Global Perceptions and Utilization of Clinical Neurophysiology in Movement Disorders.

BACKGROUND: Clinical neurophysiology (CNP) involves the use of neurophysiological techniques to make an accurate clinical diagnosis, to quantify the severity, and to measure the treatment response. Despite several studies showing CNP to be a useful diagnostic tool in Movement Disorders (MD), its more widespread utilization in clinical practice has been limited. OBJECTIVES: To better understand the current availability, global perceptions, and challenges for implementation of diagnostic CNP in the clinical practice of MD. METHODS: The International Parkinson and Movement Disorders Society (IPMDS) formed a Task Force on CNP. The Task Force distributed an online survey via email to all the members of the IPMDS between August 5 and 30, 2021. Descriptive statistics were used for analysis of the survey results. Some results are presented by IPMDS geographical sections namely PanAmerican (PAS), European (ES), African (AFR), Asian and Oceanian (AOS). RESULTS: Four hundred and ninety-one IPMDS members (52% males), from 196 countries, responded. The majority of responders from the AFR (65%) and PAS (63%) sections had no formal training in diagnostic CNP (40% for AOS and 37% for ES). The most commonly used techniques are electroencephalography (EEG) (72%) followed by surface EMG (71%). The majority of responders think that CNP is somewhat valuable or very valuable in the assessment of MD. All the sections identified "lack of training" as one of the biggest challenges for diagnostic CNP studies in MD. CONCLUSIONS: CNP is perceived to be a useful diagnostic tool in MD. Several challenges were identified that prevent widespread utilization of CNP in MD.

Guidelines for Qualifications of Neurodiagnostic Personnel: A Joint Position Statement of the American Clinical Neurophysiology Society, the American Association of Neuromuscular & Electrodiagnostic Medicine, the American Society of Neurophysiological Monitoring, and ASET-The Neurodiagnostic Society.

SUMMARY: The Guidelines for Qualifications of Neurodiagnostic Personnel (QNP) document has been created through the collaboration of the American Clinical Neurophysiology Society (ACNS), the American Society of Neurophysiological Monitoring (ASNM), the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), and ASET-The Neurodiagnostic Society (ASET). The quality of patient care is optimized when neurophysiological procedures are performed and interpreted by appropriately trained and qualified practitioners at every level. These societies recognize that neurodiagnostics is a large field with practitioners who have entered the field through a variety of training paths. This document suggests job titles, associated job responsibilities, and the recommended levels of education, certification, experience, and ongoing education appropriate for each job. This is important because of the growth and development of standardized training programs, board certifications, and continuing education in recent years. This document matches training, education, and credentials to the various tasks required for performing and interpreting neurodiagnostic procedures. This document does not intend to restrict the practice of those already working in neurodiagnostics. It represents recommendations of these societies with the understanding that federal, state, and local regulations, as well as individual hospital bylaws, supersede these recommendations. Because neurodiagnostics is a growing and dynamic field, the authors fully intend this document to change over time.

Undergraduate students' neurophysiological reasoning: what we learn from the attractive distractors students select.

The basis for mastering neurophysiology is understanding ion movement across cell membranes. The Electrochemical Gradients Assessment Device (EGAD) is a 17-item test assessing students' understanding of fundamental concepts of neurophysiology, e.g., electrochemical gradients and resistance, synaptic transmission, and stimulus strength. We collected responses to the EGAD from 534 students from seven institutions nationwide, before and after instruction. We determined the relative difficulty of neurophysiology topics and noted that students did better on "what" questions compared to "how" questions, particularly those integrating concentration gradient and electric forces to predict ion movement. We also found that, even after instruction, students selected one incorrect answer, at a rate greater than random chance for nine questions. We termed these incorrect answers attractive distractors. Most attractive distractors contained terms associated with concentration gradients, equilibrium, or anthropomorphic and teleological reasoning, and incorrect answers containing multiple terms were more attractive. We used χ2 analysis and alluvial diagrams to investigate how individual students moved or did not move between answer choices on the pre- and posttest. Interestingly, students selecting the attractive distractor on the pretest were just as likely as other incorrect students to move to the correct answer on the posttest. In contrast, of students incorrect on both the pre- and posttest, students who selected the attractive distractor on the pretest were more likely to stick with this answer on the posttest than students choosing other incorrect answers. Combining the EGAD results with alluvial diagrams can inform neurophysiology instruction to address points of student confusion.NEW & NOTEWORTHY Investigating students' alternative reasoning in neurophysiology, this research is the first to investigate how analyzing the most common incorrect answer can shed light on the concepts students struggle with when reasoning about neurophysiological problems, especially those dealing with both chemical and electrical driving forces to predict ion movement across cell membranes.

Effects of digitalized university curriculum-associated teaching on the equilibrium of autonomic neurophysiology and disposition of learners in medical school (EDUCATE-AND-LEARN): protocol for a randomized crossover study.

BACKGROUND: Homoeostasis of the autonomic nervous system (ANS) contributes to cognitive functional integrity in learners and can be greatly influenced by emotions and stress. While moderate stress can enhance learning and memory processes, long-term stress compromises learning performance in a face-to-face classroom environment. Integrative online learning and communication tools were shown to be beneficial for visualization and comprehension but their effects on the ANS are poorly understood. We aim to assess the effects of video conference-supported live lectures compared to on-site classroom teaching on autonomic functions and their association with learning performance. METHODS AND DESIGN: Fifty mentally and physically healthy medical students will be enrolled in a randomized two-period crossover study. Subjects will attend a seminar, which is held in face-to-face and simultaneously transmitted via videoconference. Subjects will be allocated in two arms in a randomized sequence determining the order in which both seminar settings will be attended. At baseline and throughout the interactive seminar subjects will undergo detailed autonomic testing comprising neurocardiac (heart rate variability), sudomotor (sympathetic skin response), neurovascular (laser Doppler flowmetry) and pupillomotor (pupillography) function. Furthermore, learning progress will be evaluated using pre- and post-tests on the seminar subject and emotions will be assessed using profile of mood state (POMS) questionnaire. STATISTICAL ANALYSIS: Carryover effects will be handled using a two-way repeated measures (mixed model). Between-group differences (baseline vs face-to-face vs videoconference) will be determined using one-way analysis of variance ANOVA followed by Student-Newman-Keul test. LIMITATIONS AND STRENGTHS: This study may elucidate complex interactions between autonomic and emotional dynamics during conventional on-site and video conference-based teaching, thus providing a basis for customized learning and teaching methods. Understanding and utilizing advanced distance learning strategies is particularly important during the current pandemic, which has been limiting on-site teaching dramatically in nearly all countries of the world.

Evaluación del desarrollo de la asignatura virtual Fisiología II en la especialidad Neurofisiología Clínica / Assessment of developing Physiology II as a virtual subject in the specialty of Clinical Neurophysiology

Introducción: La enseñanza mediante la modalidad virtual se adoptó como medida preventiva ante la propagación de la COVID-19. Para la educación médica cubana ha implicado un reto en cuanto a la reorganización de los programas de estudio. Con este propósito, se rediseño e implementó la asignatura Fisiología II en modalidad virtual, para garantizar la continuidad en la formación de residentes en Neurofisiología Clínica. Objetivo: Evaluar el desarrollo de la asignatura Fisiología II en su modalidad virtual desde la perspectiva de los estudiantes de la especialidad Neurofisiología Clínica. Métodos: Estudio exploratorio, no experimental y transversal. Mediante un cuestionario de preguntas cerradas y una abierta (aspectos positivos y negativos), se evaluó el desarrollo de la asignatura en modalidad virtual en relación con las variables: programa de la asignatura, desempeño de los profesores, escenario de las plataformas y soporte tecnológico. Resultados: La asignatura Fisiología II en modalidad virtual tuvo una alta aceptación por parte de los estudiantes. Los aspectos identificados como positivos fueron los relacionados con la gestión personal del tiempo, y la aplicabilidad y estructura de la asignatura; mientras que los negativos se orientaron hacia problemas de conectividad de internet y el entorno de estudio. Conclusiones: Las exitosas experiencias obtenidas en el desarrollo de la asignatura virtual Fisiología II sientan las bases para el empleo de este tipo de diseño en la especialidad de Neurofisiología Clínica y la posibilidad de extenderlo a otras asignaturas del plan de estudio(AU)

Introduction: Teaching through virtual modality was adopted as a preventive measure against the COVID-19 spread. For Cuban medical education, it has implied a challenge regarding the reorganization of study programs. For this purpose, the subject Physiology II was redesigned and implemented in virtual modality, in order to guarantee continuity in the training of Clinical Neurophysiology residents. Objective: To assess the development of the subject Physiology II in its virtual modality from the perspective of the students of the Clinical Neurophysiology specialty. Methods: Exploratory, nonexperimental and cross-sectional study. Through a questionnaire made up of closed questions and one open question (positive and negative aspects), the development of the subject in virtual modality was assessed in relation to the variables subject syllabus, professors' performance, platform scenario, and technological support. Results: The subject Physiology II in virtual modality had a high acceptance by the students. The aspects identified as positive were those related to individual time management, as well as the subject's applicability and structure; while the negative ones were oriented towards internet connectivity problems and the study environment. Conclusions: The successful experiences obtained in the development of Physiology II as a virtual subject lay the foundations for using this type of design in the specialty of Clinical Neurophysiology and the possibility of extending it to other subjects of the study plan(AU)

La neuroanatomía y neurofisiología en la comprensión de los trastornos del espectro autista / Neuroanatomy and neurophysiology in the study of autism spectrum disorders

Introducción: Los trastornos de espectro autista se caracterizan por presentar un déficit en la interacción y comunicación social con presencia de patrones repetitivos y restrictivos de comportamiento, intereses y actividades. En ellos estarían implicadas causas genéticas, ambientales y del desarrollo del sistema nervioso central. Un mayor conocimiento de la neuroanatomía y la neurofisiología ayudaría a comprender mejor este trastorno del neurodesarrollo. Objetivo: Profundizar en el conocimiento neuroanatómico y neurofisiológico de los trastornos del espectro autista. Métodos: Se realizó una búsqueda bibliográfica acerca del tema en las bases de datos LILACS, Scopus, SciELO, Pubmed, Medigraphic. Se escogieron 13 documentos, todos correspondientes a artículos originales que abordan el tema desde diferentes aristas. De los documentos, dos fueron localizados en Scopus, uno en Pubmed, cuatro en Medigrafhic, dos en LILACS y cuatro en SciELO. Resultados: Los trastornos de espectro autista se producen por una alteración estructural y funcional de la corteza cerebral. Los estudios de neuroimágenes han demostrado las alteraciones estructurales, fundamentalmente en la corteza prefrontal y sus conexiones, principal región encefálica implicada en la regulación de la conducta social. Las técnicas de secuenciación genómica de nueva generación muestran el origen genético en casos donde los estudios previamente señalados han resultado ser normales. Conclusiones: La profundización del conocimiento neuroanatómico y neurofisiológico de los trastornos de espectro autista permiten comprenderlos mejor(AU)

Introduction: Autism spectrum disorders are characterized by social deficits and communication difficulties, as well as restrictive, repetitive behavior patterns, interests and activities. Their causes may be genetic, environmental or related to the development of the central nervous system. Broader knowledge about neuroanatomy and neurophysiology could lead to a better understanding of this neurodevelopmental disorder. Objective: Gain insight into the neuroanatomy and neurophysiology of autism spectrum disorders. Methods: A bibliographic search about the topic was conducted in the databases LILACS, Scopus, SciELO, Pubmed and Medigraphic. A total 13 documents were selected, all of which were original papers approaching the topic from different perspectives. Two of the documents were obtained from Scopus, one from Pubmed, four from Medigraphic, two from LILACS and four from SciELO. Results: Autism spectrum disorders are caused by a structural and functional alteration of the cerebral cortex. Neuroimaging studies have shown the structural alterations, which mainly occur in the prefrontal cortex and its connections, the principal encephalic region involved in social behavior regulation. New generation genomic sequencing techniques reveal a genetic origin in cases where previous studies have been normal. Conclusions: Broader knowledge about the neuroanatomy and neurophysiology of autism spectrum disorders lead to their better understanding(AU)

Propuesta de asignatura Generalidades de la Estimulación Magnética Transcraneal para técnicos superiores de Neurofisiología Clínica / Course proposal Generalities of Transcranial Magnetic Stimulation for senior technicians of Clinical Neurophysiology

Introducción: Recientemente se inició la formación de profesionales en una nueva modalidad de Programas Técnico Superior de Ciclo Corto, en la especialidad de Neurofisiología Clínica. Esto responde a la necesidad de la formación de profesionales de la salud en el estudio de las enfermedades neurológicas. La estimulación magnética transcraneal constituye una herramienta importante en el diagnóstico y tratamiento de estas enfermedades. Sin embargo, se carece de un programa para la formación de los estudiantes en el estudio y aplicación de esta técnica. Objetivo: Diseñar un programa de curso propio sobre generalidades de la estimulación magnética transcraneal, para estudiantes de primer año de Neurofisiología Clínica. Métodos: Se realizó una investigación didáctica metodológica utilizando los métodos empíricos y teóricos observación, histórico lógico, estudio documental y bibliográfico, dialéctico, análisis y síntesis, inducción y deducción. Resultados: Se propuso un programa para curso propio que se estructuró en siete temas, con carácter presencial y duración de 32 horas. Se presentaron los contenidos por temas, objetivos, conocimientos esenciales a adquirir, habilidades principales a dominar y sistema de evaluación. Conclusiones: La aplicación de este programa contribuye al desarrollo de habilidades y el desempeño exitoso de los profesionales en formación, en el campo del conocimiento de la técnica de estimulación magnética transcraneal para el diagnóstico y tratamiento de las enfermedades neurológicas(AU)

Introduction: Recently began the training of professionals in a new modality of short-cycle Higher Technical Programs, in the specialty of Clinical Neurophysiology. This responds to the need of training health professionals in the study of neurological diseases, whose incidence rates have increased in recent years. Transcranial magnetic stimulation is an important tool in the diagnosis and treatment of these diseases. However, there is a lack of a program for the training of students in the study and application of this technique. Objective: Tto design an own course program on the generalities of transcranial magnetic stimulation, for first-year students of Clinical Neurophysiology. Method: A methodological didactic research was carried out using the empirical and theoretical methods, observation, logical historical, documentary and bibliographic study, dialectic, analysis and synthesis, induction and deduction. Results: A program for the course was proposed, structured in seven topics, with a face-to-face character and a duration of 32 hours. The contents were presented by topics, objectives, essential knowledge to acquire, main skills to master and an evaluation system. Conclusions: The application of this program contributes to the development of skills and the successful performance of professionals in training, in the field of knowledge of the transcranial magnetic stimulation technique for the diagnosis and treatment of neurological diseases(AU)

Introdução: Iniciou recentemente a formação de profissionais numa nova modalidade de Cursos Técnicos Superiores de Ciclo Curto, na especialidade de Neurofisiologia Clínica. Isso responde à necessidade de formação de profissionais de saúde no estudo das doenças neurológicas. A estimulação magnética transcraniana é uma ferramenta importante no diagnóstico e tratamento dessas doenças. No entanto, falta um programa de treinamento dos alunos no estudo e aplicação desta técnica. Objetivo: Desenhar um programa próprio sobre as generalidades da estimulação magnética transcraniana, para alunos do primeiro ano de Neurofisiologia Clínica. Método: Realizou-se uma investigação metodológica didática utilizando os métodos empírico e teórico de observação, histórico lógico, estudo documental e bibliográfico, dialética, análise e síntese, indução e dedução. Resultados: Foi proposto um programa de curso próprio, estruturado em sete temas, com caráter presencial e duração de 32 horas. Os conteúdos foram apresentados por tópicos, objetivos, conhecimentos essenciais a adquirir, competências principais a dominar e um sistema de avaliação. Conclusões: A aplicação deste programa contribui para o desenvolvimento de competências e o desempenho bem sucedido de profissionais em formação, no domínio do conhecimento da técnica de estimulação magnética transcraniana para o diagnóstico e tratamento de doenças neurológicas(AU)

Subspecialization in clinical neurophysiology: Development and current status.

OBJECTIVE: To describe the development and current status of training and certification in clinical neurophysiology (CNP); to explore the impact of the newer subspecialties in sleep medicine, neuromuscular medicine, and epilepsy; and to obtain information about aspects of practice in the subspecialty. METHODS: Information about training programs and certification was obtained from the records of the Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology, and diplomates were surveyed about their CNP practice activities and attitudes toward certification/recertification. RESULTS: In the years since the first examination was administered, a robust number of CNP training programs developed, but recently, there has been a decrease in the number of programs and fellows, although the number of programs and fellows in the subspecialties of epilepsy, neuromuscular medicine, and sleep medicine has increased. A diplomate survey indicated that most respondents devoted significant practice time to CNP procedures, especially to EEGs and EMGs. Although more diplomates performed EEGs than EMGs, a substantial portion performed both. Most diplomates were planning to or had maintained certification in CNP. CONCLUSION: Over 3,000 neurologists, child neurologists, and psychiatrists have obtained certification in CNP, and the majority are participating in recertification. Although the newer and overlapping subspecialties of epilepsy, neuromuscular medicine, and sleep medicine may be having a negative impact on CNP, it continues to have a relatively large number of programs and attracts a relatively large number of fellows.

Gender Disparity and Potential Strategies for Improvement in Neurology and Clinical Neurophysiology.

Discrimination in the workplace when documented is illegal but is seen to still exist in some forms whether based on culture, race, or gender. Each of these disparities warrants further discussion and study because of their significant impacts on hiring decisions, career advancement, and compensation. In this article, the authors have focused their attention on gender disparity in the fields of neurology and clinical neurophysiology and shared the data currently available to them. At a time when the field of clinical neurophysiology has seen enormous growth, gender disparity in leadership and compensation remain. Despite the increasing number of women entering the fields of neurology and clinical neurophysiology, women remain underrepresented in national leadership positions. Many women physicians report experiencing gender discrimination despite increasing efforts by universities and medical centers to improve inclusivity and diversity. Equity and inclusivity are not the same and there is a disconnect between the increased numbers of women and their shared experiences in the workplace. Implicit bias undermines the ability of women to advance in their careers. For neurologists, data indicate that the latest gender pay gap is $56,000 (24%), increased from $37,000 in 2015, and is one of the largest pay gaps in any medical specialty. One third of the top 12 medical schools in the United States require that maternity leave be taken through disability coverage and/or sick benefits, and most family leave policies constrain benefits to the discretion of departmental leadership. The authors recommend strategies to improve gender disparity include institutional training to Identify and overcome biases, changes to professional organizations and national scientific meeting structure, transparency in academic hiring, promotion and compensation, and mentorship and sponsorship programs.

A new assessment to monitor student performance in introductory neurophysiology: Electrochemical Gradients Assessment Device.

The basis for understanding neurophysiology is understanding ion movement across cell membranes. Students in introductory courses recognize ion concentration gradients as a driving force for ion movement but struggle to simultaneously account for electrical charge gradients. We developed a 17-multiple-choice item assessment of students' understanding of electrochemical gradients and resistance in neurophysiology, the Electrochemical Gradients Assessment Device (EGAD). We investigated the internal evidence validity of the assessment by analyzing item characteristic curves of score probability and student ability for each question, and a Wright map of student scores and ability. We used linear mixed-effect regression to test student performance and ability. Our assessment discriminated students with average ability (weighted likelihood estimate: -2 to 1.5 Θ); however, it was not as effective at discriminating students at the highest ability (weighted likelihood estimate: >2 Θ). We determined the assessment could capture changes in both assessment scores (model r2 = 0.51, P < 0.001, n = 444) and ability estimates (model r2 = 0.47, P < 0.001, n = 444) after a simulation-based laboratory and course instruction for 222 students. Differential item function analysis determined that each item on the assessment performed equitably for all students, regardless of gender, race/ethnicity, or economic status. Overall, we found that men scored higher (r2 = 0.51, P = 0.014, n = 444) and had higher ability scores (P = 0.003) on the EGAD assessment. Caucasian students of both genders were positively correlated with score (r2 = 0.51, P < 0.001, n = 444) and ability (r2 = 0.47, P < 0.001, n = 444). Based on the evidence gathered through our analyses, the scores obtained from the EGAD can distinguish between levels of content knowledge on neurophysiology principles for students in introductory physiology courses.

A framework for the ethical assessment of chimeric animal research involving human neural tissue.

BACKGROUND: Animal models of human diseases are often used in biomedical research in place of human subjects. However, results obtained by animal models may fail to hold true for humans. One way of addressing this problem is to make animal models more similar to humans by placing human tissue into animal models, rendering them chimeric. Since technical and ethical limitations make neurological disorders difficult to study in humans, chimeric models with human neural tissue could help advance our understanding of neuropathophysiology. MAIN BODY: In this article, we examine whether the introduction of human neural tissue and any consequent cognitive change is relevant to the way we ought to treat chimeras. We argue that changes in cognitive abilities are morally relevant to the extent that they increase the capacities that affect the moral status of any entity, including awareness, autonomy, and sociability. We posit that no being, regardless of species, should be treated in a way that is incommensurate with its moral status. Finally, we propose a framework that can be used to guide ethical assessment of research involving chimeras with advanced cognitive capacities. CONCLUSION: We advance this framework as a useful tool for bringing relevant considerations to the forefront for those considering the ethical merit of proposed chimeric research. In doing so, we examine concepts relevant to the question of how any entity may be treated, including moral status, dignity, and capacities.

Evaluation of a virtual neurophysiology laboratory as a new pedagogical tool for medical undergraduate students in China.

This study compared the effect of a virtual laboratory, a living tissue laboratory, and a blended laboratory on student learning about the generation and conduction of neural action potentials and perceptions about life science. Sixty-three second-year medical students were randomly assigned to one of three groups (living tissue laboratory, virtual laboratory, and blended group). The students conducted the practical activity, and then they were given a postlaboratory quiz and an attitude survey. The blended group euthanized fewer animals and spent less time to finish the animal experiment than the living tissue group did. In the postlaboratory quiz, students who performed the virtual laboratory alone got significantly lower scores than students in the other two groups, and the blended group did not get better scores than the living tissue group. The attitude surveys showed that the virtual laboratory group had a lower perceived value of the science research and activity in which they participated than the other two groups did. Here, 77.8% of all students chose the blended style as the ideal teaching method for experiments. Our findings led us to believe that isolated use of the virtual laboratory in China is not the best practice: the virtual laboratory serves as an effective preparation tool, and the blended laboratories may become the best laboratory teaching practice, provided that the software design for the virtual laboratory is further improved.

Education Research: The current state of neurophysiology education in selected neurology residency programs.

OBJECTIVE: Prior research has illustrated there is a knowledge gap in neurology residents' neurophysiology education (EEG and EMG), and we sought to understand whether this is still an issue and to recognize the barriers in order to create solutions and improve education. METHODS: Surveys were developed for adult neurology residents and one for program directors asking about confidence in neurophysiology knowledge, percent of graduates reaching level 4 ACGME (American Council of Graduate Medical Education) milestones in EEG and EMG, methods of learning used, interest in the subjects, and suggestions for improvements. RESULTS: Twenty-six program directors (19% responder rate) and 55 residents (from at least 16 different programs) completed the survey. Program directors thought that 85% of graduating residents met level 4 milestones in EEG and only 75% in EMG. Structured rotations and more time allocated to education of these topics were frequent barriers mentioned. Postgraduate year 4 residents were 60% and 67% confident in EEG and 64%, 59%, and 62.3% in EMG level 4 milestones. Learning to read EEGs was considered important throughout residents' training; however, this interest and value decreased over time with EMG. CONCLUSION: In our study, program directors suspect up to a quarter of residents may graduate not meeting level 4 ACGME milestones, and residents expressed lack of confidence in these areas. The educational methods used to instruct residents in EEG and EMG were similar as were the barriers they face across programs. This information hopefully will help fuel curriculum design and interest in these important neurology techniques.

[Intraoperative neurophysiological monitoring in Spain: its beginnings, current situation and future prospects]. / Monitorizacion neurofisiologica intraoperatoria en España: inicios, situacion actual y perspectivas de futuro.

Intraoperative neurophysiological monitoring (IONM) is nowadays another tool within the operating room that seeks to avoid neurological sequels derived from the surgical act. The Spanish Neurophysiological Intra-Surgical Monitoring Association (AMINE) in collaboration with the Spanish Society of Clinical Neurophysiology (SENFC), and the IONM Working Group of the SENFC has been collecting data in order to know the current situation of the IONM in Spain by hospitals, autonomous communities including the autonomous cities of Ceuta and Melilla, the opinions of the specialists in clinical neurophysiology involved in this topic and further forecasts regarding IONM. The data was gathered from November 2015 to May 2016 through telephone contact and/or email with specialists in clinical neurophysiology of the public National Health System, and through a computerized survey that also includes private healthcare centers. With the data obtained, from the perspective of AMINE and the SENFC we consider that nowadays the field of medicine covered by IONM is considerably large and it is foreseen that it will continue to grow. Therefore, a greater number of specialists in Clinical Neurophysiology will be required, as well as the need for specific training within the specialty that involves increasing the training period of MIRs based on competencies due to the increase in techniques/procedures, as well as its complexity.

TITLE: Monitorizacion neurofisiologica intraoperatoria en España: inicios, situacion actual y perspectivas de futuro.La monitorizacion neurofisiologica intraoperatoria (MNIO) es hoy en dia una herramienta mas dentro del quirofano que busca evitar secuelas neurologicas derivadas del acto quirurgico. Nuestro objetivo, desde la Asociacion de Monitorizacion Intraquirurgica Neurofisiologica Española (AMINE), en colaboracion con la Sociedad Española de Neurofisiologia Clinica (SENFC) y el Grupo de Trabajo de MNIO de la SENFC, ha sido recopilar datos para conocer la situacion actual de la MNIO en España por hospitales, comunidades autonomas y ciudades autonomas de Ceuta y Melilla, las opiniones de los especialistas en neurofisiologia clinica involucrados en este tema y las perspectivas de futuro. La recopilacion de los datos se ha realizado durante el periodo de noviembre de 2015 a mayo de 2016 mediante contacto telefonico o correo electronico con especialistas de neurofisiologia clinica del Sistema Nacional de Salud, y mediante una encuesta via informatica en la que tambien participaron algunos centros sanitarios privados. Con los datos obtenidos consideramos desde la perspectiva de la AMINE y la SENFC que el campo de la medicina que abarca la MNIO en estos momentos es muy amplio y seguira creciendo. Por eso, se precisa un mayor numero de especialistas en neurofisiologia clinica, asi como una mayor formacion especifica dentro de la especialidad, que implica incrementar el periodo formativo actual de los medicos internos residentes en funcion a competencias debido al incremento de las tecnicas/procedimientos, asi como su complejidad.

Interactive laboratory classes enhance neurophysiological knowledge in Thai medical students.

Interactive laboratory class (ILC) is a two-way communication teaching method that encourages students to correlate laboratory findings with materials from lectures. In Thai medical education, active learning methods are uncommon. This paper aims to establish 1) if ILCs would effectively promote physiology learning; 2) if effectiveness would be found in both previously academically high-performing and low-performing students; and 3) the acceptability of ILCs to Thai medical students as a novel learning method. Two hundred seventy-eight second-year medical students were recruited to this study. We conducted three ILC sessions, which followed corresponding lectures. We carried out multiple-choice pre- and post-ILC assessments of knowledge and compared by repeated-measures ANOVA and unpaired t-test. Subgroup analysis was performed to compare high-performance (HighP) and low-performance (LowP) students. After the ILCs, participants self-rated their knowledge and satisfaction. Post-ILC test scores increased significantly compared with pre-ILC test scores in all three sessions. Mean scores of each post-ILC test increased significantly from pre-ILC test in both LowP and HighP groups. More students self-reported a "very high" and "high" level of knowledge after ILCs. Most students agreed that ILCs provided more discussion opportunity, motivated their learning, and made lessons more enjoyable. As an adjunct to lectures, ILCs can enhance knowledge in medical students, regardless of previous academic performance. Students perceived ILC as useful and acceptable. This study supports the active learning methods in physiology education, regardless of cultural context.

Clinical Neurophysiology Training in a Developing Country: Institutional Resources and Profiles.

PURPOSE: The purpose of this study was to describe the characteristics and preferences of clinical neurophysiology (CN) fellows, as well as the resources available for their training, in a developing country such as Mexico. METHODS: An online survey (25 questions) was given to Mexican CN fellows from May to June 2017, covering their reasons for choosing the CN subspecialty, their activities, future plans, institutional resources, and administrative staff. Descriptive statistics were used. RESULTS: Total respondents: 20/22 (90%), 65% female from 7 CN centers (80% public and 20% private hospitals) in Mexico City. Seventy-five percent chose CN out of personal interest, and all were not unsatisfied with their academic program. Most plan to work in private practice (75%) and are interested in learning EEG (85%) and intraoperative monitoring (75%-85%). The highest-reported training time by CN area allocated by the programs was as follows: EEG (27%), electromyography (22%), and evoked potentials (16%). The average number of fellows per center was 4; 75% of the centers perform epilepsy surgery, of which 60% offer invasive intracranial studies for the evaluation of surgical candidates. CONCLUSIONS: Mexican CN fellows are satisfied with their choice and with the academic program. They are increasingly interested in intraoperative monitoring, which is not addressed in current Mexican CN Programs.