Neurology chiefs put trainees to the test, quiz-show style

The 62-year-old woman in the video was experiencing a bizarre visual phenomenon.  

“Look at the pen in front of me, and tell me what happens to my face,” her neurologist asked her.  

“You disappeared!” she gasped. 

The doctor had her repeat the task. “You’re not there! You’re headless!” the patient exclaimed. “How do you do that?” 

The video ended. Then a slide appeared on the screen: “This phenomenon is called _____ _________ blindness.”  

The Neurology residents, fellows, and physicians watching that day in an auditorium at the Hospital of the University of Pennsylvania used their phones to fill in the blanks using Kahoot!, a game-based learning platform.  

Then Sashank Prasad, MD, chief of Neurology at Penn Presbyterian Medical Center, revealed the diagnosis: The patient had post-fixation blindness. When her eyes fixed on a target, like the pen, they couldn’t see anything beyond that point. The case, Prasad explained later, vividly illustrated a rare but important clinical phenomenon to be aware of in patients with a particular pattern of visual loss from a tumor behind the eyes. 

The joy of listening 

This is Neurobowl, an interactive case-based session to teach uncommon neurological conditions, and an effort by two long-time friends and colleagues—Prasad and Raymond Price, MD, chief of Neurology at Pennsylvania Hospital—to reimagine how the next generation of neurologists is trained. 

“It's meant to be a way to remind clinicians of the joy that can come from listening to patients, figuring out how to help them, and always remaining curious to learn more,” Prasad said.  

They introduce a spectrum of rare neurological disorders, centered with videos of patients giving their own histories. Prasad and Price always have their eye out for patients whose cases might make for good learning opportunities, and after examining them, will ask for their permission to record them reiterating or demonstrating their symptoms. The quiz element encourages interaction from the audience. After sharing the answers, they sprinkle in studies and historical context about the disorder.  

“We’re trying to do more to engage students and highlight the different areas of neurology,” Price said, “and help students rediscover how the neuro exam can lead you to diagnoses and conclusions.” 

Prasad and Price met on their first day as students at the Perelman School of Medicine, when they were seated alphabetically for their White Coat ceremony, and cemented their friendship as anatomy lab partners that first year.  

They both matched into the Neurology residency at Penn Medicine, did fellowships here, and then their careers took parallel paths as clinician educators. Price, who stayed at Penn, has been Neurology residency program director since 2012, while Prasad ran the Neurology residency program at Harvard Medical School for several years. In 2023, Prasad became chief of Neurology at Presbyterian; the following year, Price was named Neurology chief at Pennsylvania Hospital.  

A key question they’ve been asking themselves relates to the future of their field: How can neurology faculty provide excellent care across the health system, conduct cutting-edge research, value clinical education, “and make neurology as inspiring as it can be?” Prasad said.  

A new grand rounds 

Neurobowl is one way. Typically, in grand rounds—a staple of medical education—a subspecialist reads a patient case history to an audience, and “it is not uncommon to see people falling asleep,” Price said. Multiple choice exams are still common, but open-ended questions “are more reflective of how you care for patients,” Price said. “Patients don’t come in and say, ‘I have one of these problems. Tell me which one it is.’” 

The pair developed an early version of the trivia game years ago, while still working in different cities, to expand the reach of neurology education. But it was the isolation of the COVID-19 pandemic that pushed them to create a regular event. They debuted Neurobowl on Zoom for the American Academy of Neurology in July 2020 and offered it monthly throughout the pandemic. 

“We worried about residents in our own programs and across the country going through their training during that period, hardly being able to interact directly with patients,” Prasad said. “We thought we could build a community of people wanting to learn neurology,” using online tools like Zoom and Kahoot, which were exploding in popularity. 

Making an impact 

More than 700 people logged on the first evening, and years later, the neurologists still draw a loyal following every other month to their Zoom sessions. They’ve even heard from trainees in other time zones who set their alarms to tune in at 1 or 2 a.m., which is “incredibly rewarding,” Price said.  

Felipe Jones, MD, a Neuromuscular Medicine fellow at Mayo Clinic in Rochester, MN, first learned about Neurobowl in early 2021, towards the end of his Internal Medicine internship year, and has watched nearly every session since then. 

“Drs. Price and Prasad do an amazing job at selecting remarkable cases with key teaching points, which I’ve found very memorable,” Jones said. “Several diseases or physical exam findings displayed...are relatively rare and one could go an entire residency without learning about them, if it were not because of this type of educational activity.”  

Besides the online trivia every other month, Prasad and Price have presented it for grand rounds at New York University, University of Michigan, Boston University, Yale, and other institutions. 

Back on that fall day, during Penn’s Neurology grand rounds, another patient on the screen was suffering from a headache, loss of movement in his left arm, and peripheral vision loss in his left eye. He shared that he had experienced these symptoms another time, 10 years earlier, after he underwent radiation following the removal of a brain tumor. 

Then the question popped up: “The acronym for his diagnosis was likely ________ syndrome.”  

Price waited a minute for answers to come in before revealing the likely diagnosis: SMART syndrome, a disorder of stroke-like attacks that can occur after radiation therapy, first described in a 2006 Neurology journal article. 

In a case like this, Price explained, the key to diagnosing the patient is “to ask about a history of radiation.” The syndrome can develop between three and 35 years after childhood radiation to the brain, he added.  

The game has had a direct impact on patients. Price once showed a case of a specific type of autoimmune encephalitis, a rare condition that causes swelling in the brain. Six months later, at the American Academy of Neurology’s national meeting, a trainee from Canada came up to him. She had attended that round of trivia, and it was her first time hearing about the disorder. The case reminded her of a patient. She had the patient tested, it came back positive for the condition, and the patient received treatment. 

The story perfectly illustrated why Prasad and Price do what they do.  

“Neurology is really tough and requires a lot of collaboration,” Prasad said. “At best, some of us know some of these things. Together, we’re a lot stronger.”