Education Research: Neuroradiology curriculum in neurology residency training programs: How we teach neuroimaging.

OBJECTIVE: To better understand how the essential skill of interpreting various neuroimaging studies is taught to neurology residents in Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs. METHODS: A 22-question survey was sent electronically to 150 ACGME adult neurology program directors. We collected data regarding the presence of a neuroimaging curriculum, frequency of review sessions and testing, resource availability, and program director confidence in neuroimaging skills of graduating residents. We collected average scores on the neuroimaging section of the Resident In-service Training Examination of graduating residents for the past 3 years, which we attempted to correlate with resource availability. RESULTS: One-third of neurology residency programs do not have a neuroimaging curriculum, and half of training programs do not require a neuroimaging rotation. On average, trainees spend 1 hour per week reviewing imaging with radiologists. Program directors believed trainees receive insufficient neuroimaging training, with a median satisfaction rating on a Likert scale (0-100) of 35 (interquartile range 27-47). Few programs take advantage of online training resources. CONCLUSION: Opportunities exist to improve neuroimaging education in neurology resident education. This can be done by closer adherence to the American Academy of Neurology neuroimaging curriculum guidelines, especially by expanding access to online resources and additional emphasis on imaging review with neurology subspecialists.

A dozen years of evolution of neurology clerkships in the United States: Looking up.

OBJECTIVE: To report a 2017 survey of all US medical school neurology clerkship directors (CDs) and to compare the results to similar surveys conducted in 2005 and 2012. METHODS: An American Academy of Neurology (AAN) Consortium of Neurology Clerkship Directors (CNCD) workgroup developed the survey that was sent to all neurology CDs listed in the AAN CNCD database. Comparisons were made to similar 2005 and 2012 surveys. RESULTS: The response rate was 92 of 146 programs (63%). Among the responding institutions, neurology is required in 94% of schools and is 4 weeks in length in 75%. From 2005 to 2017, clerkships shifted out of a fourth-year-only rotation (p = 0.035) to earlier curricular time points. CD protected time averages 0.24 full-time equivalent (FTE), with 31% of CDs reporting 0.26 to 0.50 FTE support, a >4-fold increase from prior surveys (p < 0.001). CD service of >12 years increased from 9% in 2005 to 23% in 2017. Twenty-seven percent also serve as division chief/director, and 22% direct a preclinical neuroscience course. Forty-nine percent of CDs are very satisfied in their role, increased from 34% in 2012 (p = 0.046). The majority of CDs identify as white and male, with none identifying as black/African American. CONCLUSION: Changes since 2005 and 2012 include shifting of the neurology clerkship to earlier in the medical school curriculum and an increase in CD salary support. CDs are more satisfied than reflected in previous surveys and stay in the role longer. There is a lack of racial diversity among neurology CDs.

Coding in Stroke and Other Cerebrovascular Diseases.

Accurate coding is critical for clinical practice and research. Ongoing changes to diagnostic and billing codes require the clinician to stay abreast of coding updates. Payment for health care services, data sets for health services research, and reporting for medical quality improvement all require accurate administrative coding. This article provides an overview of coding principles for patients with strokes and other cerebrovascular diseases and includes an illustrative case as a review of coding principles in a patient with acute stroke.

Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research.

PURPOSE: The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use. METHODS: Key clinical and research variables were incorporated into a Microsoft Access database. To assess its utility for multicenter research data collection, the authors performed a 21-center feasibility study in which each center entered data from 12 consecutive intensive care unit monitoring patients. To assess its utility as a clinical report generating tool, three large volume centers used it to generate daily clinical critical care EEG reports. RESULTS: A total of 280 subjects were enrolled in the multicenter feasibility study. The duration of recording (median, 25.5 hours) varied significantly between the centers. The incidence of seizure (17.6%), periodic/rhythmic discharges (35.7%), and interictal epileptiform discharges (11.8%) was similar to previous studies. The database was used as a clinical reporting tool by 3 centers that entered a total of 3,144 unique patients covering 6,665 recording days. CONCLUSIONS: The Critical Care EEG Monitoring Research Consortium database has been successfully developed and implemented with a dual role as a collaborative research platform and a clinical reporting tool. It is now available for public download to be used as a clinical data repository and report generating tool.

Coding and billing issues in hospital neurology compensation.

BACKGROUND: Accurate coding and billing are critical for the financial health of hospitals. Neurologic inpatient services have specific, complex documentation requirements, which can result in inadequate billing. METHODS: We retrospectively compared coding practices from July 2013 to June 2014 (FY2014) using evaluation and management codes for initial inpatient encounters (CPT 99221-3) of a neurohospitalist group (NHG) to a hospital medicine group (HMG) and to national benchmarks. We further examined a sample of the lowest level encounters (CPT 99221) from the 4th quarter of FY2014 for specific deficiencies and compared these among groups. RESULTS: Low codes (CPT 99221) were more common in the NHG than the HMG and national benchmarks (54% vs 7% vs 4%, p < 0.01). Deficiencies in the examination were the most common reason for low coding in the NHG compared to the HMG (62% vs 5%, p < 0.001). Deficiencies in social history were more common in the NHG than the HMG (11% vs 0%, p < 0.003) but deficiencies in family history (34% vs 37%, p = 0.75) and review of systems (30% vs 30%, p = 1.0) were common in both groups. In the NHG group, documentation did not reflect the acuity of patients' medical conditions. CONCLUSIONS: Neurologists should pay close attention to documentation requirements-especially the neurologic examination-in order to allow for accurate coding and billing.