Publications by authors named "Arielle Kurzweil"

12 Publications

  • Page 1 of 1

Using Objective Structured Clinical Exams (OSCE) to Teach Neurology Residents to Disclose Prognosis after Hypoxic Ischemic Brain Injury.

J Stroke Cerebrovasc Dis 2021 Jul 11;30(7):105846. Epub 2021 May 11.

Department of Neurology, NYU Langone Medical Center, New York, NY, United States; Department of Neurosurgery, NYU Langone Medical Center, New York, NY, United States. Electronic address:

Background: Neurologists need to be adept at disclosing prognosis and breaking bad news. Objective structured clinical examinations (OSCE) allow trainees to practice these skills.

Methods: In 2017, in conjunction with the NYU School of Medicine Simulation Center, neurology faculty designed an OSCE case in which a resident had to inform a standardized patient (SP) her father had severe global hypoxic ischemic injury. The residents were surveyed on the experience using a Likert scale from 1 (worst) to 5 (best). The SP completed a behavioral anchored checklist and marked items as "not done," "partly done," or "well done".

Results: 57 third and fourth year neurology residents completed the case from 2018 to 2020, 54 (95%) of whom completed the post-OSCE survey. Residents reported feeling moderately prepared for the simulation (mean Likert score 3.7/5), and thought their performance was average (3.4/5). Overall, they found the case to be very helpful (4.6/5). The residents performed well in the realms of maintaining professionalism (64% rated "well done"), developing a relationship (62% rated "well done"), and information gathering (61% rated "well done"). There was room for improvement in the realms of providing education and presenting the bad news (39% and 37% rated "partly/not done," respectively).

Conclusions: OSCE cases can be used to teach neurology trainees how to discuss prognosis and break bad news. Feedback about this simulation was positive, though its efficacy has yet to be evaluated and could be a future direction of study.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105846DOI Listing
July 2021

Sleep-deprived residents and rapid picture naming performance using the Mobile Universal Lexicon Evaluation System (MULES) test.

eNeurologicalSci 2021 Mar 2;22:100323. Epub 2021 Feb 2.

Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA.

Objective: The Mobile Universal Lexicon Evaluation System (MULES) is a rapid picture naming task that captures extensive brain networks involving neurocognitive, afferent/efferent visual, and language pathways. Many of the factors captured by MULES may be abnormal in sleep-deprived residents. This study investigates the effect of sleep deprivation in post-call residents on MULES performance.

Methods: MULES, consisting of 54 color photographs, was administered to a cohort of neurology residents taking 24-hour in-hospital call ( = 18) and a group of similar-aged controls not taking call (n = 18). Differences in times between baseline and follow-up MULES scores were compared between the two groups.

Results: MULES time change in call residents was significantly worse (slower) from baseline (mean 1.2 s slower) compared to non-call controls (mean 11.2 s faster) ( < 0.001, Wilcoxon rank sum test). The change in MULES time from baseline was significantly correlated to the change in subjective level of sleepiness for call residents and to the amount of sleep obtained in the 24 h prior to follow-up testing for the entire cohort. For call residents, the duration of sleep obtained during call did not significantly correlate with change in MULES scores. There was no significant correlation between MULES change and sleep quality questionnaire score for the entire cohort.

Conclusion: The MULES is a novel test for effects of sleep deprivation on neurocognition and vision pathways. Sleep deprivation significantly worsens MULES performance. Subjective sleepiness may also affect MULES performance. MULES may serve as a useful performance assessment tool for sleep deprivation in residents.
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http://dx.doi.org/10.1016/j.ensci.2021.100323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876539PMC
March 2021

Training in Neurology: Identifying and addressing struggling colleagues in the era of physician burnout.

Neurology 2020 10 11;95(17):796-799. Epub 2020 Aug 11.

From the Departments of Neurology (R.S.S., A.L., A.N., A.M.K.), Neurosurgery (A.L.), and Medicine (S.Z.), New York University School of Medicine, NY.

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http://dx.doi.org/10.1212/WNL.0000000000010601DOI Listing
October 2020

The psychosocial implications of COVID-19 for a neurology program in a pandemic epicenter.

J Neurol Sci 2020 09 14;416:117034. Epub 2020 Jul 14.

New York University Grossman School of Medicine Department of Neurology, New York, NY, USA; New York University Grossman School of Medicine Department of Ophthalmology, New York, NY, USA. Electronic address:

Objective: We discuss the psychosocial implications of the COVID-19 pandemic as self-reported by housestaff and faculty in the NYU Langone Health Department of Neurology, and summarize how our program is responding to these ongoing challenges.

Methods: During the period of May 1-4, 2020, we administered an anonymous electronic survey to all neurology faculty and housestaff to assess the potential psychosocial impacts of COVID-19. The survey also addressed how our institution and department are responding to these challenges. This report outlines the psychosocial concerns of neurology faculty and housestaff and the multifaceted support services that our department and institution are offering in response. Faculty and housestaff cohorts were compared with regard to frequencies of binary responses (yes/ no) using the Fisher's exact test.

Results: Among 130 total survey respondents (91/191 faculty [48%] and 37/62 housestaff [60%]), substantial proportions of both groups self-reported having increased fear (79%), anxiety (83%) and depression (38%) during the COVID-19 pandemic. These proportions were not significantly different between the faculty and housestaff groups. Most respondents reported that the institution had provided adequate counseling and support services (91%) and that the department had rendered adequate emotional support (92%). Participants offered helpful suggestions regarding additional resources that would be helpful during the COVID-19 pandemic.

Conclusion: COVID-19 has affected the lives and minds of faculty and housestaff in our neurology department at the epicenter of the pandemic. Efforts to support these providers during this evolving crisis are imperative for promoting the resilience necessary to care for our patients and colleagues.
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http://dx.doi.org/10.1016/j.jns.2020.117034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358162PMC
September 2020

Training in neurology: Flexibility and adaptability of a neurology training program at the epicenter of COVID-19.

Neurology 2020 06 8;94(24):e2608-e2614. Epub 2020 May 8.

From the Departments of Neurology (S.A., S.S., N.A.-F., A.K., L.J.B., S.L.G.), Population Health (L.J.B.), and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine, New York.

Objective: To outline changes made to a neurology residency program in response to coronavirus disease 2019 (COVID-19).

Methods: In early March 2020, the first cases of COVID-19 were announced in the United States. New York City quickly became the epicenter of a global pandemic, and our training program needed to rapidly adapt to the increasing number of inpatient cases while being mindful of protecting providers and continuing education. Many of these changes unfolded over days, including removing residents from outpatient services, minimizing the number of residents on inpatient services, deploying residents to medicine services and medical intensive care units, converting continuity clinic patient visits to virtual options, transforming didactics to online platforms only, and maintaining connectedness in an era of social distancing. We have been able to accomplish this through daily virtual meetings among leadership, faculty, and residents.

Results: Over time, our program has successfully rolled out initiatives to service the growing number of COVID-related inpatients while maintaining neurologic care for those in need and continuing our neurologic education curriculum.

Conclusion: It has been necessary and feasible for our residency training program to undergo rapid structural changes to adapt to a medical crisis. The key ingredients in doing this successfully have been flexibility and teamwork. We suspect that many of the implemented changes will persist long after the COVID-19 crisis has passed and will change the approach to neurologic and medical training.
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http://dx.doi.org/10.1212/WNL.0000000000009675DOI Listing
June 2020

Rapid implementation of virtual neurology in response to the COVID-19 pandemic.

Neurology 2020 06 1;94(24):1077-1087. Epub 2020 May 1.

From the Department of Neurology (S.N.G., S.C.H., L.J.B., A.K., H.W., S.L.G., N.A.B.), New York University Grossman School of Medicine; Department of Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; and Department of Population Health (L.J.B.), New York University Grossman School of Medicine.

The COVID-19 pandemic is causing world-wide social dislocation, operational and economic dysfunction, and high rates of morbidity and mortality. Medical practices are responding by developing, disseminating, and implementing unprecedented changes in health care delivery. Telemedicine has rapidly moved to the frontline of clinical practice due to the need for prevention and mitigation strategies; these have been encouraged, facilitated, and enabled by changes in government rules and regulations and payer-driven reimbursement policies. We describe our neurology department's situational transformation from in-person outpatient visits to a largely virtual neurology practice in response to the COVID-19 pandemic. Two key factors enabled our rapid deployment of virtual encounters in neurology and its subspecialties. The first was a well-established robust information technology infrastructure supporting virtual urgent care services at our institution; this connected physicians directly to patients using both the physician's and the patient's own mobile devices. The second is the concept of one patient, one chart, facilitated by a suite of interconnected electronic medical record (EMR) applications on several different device types. We present our experience with conducting general teleneurology encounters using secure synchronous audio and video connections integrated with an EMR. This report also details how we perform virtual neurologic examinations that are clinically meaningful and how we document, code, and bill for these virtual services. Many of these processes can be used by other neurology providers, regardless of their specific practice model. We then discuss potential roles for teleneurology after the COVID-19 global pandemic has been contained.
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http://dx.doi.org/10.1212/WNL.0000000000009677DOI Listing
June 2020

Education Research: Teaching and assessing communication and professionalism in neurology residency with simulation.

Neurology 2020 02 20;94(5):229-232. Epub 2020 Jan 20.

From the Departments of Neurology (A.M.K., A.L., P.P., S.K.R., A.N., C.Z., K.I., L.J.B.), Neurosurgery (A.L.), Medicine (S.Z.), Ophthalmology (L.J.B., S.L.G.), and Population Health (L.J.B.), New York University School of Medicine.

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http://dx.doi.org/10.1212/WNL.0000000000008895DOI Listing
February 2020

Objective Structured Clinical Exams (OSCE) are a feasible method of teaching how to discuss a nonepileptic seizure diagnosis.

Epilepsy Behav 2019 11 22;100(Pt A):106526. Epub 2019 Oct 22.

Department of Neurology, New York University School of Medicine, New York, NY, United States of America; Department of Neurosurgery, New York University School of Medicine, New York, NY, United States of America.

Objective: Presenting the diagnosis of psychogenic nonepileptic seizures (PNES) can be a difficult task, but disclosing this information effectively is important to optimize patient outcomes. We sought to develop a standardized method to teach neurology residents how to introduce the diagnosis of PNES via an objective structured clinical examination (OSCE) with a standardized patient (SP).

Methods: In conjunction with the New York University School of Medicine Simulation Center (NYSIM), we designed an OSCE in which a resident had to inform a SP of her diagnosis of PNES and discuss a treatment plan. The SP was provided with details to gradually disclose depending on what the resident said about the history of her episodes, triggers for her episodes and her history of sexual abuse. Each encounter was observed by an attending physician who provided real-time feedback to the resident after the session. Additionally, the SP completed an objective written checklist of items the resident should have covered in the session and gave them verbal feedback.

Results: Twenty-six adult neurology (n = 22), child neurology (n = 3), and neuropsychiatry (n = 1) residents participated in this OSCE in 2018 and 2019, with full data available for 25 participants. Residents reported the OSCE was very useful (mean Likert score of 4.9/5). They felt moderately prepared (mean Likert score 3.8/5) and rated their performance as a mean of 3.3/5. On the SP's checklist, most residents were rated as Well Done in the domains of information gathering, relationship development, and education and counseling. Only in the domain of psychosocial assessment were most residents rated as Not Done (only 7/25 inquired about past trauma as a risk factor for PNES).

Significance: The OSCEs are a feasible and useful way to teach neurology residents about discussing PNES, as they allow for provision of real-time practice and feedback in a safe environment without real patients.
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http://dx.doi.org/10.1016/j.yebeh.2019.106526DOI Listing
November 2019

Teaching NeuroImages: Hippocampal sclerosis in cerebral malaria.

Neurology 2019 07;93(1):e112-e113

From the Departments of Neurology (K.L., D.B., A. Lord, B.C., A. Lewis, A.K.) and Neurosurgery (A. Lord, B.C., A. Lewis), NYU Langone Medical Center, New York.

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http://dx.doi.org/10.1212/WNL.0000000000007725DOI Listing
July 2019

Education Research: Simulation training for neurology residents on acquiring tPA consent: An educational initiative.

Neurology 2018 12;91(24):e2276-e2279

From the Departments of Neurology (S.K.R., A.M.K., L.J.B., K.I., S.L.G., A.L.) and Medicine (S.Z.), New York University School of Medicine, New York.

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http://dx.doi.org/10.1212/WNL.0000000000006651DOI Listing
December 2018

The Struggling Trainee: Principles of Effective Remediation.

Semin Neurol 2018 08 20;38(4):486-492. Epub 2018 Aug 20.

Department of Neurology, New York University School of Medicine, New York University, New York, New York.

Struggling trainees exist in all residency programs across all fields. Remediation, the act of improving deficiencies in struggling trainees, is necessary to promote the graduation of competent physicians. Deficiencies may be primarily cognitive or behavioral, and occasionally physical limitations do arise during residency. Remediation is challenging for all parties involved, and there is a paucity of literature to help guide the most effective process. In this review, we outline key principles of effective remediation of a struggling trainee in the modern era of medical education. A systematic approach that begins early, is consistent, and remains sensitive to a trainee's need for self-reflection in a nonjudgmental culture is essential for successfully remediating a trainee.
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http://dx.doi.org/10.1055/s-0038-1667137DOI Listing
August 2018

Gerstmann-Sträussler-Scheinker syndrome masquerading as multiple sclerosis.

J Neurol Sci 2011 Oct 11;309(1-2):55-7. Epub 2011 Aug 11.

Baird MS Center, Jacobs Neurological Institute SUNY Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14203, United States.

Gerstmann-Sträussler-Scheinker syndrome (GSS) is a rare degenerative disorder of the central nervous system that belongs to the family of human spongiform encephalopathies, or prion diseases. GSS is almost always inherited and mostly carried in an autosomal dominant pattern. Nevertheless, GSS is genetically and phenotypically heterogeneous; among the different prion diseases GSS has the longest clinical course thereby has the potential to mimic the clinical course of different neurological disorders. Here, we report of a patient with a progressive ataxic syndrome, with MRI and CSF findings suggestive of a demyelinating-inflammatory process as multiple sclerosis and the cues that prompted to a final diagnosis of GSS.
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http://dx.doi.org/10.1016/j.jns.2011.07.028DOI Listing
October 2011