	3.64	3.61
84	Disorders of bones, joints, ligaments, and meninges	3.64	3.29
85	Lower back and lower limb pain	3.55	3.97
86	Limb apraxia	3.55	3.84
87	Nerve conduction studies	3.55	3.65
88	Spinal cord trauma	3.45	3.87
89	Electroencephalography	3.45	3.45
90	Neurological complications of vaccination	3.45	3.19
91	Caloric testing	3.45	3.06
92	Craniocerebral trauma	3.27	3.87
93	Hearing loss	3.27	3.45
94	Cerebral catheter angiography	3.27	3.16
95	Neurocutaneous syndromes	3.27	3.06
96	Disturbances of taste and smell	3.27	3
97	Electromyography	3.18	3.55
98	Effect of physical agents on the nervous system (e.g., heat, radiation, and altitude)	3.18	2.81
99	Mitochondrial disorders	3.18	2.58
100	Channelopathies	3.09	2.48
101	Neuropsychology	3.00	2.61
102	Uro-dynamic studies	3.00	2.39
103	Audiogram	2.91	2.74
104	Functional neuroimaging (functional magnetic resonance imaging, positron emission tomography, single photon emission computed tomography)	2.82	3.19
105	Neurotoxins of animals and plants	2.82	2.68
106	Marine toxins	2.82	2.58
107	Depression and psychosis	2.82	2.52
108	Behavior and personality disturbances	2.64	2.74
109	Evoked potentials	2.55	2.84
110	Developmental disorders of the nervous system	2.36	2.52
111	Electronystagmogram	2.27	2.58
112	Global developmental delay and developmental regression	2.09	2.29
113	Inborn errors of metabolism of the nervous system	2.09	2.29
114	Transcranial magnetic stimulation	1.91	2.29
115	Intraoperative monitoring	1.73	2.1

Notes: ^aThe topics are ordered by their ranking by staff then by residents.

^bSimilar topics are grouped to minimize redundancy.

^c“Rating average” is on a scale of five indicating how desirable a topic is for inclusion.