Curriculum Innovation: A Resident-Created Multiple-Choice Question of the Week to Augment Case-Based Learning

Morning report (MR) has been a foundation of learning in many neurology residency programs. However, fortification of the high-yield learning points during MR cases may be achieved with supplementary educational initiatives to promote effective long-term retention and test-enhanced learning.

During the 2020-2021 academic year, chief residents of our neurology training program sought to implement neurology certification board-style multiple-choice questions (MCQs) based on cases presented at MR to enhance case-based learning.

A chief resident was selected weekly to write a MCQ based on an instructive case presented in MR from the prior week. The National Board of Medical Examiners item writing guide and online tutorial were used as guidelines for constructing MCQs. MCQs featured a clinical vignette in the question stem, and images were added to augment select cases. The MCQs were distributed using Qualtrics, which generated a web link and tracked anonymous answers. The Qualtrics link was added to the departmental weekly newsletter and labeled question of the week (QOW). Detailed explanations for each QOW were provided. A feedback survey was sent to the departmental education committee after study completion.

Forty MCQs were written by the chief residents, and 1 question was distributed weekly in the departmental newsletter. After week 24, the QOW was restructured to enhance visibility. The mean number of residents who completed the MCQ was 13 (of 29 neurology residents [range 4-29]). The overall median response rate was 38%. When stratified by weeks 1-24 and 25-40 to account for QOW reformatting, the median response rate for weeks 1-24 and weeks 25-40 were 24% and 55%, respectively (p = 0.0013). In a poststudy survey sent to the education committee, 90% of respondents felt that resident-created MCQs were similar to board-style questions and added educational value to resident learning.

A chief resident QOW initiative was feasible and led to neurology resident academic engagement and enrichment, which supplemented case-based learning through a test-enhanced learning approach. Resident participation was significantly increased with enhanced visibility of QOW in weekly emails compared with hyperlink format.