How well do junior neurology residents recognize multiple sclerosis? Analysis of the "Close the Loop" resident...

To evaluate diagnostic accuracy and patterns of errors among junior neurology residents evaluating acute presentations of multiple sclerosis and other demyelinating diseases.

We retrospectively reviewed a morning-report case log of overnight neurology consultations presented by postgraduate year-2 residents at a New York academic center over 6 years. Cases with an initial resident impression of multiple sclerosis/demyelinating disease or a final diagnosis of multiple sclerosis/demyelinating disease were analyzed using a predefined localization-etiology schema.

Among 1301 cases with uncertain initial diagnoses, 66 (5.1%) had an initial resident impression of multiple sclerosis/demyelinating disease and 57 (4.4%) had a final multiple sclerosis/demyelinating disease diagnosis. Overall diagnostic accuracy for multiple sclerosis/demyelinating disease presentations was 66.7%. Of initial multiple sclerosis/demyelinating disease impressions, 33.3% were incorrect (over-called); most errors occurred at the level of neurologic versus non-neurologic (40.9%) and central nervous system etiologies (40.9%). Among confirmed multiple sclerosis/demyelinating disease cases, 22.8% were under-called, predominantly due to errors in central nervous system etiology (69.2%).

Acute multiple sclerosis/demyelinating disease presentations pose educational challenges for neurology residents, with errors primarily arising from misclassification of central nervous system etiologies. Diagnostic accuracy was influenced by prior disease history and patient age, highlighting cognitive biases such as framing and anchoring. Structured feedback models like "close the loop" may help improve multiple sclerosis diagnostic acumen in residency training and clinical practice.