Education Research: Learning to Prognosticate

Background and Objectives: Pediatric neuroprognostication is technically challenging and ethically complex. Despite its importance, little is known about how child neurology residents learn to estimate and communicate neurologic prognosis. Current educational interventions focus on communication but lack pediatric-specific focus. This exploratory qualitative study sought to describe how graduating residents conceptualize pediatric neuroprognostication, their educational experiences, and what gaps they identify in learning to prognosticate. Methods: Semistructured, one-on-one virtual interviews with senior child neurology residents (postgraduate year 5 or 6) were audio-recorded, transcribed, and deidentified. Participants also completed a postinterview survey on exposure to and perceived effectiveness of different learning modalities. Transcripts were analyzed iteratively using a constructivist grounded theory approach with regular consensus meetings. Preliminary themes and subthemes were presented to participants with opportunity for feedback using a standardized set of member checking questions. The findings of the study were mapped to elements of a targeted needs assessment in Kern's six-step model for curriculum development to help inform future educational efforts. Results: Fifteen residents representing 12 institutions across 10 states participated, representing diverse program sizes and geographic regions. Residents most frequently reported learning neuroprognostication through observation of attending physicians and clinical practice, while coaching/direct mentorship was also felt to be effective but less available. Qualitative analysis yielded 4 themes: conceptualizing content of neuroprognostication (for example, framing around common outcome domains), educational contributors (emphasizing the importance of effective modeling and graded autonomy), perceived efficacy in prognostication (such as relying on structured approaches), and identified gaps in education (including specific topics and modalities). These themes were then mapped to elements of a targeted needs assessment using Kern's six-step approach to curriculum development, highlighting opportunities and gaps in current educational approaches. Discussion: This qualitative study provides important context for considering strategies to improve resident education on neuroprognostication. The identified gaps highlight needs for structured debriefing and feedback with a particular opportunity for coaching-based strategies, consideration of simulation or roleplay-based modules, and focusing content development on pediatric disease-specific and ethical considerations. Limitations include the need for future work focused on educator perspectives. These findings provide a basis for developing neuroprognostication curricula for child neurology residents.