Residency spiral concussion curriculum design.

BACKGROUND: Resident-focused concussion curricula that measure learner behaviours are currently unavailable. We sought to fill this gap by developing and iteratively implementing a Spiral Integrated Concussion Curriculum (SICC). APPROACH: Programme elements of the concussion curriculum include academic half-days (AHDs) and three half-day clinics for first- and second-year family medicine residents. Our SICC utilises social cognitive learning principles, the constructivism paradigm and utilisation-focused evaluation. EVALUATION: A mixed-method evaluation with a pre-/post-test design and interviews was utilised. Surveys and knowledge tests were used to measure knowledge and confidence pre-AHD and 6 months post-AHD. Interviews at 6 months explored programme perception and behaviour change. Of the 141 programme attendees, 114 (80%) participated in the pre-intervention knowledge test and 33 completed the pre- and post-AHD test. Immediate pre-/post-testing demonstrated statistically significant improvement in knowledge (p = 0.042). At 6 months post-AHD, residents in Cycle 1 (n = 5) had a knowledge decrease of 3.33% (p > 0.05). Residents in Cycle 2 (n = 7) had a knowledge increase of 11.6% (p > 0.05). Both cycles of residents had an increase in confidence (Cycle 1: 65.0% [p = 0.025]; Cycle 2: 62.8% [p = 0.0014]). Residents (5 out of 6) reported positive behavioural changes at 6 months. Valued programme elements included concussion diagnosis and management, the self-study guide resource and the organised structure. IMPLICATIONS: The SICC enriched these residents' learning and fostered sustained knowledge improvement and behavioural change at 6 months post-intervention. This approach may provide a workable design for future competency-based curriculum development.

Stroke Recovery During the COVID-19 Pandemic: A Position Paper on Recommendations for Rehabilitation.

Health care delivery shifted and adapted with the COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus 2. Stroke care was negatively affected across the care continuum and may lead to poor community living outcomes in those who survived a stroke during the ongoing pandemic. For instance, delays in seeking care, changes in length of stays, and shifts in discharge patterns were observed during the pandemic. Those seeking care were younger and had more severe neurologic effects from stroke. Increased strain was placed on caregivers and public health efforts, and community-wide lockdowns, albeit necessary to reduce the spread of COVID-19, had detrimental effects on treatment and recommendations to support community living outcomes. The American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group Health and Wellness Task Force convened to (1) discuss international experiences in stroke care and rehabilitation and (2) review recently published literature on stroke care and outcomes during the pandemic. Based on the findings in the literature, the task force proposes recommendations and interdisciplinary approaches at the (1) institutional and societal level; (2) health care delivery level; and (3) individual and interpersonal level spanning across the care continuum and into the community.