Single-centre study surveying neurology trainees' and faculty's perceptions of the impact of the COVID-19 pandemic on residents' medical education.

OBJECTIVE: To assess perceptions of our neurology residents and faculty regarding training experience and medical education during the early COVID-19 pandemic. METHODS: We distributed two online, voluntary and anonymous surveys to trainees and teaching faculty of our Neurology Department at Henry Ford Hospital. Surveys inquired about trainees' stress, well-being, clinical experience and satisfaction with medical education and available support resources during the first wave of the COVID-19 pandemic in Michigan (mid-March to June 2020). RESULTS: A total of 17/31 trainees and 25/42 faculty responded to the surveys. Eight (47%) trainees reported high stress levels. Nine (57%) were redeployed to cover COVID-19 units. Compared with non-redeployed trainees, redeployed residents reported augmented medical knowledge (89% vs 38%, p=0.05). There was no difference in the two groups regarding overall satisfaction with residency experience, stress levels and didactics attendance. Twenty-one (84%) faculty felt that the redeployment interfered with trainees education but was appropriate, while 10 (59%) trainees described a positive experience overall. Both trainees and faculty believed the pandemic positively impacted trainees' experience by increasing maturity level, teamwork, empathy, and medical knowledge, while both agreed that increased stress and anxiety levels were negative outcomes of the pandemic. Twelve (70%) trainees and 13 (52%) faculty were interested in pursuing more virtual didactics in the future. CONCLUSION: Our findings provide an objective assessment of residents' experience during the COVID-19 pandemic and can guide teaching programmes in their medical education response in the face of future global crises.

Tales of a department: how the COVID-19 pandemic transformed Detroit's Henry Ford Hospital, Department of Neurology-part I: the surge.

The COVID-19 pandemic has reshaped the way healthcare systems operate around the world. The major hurdles faced have been availability of personal protective equipment, intensive care unit beds, ventilators, treatments and medical personnel. Detroit, Michigan has been an epidemic 'hotspot' in the USA with Wayne County among the hardest hit counties in the nation. The Department of Neurology at Henry Ford Hospital, in the heart of Detroit, has responded effectively to the pandemic by altering many aspects of its operations. The rapid engagement of the department and enhanced utilisation of teleneurology were two of the pivotal elements in the successful response to the pandemic. In this review, we describe the transformation our department has undergone, as it relates to its infrastructure redesigning, coverage restructuring, redeployment strategies, medical education adaptations and novel research initiatives.

A significant temporal and quantitative relationship exists between high-density lipoprotein levels and acute ischemic stroke presentation.

BACKGROUND: Reduced serum high-density lipoprotein (HDL-C) is an independent risk factor for ischemic stroke in elderly men. The temporal and quantitative relationships between HDL-C and acute ischemic stroke have not been defined. METHODS: We identified patients with first ever acute ischemic stroke presenting to our hospital between 2003 and 2006. Patients with serum fasting lipid levels drawn within 24 h of admission and at least one follow-up visit with a neurologist in our hospital were included. Clinical and laboratory data before, immediately after, and several weeks after the index stroke were collected. RESULTS: 191 patients were included (47% women, mean age 62 years). The mean time interval between pre-stroke lipid data and index stroke was 5.2 months; 50% of these patients were taking a statin medication. The mean time interval between index stroke and follow-up lipid testing was 2.6 months. Immediately after the index stroke, HDL-C levels decreased by 18% (p<0.001) relative to pre-stroke levels. This phenomenon was independent of stroke severity, and was blunted among patients with a prior history of myocardial infarction (p<0.01). HDL-C levels increased to pre-stroke levels within 3 months post-stroke. CONCLUSIONS: HDL-C levels decrease significantly at the time of acute ischemic stroke. Prior history of myocardial infarction diminishes HDL-C depression at the time of stroke. HDL-C may be an acute phase reactant or nascent biomarker of acute stroke susceptibility. Further prospective studies are needed.