Education Research: Comparison of Lecture-Based and Direct Instruction Didactics to Improve Neurologic Examination...

Teaching medical students how to perform an accurate neurologic examination (NE) is a primary objective of the neurology clerkship. Despite this emphasis, medical students often lack confidence in performing the NE. There is limited research on the effect of teacher-centered instruction methods on NE confidence. We designed this study to compare the impact of a lecture-based (LB) didactic and a direct instruction (DI) didactic on medical students' NE confidence during the neurology clerkship.

We conducted a teacher-centered, NE didactic during a four-week neurology clerkship. Third-year medical students (MS3s) were assigned to an LB didactic providing an overview of the NE or a DI didactic focused on examination pitfalls and practice opportunities. Preclerkship and postclerkship surveys assessed self-reported confidence of MS3s in performing various aspects of the NE and the perceived benefit of each didactic on examination skills. Clerkship evaluations of physical examination skills assessed the impact of each teaching method on NE performance. The primary outcome was change in composite NE confidence scores from baseline. Secondary outcomes were change in individual NE confidence scores from baseline, perceived didactic benefit, and clerkship physical examination scores.

A total of 103 MS3s participated in our study (LB = 52, DI = 51). Change in NE confidence scores from baseline did not differ between groups (LB mean = 7.62, DI mean = 7.66, p = 0.97, d = 0.007). Presurvey strength testing confidence scores were higher in the DI group (LB mean = 3.04, DI mean = 3.44, p = 0.038, d = 0.46). There were no other significant differences in other confidence scores between groups (p > 0.13). Students reported higher agreement with the DI didactic being beneficial for their NE skills than the LB didactic (LB mean = 3.97, DI mean = 4.52, p = 0.0013, d = 0.82). Clerkship physical examination evaluation scores did not differ between groups (LB and DI median = 4, interquartile range [IQR] = 3-4, p = 0.074, r = 0.070).

Emphasizing challenging NE pitfalls with DI is perceived by students to be more beneficial for learning examination skills than LB methods. However, DI is not clearly superior to LB teaching methods in improving NE confidence. Future research could further evaluate the efficacy of DI teaching methods with randomized trials and interval assessment of their effects on NE confidence throughout the neurology clerkship.