Neurology Charades - A novel approach to teaching hypothesis driven neurological examination to medical students in the Covid-19 era

Background: Localizing the lesion responsible for a patients symptoms is one of the most stimulating
aspects of clinical neurology. Despite this, neurophobia remains prevalent in medical education. Covid-19
has impacted on students exposure to the clinical environment and ability to practice hypothesis driven
neurological examination on real patients. Furthermore, the current pandemic has impacted on
opportunities for social engagement and interaction within an educational setting. We describe a method
of delivering neurological examination teaching which utilizes simulation-based education and serious
games in healthcare to create a charades-based interactive card game, which aims to increase student
opportunities for repetitive, hands-on practice in the context of Covid-19 and provide an opportunity for an enjoyable method of learning in a safe environment.

Summary of Work: A series of charades flashcards were developed. Each card described typical
examination findings in a common neurological disorder (e.g., left middle cerebral artery infarct would
include expressive dysphasia, right homonymous hemianopia and right sided weakness). A flipped
classroom approach was utilised. Medical students received pre-course learning materials in the form of
instructional videos demonstrating neurological examinations and core principles of clinical neuroanatomy.
Students then attended a 2-hour face-to-face workshop. Following an opportunity to practice traditional
screening neurological examination on each other, students were divided into groups. Using the
flashcards, individual students took turns to act out the examination findings listed on their card. After
examination by their team mate, a diagnosis was determined. The winning group was the group which
deduced the most diagnoses in the shortest time. Strict adherence to Covid-19 mitigating factors was
maintained throughout the sessions.

Summary of Results: Preliminary feedback from students demonstrates the approach described is
enjoyable and useful in teaching the neurological examination.

Discussion and Conclusions: Charades may be a viable approach to teaching hypothesis driven neurological
exam to medical students, particularly in the setting of COVID-19 restrictions. This approach may also be
helpful at making the neurological examination less daunting for students and in providing an opportunity
to interact and play in a safe manner where remote learning has limited student opportunities for social
interaction.

Take-home Messages: Neurology charades may be an effective and enjoyable means of teaching
hypothesis driven neurological examination