Develop a needs assessment process identifying gaps in neurology residency curricula; apply a TBL approach to effectively teach the topic.

An effective, adaptable needs assessment process can facilitate a responsive approach to the developing learning needs of its trainees. Once a curricular gap has been identified, a team based learning (TBL) format has been found to be flexible and effective in addressing learning issues faced by residents.

We identified the most common chief complaints (CCs) encountered in outpatient neurology resident clinic. Teaching of the clinical approach to cognitive impairment (CI) was found to be most needed. We created a TBL session to augment the PGY2 bootcamp curriculum. Incoming residents completed a baseline Individual Readiness Assurance Test (iRAT) before attending a CI lecture. Next, teams of 3-4 residents responded to short answer questions for 3 clinical vignettes followed by group discussion of responses. We assessed the change in confidence via repeated surveys completed before lecture and after TBL.

Incoming PGY2s were surveyed on their confidence in clinical recognition, workup, and management of the identified most common CCs using Likert scales.

In the following year’s bootcamp, a CI focused TBL was implemented. Wilcoxon signed-rank tests showed a significant increase in confidence after TBL across all three domains, including clinical recognition (p=0.007), workup (p=0.004), and management (p=0.004) of CI. Compared to the 2022 cohort after bootcamp, a Mann-Whitney U test showed a significant increase in confidence in CI workup for the 2023 cohort that attended TBL (p<0.01).

The needs assessment process can be adapted based on the current educational and clinical environment to find high frequency curricular gaps. Educators can then proactively implement educational activities. In this example, TBL was added to existing instruction given its efficacy, adaptability, and ease of application without the resource needs of simulation.