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Education Research: Case-Based and Near-Peer Teaching on Functional Neurologic Disorder in the Neurology Clerkship: A
Martin Viola1, Haatem Reda1,2, Alexandra Hovaguimian1,3
1Harvard Medical School, Boston, MA.
Background And Objectives:
Undergraduate medical education on functional neurologic disorders (FNDs) is limited and misconceptions regarding the diagnosis of FND are common, negatively affecting medical student knowledge, and attitudes about FND. We developed a multicomponent educational program on FND and delivered it to medical students previously assigned at random to 1 of 2 neurology clerkship sites, evaluating its effects on FND knowledge and attitudes.
Methods:
This program, run monthly from January to December 2025, consisted of a case-based session delivered by an attending neurologist followed by a near-peer session delivered by a medical student. Primary outcome was FND knowledge, measured via 10 multiple choice questions; between-group difference in mean percentage correct was evaluated using 5,000 bootstrapped samples. Student attitudes on FND, serving as exploratory outcomes, were measured using Likert-style items; between-group differences were evaluated using standardized mean differences (SMDs), with |0.2|, |0.5|, and |0.8| interpreted as small, medium, and large effect sizes, respectively. Student feedback was also evaluated to guide future implementation.
Results:
Primary outcome data were available for 26/52 intervention site and 15/49 control site students. Intervention site students correctly answered more FND knowledge items (mean = 92%, SD = 8%) than students at the control site (mean = 72%, SD = 27%, mean difference = 20%, 95% CI 8.5%-36%). On FND attitude items, intervention site students demonstrated moderate effects in the direction of greater self-reported understanding (SMD = 0.57, 95% CI -0.11 to 1.3) and comfort with FND (SMD = 0.64, 95% CI -0.05 to 1.3). They also reported greater disagreement with the statement that psychiatrists, not neurologists, should care for patients with FND (SMD = -1.1, 95% CI -1.8 to -0.35). In their feedback, students valued learning about FND but questioned the need for 2 sessions.
Discussion:
Compared with a control group, medical students at a clerkship site that implemented case-based and near-peer didactic sessions demonstrated greater clinical knowledge of FND, as well as signals of more positive and less negative attitudes toward patients with FND. Although limited by sample size and response rates, these findings support the implementation of focused didactics on FND in neurology clerkships.