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Article Figures & Data
Figures
- Figure 1 Pilot Program Resident Survey Responses
Resident responses (n = 55) to survey questions distributed at the conclusion of each of 6 sessions during 2016 pilot program.
- Figure 2 Number of Representative Outpatients Followed per Resident
At the conclusion of each of the 6 sessions in our 2016 pilot series, residents were asked how many patients they had followed who had the specific condition that was the focus of the session. For example, “How many patients with migraine have you personally followed in clinic that are receiving an interventional therapy (e.g., botox, nerve blocks)?” Responses (n = 55) were aggregated across the 6 sessions and expressed as a percentage of residents responding in each category. PGY = postgraduate year.
- Figure 3 Program Success at Achieving Educational Objectives
Resident (R) (n = 21), faculty (F) (n = 6), and patient (P) (n = 6) perspectives on to what extent the outpatient series met its educational objectives of (a) improving residents' understanding of the roles and responsibilities of an outpatient neurologist; (b) sharing the patient's perspective on living with chronic neurologic disease; and (c) exposing residents to effective strategies for shared decision making.
- Figure 4 Additional Resident Survey Responses
Resident responses (n = 21) to additional survey questions about session learning topics and format for the final 2020 program.
Tables
- Table 1
Major Themes From Qualitative Evaluation of Pilot Program (2016–17) and Select Illustrative Quotes
Residents The central value of the patient perspective
“Important to hear directly from the patient how our treatment decisions impact people's lives, families, and emotions.”
“[It was useful] to hear about how patient's lives are impacted by chronic disease—what they would have found useful to hear at the beginning.”
The session format supports learning about outpatient management
“I appreciate the question-and-answer discussion format as I think it is more interactive than a lecture and therefore more engaging.”
“I found the format to be quite unique and different from other noon conferences. In general, we either see the purely didactic noon conference or the more clinical master clinician rounds (where there is less didactic content). This seminar provides both didactic and clinical components in an interactive and interesting way.”
Seasoned faculty served as role models
“The combo of the patient's story and expert opinion is invaluable.”
“One aspect that is difficult to appreciate in typical didactic sessions is how patients manage with empiric trial-and-error management of headaches; it was great hearing…both the patient and doctor perspectives.”Faculty Strengthening patient-clinician relationship
“I think it was helpful for everyone involved. It brought the patient and I closer and to another level that will be helpful in care. I think it was helpful for the residents. And I know the patient enjoyed taking part.”
“[The most useful aspect for me] was probably strengthening my relationship with the patient and, I hope, making her feel more empowered.”
Increased understanding of common outpatient disorders
“For the residents, I would hope that they realize that all “functional” patients have brain conditions, even if we don't know how to diagnose or treat them—and that having that attitude towards a patient … decreases the patient's shame, or feeling responsible for their symptoms.”Patients Helping physicians learn about and value the patient perspective
“I agreed to do it because I think the people that are going to be involved in the patient's care should be aware of what the patient experiences. The more they know about the real-life experience, the better prepared they will be.”
“I like the idea of taking patients' perspective into consideration. It is important for doctors to hear from people of different backgrounds. Sometimes, doctors will ask me a question and I think they don't realize how my background affects my knowledge and experience.”
Participating in the sessions helped patients learn something new
“I already knew what [my neurologist] was thinking regarding my case, but there were things she said to the other doctors that made me think about it a different way. I found this very enlightening. When she put my case into a broader context…that was an “Aha” moment for me.”
Sharing and teaching is a way to “give back”
“It is great to hear that what we went through as a family is paying off and helping others.” 1. Choose appropriate topics: focus on management topics within outpatient neurology not frequently encountered by residents, e.g., usually managed in subspecialty clinics or requiring multiple years of follow-up. 2. Choose appropriate faculty members: select an experienced outpatient neurologist and prioritize clinical expertise over research credentials 3. Choose appropriate patients: select a patient (a) with a prolonged disease course requiring shared decision making at multiple stages, (b) who has a good relationship with their neurologist, (c) who has a good understanding of their illness, (d) is an effective communicator, and (e) who is comfortable sharing personal details about their values and the impact of their illness. Attend to the diversity of patients selected to ensure that representative voices are heard. 4. Plan the conversation: identify session learning objectives and create a session guide including a summary of the patient's clinical course and anticipated questions for the neurologist and the patient. Share this guide with the patient and faculty ahead of time to help them prepare and make changes. Although each session varies, a general outline might include the following: • Brief history from the patient's perspective of initial symptoms and signs • Discussion of early conversations about diagnosis and impact on the patient • Identifying key treatment decision points and sharing the patient's and the clinician's perspective • Identifying challenges the patient may have faced during their course • Clinician's overview for outpatient management of the featured condition • Patient's perspective on living with their neurologic condition 5. Moderate the session: use a moderator during the session to manage time, direct the flow of the discussion, and balance the perspectives of the patient and the faculty member. 6. Emphasize desired learning objectives: ask faculty to prepare 3–5 teaching slides to illustrate key concepts. 7. Encourage resident participation: save time for questions. - Table 3
Major Themes From Qualitative Evaluation of Final Program (2020–21) and Select Illustrative Quotes
Focus on patient perspective and experience is highly valuable “[What I liked best was] hearing the patient's perspective on how their diagnosis affects their life and the factors that go into their decisions (e.g., whether to get surgery, medications, etc.).”—Resident
“Great to hear about specifically about patient worries, hopes and values as it pertained to the role of epilepsy surgery.”—Resident
“I think it is really important to get the patient's perspective but also to see a patient who is doing really quite well. I think for whatever reason MS gets kind of [negative reputation] … I want to give a strong voice and accurate information to the next crop of physicians/neurologists.”—PatientSeries format is unique and effective “[It] is more engaging because we are hearing firsthand from the patient and their neurologist.”—Resident
“The format [worked well] with practitioner and patient with a moderator to help facilitate. It's good to have pre-emptive slides that cover major topics or themes that are expected to be covered during the session.”—Resident
“One thing I thought worked really well was that there were 3 voices: myself, the patient and [the moderator]. This helped to keep things engaging and interesting for the residents.”—FacultyIncreased understanding of outpatient topics not covered elsewhere “We have precious little [teaching] in outpatient neurology in a program largely pressed into service of inpatient care … this series stands out as one of the few to explore and demonstrate management of complex and chronic neurological care.”—Resident
“Helpful to frame the world of outpatient neurology, which is most of the field.”—Resident
“I think exposure to common outpatient scenarios…is really important and helpful, to expose young neurologists to what is out there. Residents do not see a lot of the common outpatient conditions.”—FacultyInteraction between the physician and the patient offers insight into shared decision making “I learned that patients have a lot to offer in their expertise with the disease.”—Resident
“Implicitly, I think they might learn that outpatient management is a long-term relationship that involves both diagnostic and management shared decisions.”—Faculty
“The patient matters. It will take time between the neurologist and the patient; a lot of working together to find the best solution.”—PatientModeling and instilling values of humanism “Refreshing and wonderful connection to outpatient neurology and the patient experience. … Really helped to instill the humanistic component of practicing neurology into our learning.”—Resident
“The extreme anxiety with an unpredictable paroxysmal disorder that really requires a doctor as mentor so patient doesn't feel as scared…You can't lecture on that.”—Faculty
“On a personal level, I think how you present life-changing news to patients is vitally important. If somebody remembers what I experienced in a bad moment when they are being told they have 10 things to do but need to go tell this patient a tough diagnosis, maybe they will remember to think about it, take a moment, turn off their pager, and…recognize how impactful the conversation will be.”—Patient
“I wish they could be more positive with their patients. It is brutal to hear ‘we don't know if you will get better.’ I hope that they say that there are ways that you can better, that there is support for you.”—Patient
“You have to believe your patient. That is the hardest part. A lot of people do not know about this diagnosis of [FND], but now I hope they know. You don't just want to say ‘you're stressed out.’”—PatientUnique benefits for patients: understanding, contribution, and hope Understanding
“To sit down and see the slides on the screen and hear [my doctor] talk about [my diagnosis] was very helpful for me. I liked hearing it again…it helped me understand my condition a little bit better.”—Patient
“I was also just reminded about the progress I have made. I didn't know that PT was such a scarce resource for people with FND, that makes me so sad. I want to be part of the solution to help address this problem!”—Patient
Contribution
“I loved that I could share my truth. The residents and my outpatient doctor told me that they were impacted by this, which felt so great…It made me feel like [the residents] really heard me.”—Patient
Hope
“I learned my doctor cares if I meet my dreams in life, that made me cry. He is working to make this happen. I knew doctors care, but it was unbelievable to learn that my doctor cares this much.”—Patient Name Location Contribution Christopher T. Doughty, MD Department of Neurology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; and analysis or interpretation of data Galina Gheihman, MD Department of Neurology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA Drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data; and additional contributions: co–first author Tracey A. Milligan, MD Department of Neurology, New York Medical College/Westchester Medical Center, Valhalla, NY Drafting/revision of the manuscript for content, including medical writing for content, and study concept or design Tracey A. Cho, MD Department of Neurology, University of Iowa, Iowa City Drafting/revision of the manuscript for content, including medical writing for content; study concept or design; and analysis or interpretation of data
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