Education Research: Bedside Rounding Alliance for Internal Medicine & Neurology (BRAINs): A Trainee-Led Program to...

Patients with neurologic symptoms are often first assessed by general medical providers, many of whom endorse low confidence and knowledge in evaluating neurologic patients. To address this gap, we designed, implemented, and evaluated the Bedside Rounding Alliance for Internal Medicine & Neurology Residents (BRAINs) Program.

Program objectives for internal medicine residents (IMRs) were to develop an approach to obtaining a focused neurologic history and to performing a focused physical examination. Objectives for neurology instructors were to demonstrate a focused neurologic history and examination and practice observing learners examining patients and providing specific feedback.

BRAINs paired neurology trainees (residents and fellows) with teams of 4-5 IMRs and subinterns for a 45-minute structured bedside teaching session bimonthly. Neurology instructors demonstrated a focused history and examination at the bedside for a patient admitted with a neurologic concern. IMRs then practiced a hands-on examination with real-time feedback. We evaluated the BRAINs program using a mixed quantitative-qualitative postsession survey. Neurology educators were surveyed on their teaching experiences.

Seventy-four IMRs participated and completed the survey since 2022. Participants agreed that BRAINs met the learning objectives of developing an approach to obtaining a neurologic history (69/74, 84%) and performing a neurologic examination (71/74, 96%). IMRs felt more confident in taking a focused history (62/74, 85%) and performing an examination (69/74, 93%) after the session. Ninety-five percent felt that bedside teaching was more effective than traditional didactics. Eighteen neurology educators completed the survey. One hundred percent reported that BRAINs was an effective way to practice near-peer teaching, and 89% reported that it was more effective than traditional didactics. Feedback from IMRs and educators helped iteratively improve the initiative.

The BRAINs program offered a scalable and adaptable structured teaching session that accommodates learners at various levels and promotes near-peer teaching in the clinical setting. The program is not resource intensive and can be scaled to different specialties, populations of learners, and hospitals. The BRAINs program is an educational innovation that supports cross-departmental camaraderie, empowers near-peer educators, and equips IMRs with increased confidence in neurologic knowledge and skills.