A critical systematic review assessing undergraduate neurology pipeline programs

Abstract

Background:

Although current programs exist to encourage undergraduate interest in neuroscience and neurology, few students go on to pursue a career in neurology. Thus, there is a need for more neurologists in the US. To assess undergraduate pipeline programs and their goals of garnering interest and knowledge of neurology, we systematically reviewed available literature on existing undergraduate neurology pipeline programs.

Methods:

A medical librarian conducted an electronic database search of PubMed, EMBASE, PsycINFO, Education Source, and ERIC based on a search strategy developed with a team of undergraduates and a neurologist. Of the 2,852 articles screened, 33 met the systematic review criteria and were evaluated based on the type and goal of the pipeline program, its delivery, and efficacy.

Results:

The 33 programs were classified into subtypes of pipeline programs, with focuses ranging from student-led projects to early clinical research opportunities. All programs were found to be successful in attracting student interest in neurology, providing exposure to relevant opportunities, and classroom enrichment.

Discussion:

The existing literature shows that neurology pipeline programs successfully inspire interest in a career in neurology among undergraduate students. These programs are valuable supplements to undergraduate neuroscience curricula and instrumental in introducing students to various fields.

Introduction

Over 7,208 students major in neuroscience in college (1), and nearly one-fifth of them express interest in going to medical school. However, under 3 % of pre-medical students matriculating into medical school indicate an interest in pursuing a career in neurology. Thus, a disconnect appears between this expressed interest in neuroscience among undergraduates and the long-term pursuit of the field (2). This dwindling interest among undergraduate students is oftentimes attributed to limited clinical experience, lack of guidance and support from mentors, and insufficient knowledge about neuroscience that motivates them to pursue such a field of study (3). Additionally, the COVID-19 pandemic has led to increased concern among neurology residents on the future of neurological patient management, care, and research, which could translate to unease about the profession at the undergraduate level (4).

Early exposure to neuroscience-based training programs and research opportunities has been proven to bolster students’ interest in learning about neuroscience (5). However, such programs for undergraduate students appear inaccessible to a wide student population, making integration into the classroom and related settings imperative to create a more adaptable way of learning (6). A pipeline program, described as a structured educational pathway that guides students from an early stage through various stages of education and training toward a specific career, plays a vital role in ensuring broader accessibility to certain career paths. Expanding neuroscience curricula with diverse programs or research opportunities may not only make neuroscience more interdisciplinary for students but also garner interest among underrepresented minority (URM) students and better inform them of related careers to pursue in neuroscience (7).

We conducted a systematic review of the literature on past and current undergraduate neurology pipeline programs to better understand their intent in garnering student interest in neuroscience. Our research question was: What neurology pipeline programs have been designed and implemented to attract undergraduate students into neurology? We also wanted to further analyze program designers, delivery methods, target audience (including any programs for URM students due to a shortage of URM neurologists), and success measurements.

Methods

We conducted a systematic review to identify existing neurology pipeline programs using the Population, Intervention, Control, and Outcome (PICO) framework to strategize and develop our research question. We limited our population for this systematic review to undergraduate students; studies of programs that focused on populations of K-12 students were evaluated in a separate review. Interventions refer to the implementation of neurology pipeline programs intended to impart knowledge about neuroscience to students. We also measured the outcomes of the programs or the success with which they achieved such goals.

Under the guidance of a neurologist (MTM), a team of six undergraduate research assistants (AK, IY, JE, KO, NL, and RA) iteratively created a list of keywords related to neurology education and career pipelines, which a medical librarian (CP) then expanded and refined. The librarian searched PubMed, Embase, and PsycINFO via the Ovid platform and Education Source and ERIC via the EBSCO platform for articles describing neurology pipeline programs. For our study, this was defined as: any initiative that introduced, educated, or imparted students with the knowledge and an interest in neurology that may inspire them to explore these interests to potentially pursuing the field. Each search strategy included a combination of keywords and controlled vocabulary appropriate to each database. The complete search details can be found in Appendix A. The strategy was registered via the Open Science Framework (OSF) with the registration doi: 10.17605/OSF.IO/2G8CN.

The search was conducted on July 5, 2022, and was not limited by the language or year the article was published. The resulting citations and abstracts were put into Covidence software. As shown in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram (Figure 1), 278 duplicate studies were removed, and 2,574 studies were screened for inclusion by the six reviewers (AK, IY, JE, KO, NL, and RA) based on the following inclusion criteria: (1) The program must be related to neuroscience or neurology, (2) The population of participants was limited to students in either K-12 education or undergraduate college students, and (3) The program had to have been implemented and provided specified outcomes. Before the Covidence screening, the medical librarian (CP) met with the reviewers to review the screening process and to ensure fidelity. Two different reviewers independently screened and voted upon each citation, and disagreements were resolved through discussion, resulting in a final vote. 146 studies were selected for full-text review, with 56 ultimately meeting the inclusion criteria after two rounds of in-depth independent screening. These 56 studies were then differentiated by targeted age groups: K-12 and undergraduate students. Of these, 20 were relevant to the K-12 age group, 28 were relevant to undergraduates, and 8 described programs that included participants in both target groups. In the mixed group, the reviewers determined which age groups benefited more directly. Ultimately 33 studies were included for this review, 28 exclusively targeted to undergraduate students, and 5 from the mixed group section of articles. A summary of the included programs is included in Table 1.

Figure 1

Results

Publications analysis

The articles were published between 1997 and 2022, with 25/33 (76%) published in the last ten years. Although the articles targeted an undergraduate student population, only about 5/33 (15.2%) explicitly mentioned including or targeting a URM student demographic. Programs targeted at URM students are marked with an asterisk (*) in Tables 2–6. The most common journals for the articles to be published in were the CBE – Life Sciences Education, Journal of Neuroscience Education (JUNE), PLOS One, Neurology, and Advances in Physiology Education.

Programmatic content analysis

To better assess the different measures of success with each pipeline program, the 33 programs were classified into subtypes of pipeline programs implemented for undergraduate students.

Six programs (6, 14–18) emphasized student involvement in case-study-based or collaborative-based projects (Table 2). Case-study-centered programs required students to analyze literature-based case studies on neurological illnesses. In project-based approaches, students presented their findings on neurological themes to peers, fostering teamwork and enhancing scientific literature analysis skills (16). Students provided feedback and assessed their knowledge through pre- and post-assessments and surveys.

Eight programs (19–26) involved learning tools and activities to help enrich the undergraduate classroom (Table 3). Interactive modules augmented students’ current curriculum, introducing them to various neurological conditions and procedures, from Parkinson’s disease to electroencephalograms (EEG). Progress was recorded frequently, and participation, engagement, knowledge reports, and final exams determined grades. Both students and faculty evaluated overall effectiveness.

Five programs (8–10, 12, 13) were integrative courses, with neuroscience and other science and non-science-related subjects for a unique perspective on neurological concepts (Table 4). These interdisciplinary disciplines ranged from media to art to convey neurological concepts by catering to students’ diversified interests through cross-disciplinary learning. One program, for example, taught students’ neural mechanisms through yoga and other mindful habits (9). Other courses focused on broader methodological analyses, such as the intersection between neuroscience with technology or environmental issues. Toward the end of these programs, data for student progress was collected through open-ended questionnaires, writing reflections, or final examination scores.

Six programs (4, 7, 11, 27–29) were internships or REU (Research Experience for Undergraduates) programs, exposing students to firsthand clinical or field research opportunities to pique their interests in neurology (Table 5). Students were able to attain valuable technical skills, which they could utilize in future professional endeavors. Furthermore, students were informed of different career paths with which they could specialize in neurology, which were not just healthcare-driven but also research-driven. One program, for instance, introduced students to experiences that can reinforce their confidence in research, such as attending weekly seminars and presenting their research in symposia at the end of the program (7). These programs were often implemented over the summer, allowing students to better immerse themselves in the experience compared to other short-term programs. Completion rates, qualitative feedback, and surveys measured program outcomes. Longitudinal assessments were conducted by some programs to gage how students augmented their experiences by measuring career progression into graduate studies. In one program, many students who originally expressed an interest in matriculating into medical school remained interested in this pursuit. In contrast, others who did not share this initial interest ended up enrolling in graduate programs, such as master’s or doctoral programs (4). Programs also assessed student feedback and impressions to assess how well they enriched students’ experiences.

Eight programs (5, 30–36) were extracurricular workshops or capstone projects for students to participate in and further their neuroscience knowledge. Some of these programs also involved the direction of medical students or neurology residents, and undergraduates presented their applied knowledge to a younger audience, from K-12 students (Table 6). Through interactive field studies and presentations, undergraduates taught core concepts, such as brain structure, disorders, and physiology, in a comprehensible manner to children and adolescents. These programs benefited both high school students and undergraduates, with the latter gaining mentorship and encouragement by medical students and residents. Feedback was largely positive, with undergraduates expressing gained confidence in their ability to educate a younger audience on complex topics. Pre- and post-assessments were given to the younger students to compare their learning outcomes, and surveys were given to both undergraduates and their students to assess their experiences in this type of environment. Other programs had undergraduates participating in learning activities, such as Brain Games or attending academic conferences to reaffirm their interest in learning newfound neurology-related concepts (31).

Programmatic assessment

In the case-study or project-based programs, one program (14) utilized qualitative methods of measurement, largely analyzing students’ feedback after completing the program. While the remaining five programs (6, 15–18) utilized a mixed methods analysis of the programs. Qualitative data came from student feedback, with many expressing increased knowledge of neurological concepts and lasting positive impressions. Many students appreciated the case studies, as they allowed a stronger grasp of learning objectives and application of their knowledge to real-life scenarios. Quantitative data came from surveys rating students’ experiences (usually on a Likert scale), comparison of grades on pre-and post-assessments, and completion of assignments. All six programs concluded that students felt more confident in their abilities to understand neurological concepts.

Of the eight pipeline programs (19–26) with interactive learning tools in neuroscience courses or labs, only two (19, 22) utilized qualitative data from student feedback and overall completion of the modules or activities to measure program outcomes. Four programs (21, 24–26) were assessed with quantitative methods, evaluating students’ recorded answers from pre- and post-surveys, questionnaires, and exams. Two programs (20, 23) used a mixed methods approach, with qualitative data from student feedback and quantitative data from Likert-scale ratings, completed lab reports, and a comparison of course performance with a control student group. All programs reported students having increased content knowledge and confidence in conveying this comprehension.

Of the six pipeline programs (4, 7, 11, 27–29) designed to expose undergraduate students to extracurricular research experience, four programs (11, 27–29) were assessed using qualitative methods, largely from student performance in the labs and feedback from working in a lab. Two programs (4, 7) were measured with mixed methods, assessing qualitative data from student impressions and feedback and quantitative data from survey responses. All programs concluded that participation in labs left students with positive impressions and enriched their experiences by gaining research exposure.

In the five pipeline programs (8–10, 12, 13) that involved interdisciplinary neuroscience courses, three programs (9, 12, 13) were measured with only quantitative methods, assessing students’ pre- and post-exam scores and numerical ratings from surveys or questionnaires. Two programs (8, 10) were measured with a mixed methods approach, with quantitative data from examination scores after course completion or numerical ratings from questionnaires and qualitative data from students’ quality of portfolio work from the courses, written reflections, or verbal feedback and attitudes.

In the eight capstone-based programs (5, 30–36), six of these programs (5, 30, 33–36) were measured using a mixed methods approach, with quantitative data from numerical surveys, statistical analyses, or pre-and post-exam score comparisons, and qualitative data from students’ verbal feedback or open-ended questionnaires. Two programs (31, 32) were measured with solely qualitative data, using anecdotal evidence or open-ended questionnaires.

Discussion

Our systematic review introduced a diverse range of pipeline programs and experiences that can inspire undergraduate students to pursue a career in neuroscience or neurology. Ranging from collaborative projects to interdisciplinary approaches, all programs are intended to deliver neuroscience concepts and potential careers. Programs that exhibited the greatest support in facilitating undergraduates’ interest in neuroscience prioritized partnerships with other student populations and offered primary research experience.

Uniquely, involving undergraduates in teaching younger students proved to be valuable. Undergraduates could improve their presentation and communication skills by teaching younger children about neuroscience, and the younger students gain exposure to new concepts in neurology that may inspire them to explore the field in the future. Capstone projects and research opportunities allowed students to immerse themselves in first-hand research and develop their own curriculum, leaving them with a firmer grasp of learned skills and experiences they can build upon.

The continuation of these programs can enhance students’ knowledge of neurology and career opportunities within the field. The integration of other disciplines was a unique aspect of neurology pipeline programs, which attracted students and enabled interactive learning. By incorporating these methods into existing curricula, we can cultivate a diversified and knowledgeable group of students to pursue neurology-related specializations. It can also broaden opportunities for students who are uncertain about their career paths or are underrepresented in these areas of study.

Another relevant consideration from this systematic review is the effects of the COVID-19 pandemic on attracting undergraduates into the field of neurology, as well as the delivery and availability of pipeline programs. As a result of the pandemic, undergraduates may feel anxious or uncertain about future careers, employment prospects, and continuing education. In a recent survey regarding the future of neurological practice post-pandemic, neurology residents expressed concern about the significant proportion of patients forced to postpone appointments, a lack of training in emergency response, and the need to adapt to teleneurology (4). Undergraduates already involved in patient care or neurology research during the pandemic may develop similar concerns about pursuing a neurology career. At the same time, those just learning about the field may be discouraged from getting involved with pipeline programs. Furthermore, the pandemic has had an impact on the delivery and availability of neurology pipeline programs. A systemic review of neurology training programs during the pandemic indicated a change in clinical routine for neurology residents, reduced research activities, and delivery of education via online services rather than in-person (11). Yet, many neurology residents reported having sufficient facilities to continue neurology research remotely. This offers a mixed outlook on pipeline programs during and post-pandemic. On the one hand, there may be limited access to in-person and clinical activities for undergraduate students. On the other hand, they may have increased access to virtual opportunities for research that may not have been available before. Even if virtual neurology pipeline programs are more available, that does not mean that all undergraduates will have equal financial opportunity or time to participate (11).

Limitations

The screening process of this systematic review has resulted in the exclusion of multiple articles that presented promising pipeline programs designed for an undergraduate audience due to a lack of implementation or no measurable/irrelevant outcomes. Of those implemented, some programs were excluded from this systematic review as they were not designed to inspire students to explore neurology but to teach general skills, such as reading scientific journals, enacting collaboration, or simply passing a class.

Of the programs studied, a significant limitation was the extent to which undergraduate encouragement into neurology was achieved. Most programs were short-term; therefore, no insight was provided after program completion into how these students went on to strengthen their interests. Longitudinal investigations could provide deeper insight into whether these programs do play a transformative role in students’ career preparation or decision to pursue neurology. However, this raises significant challenges due to numerous reasons. In the time between students’ participation in an early-exposure pipeline program and their ultimate career choice, they may undergo various educational and/or personal experiences that may ultimately shape their decision, whether in or out of neurology, making it harder to gage the success of a particular program. Data collection on the long-term career trajectories of program participants can also be logistically challenging. It often requires sustained tracking efforts, which may not be feasible for all pipeline programs, especially those with limited resources. Also, due to the duration these programs can entail, students may face attrition in wanting to continue participating beyond a program’s formal conclusion.

Another drawback to these programs is the geographical accessibility to certain neurology pipeline programs. Limited access to neurology pipeline programs may be especially prevalent in more rural or underserved areas, of which underrepresented students may reside as well, ultimately impacting program representation and participation. Additionally, some programs may be limited in their funding or resources available to extend to a broader student population and thus, provide them with enriching opportunities. These caveats in geographical and resource inaccessibility should be addressed toward efforts in the improvement of neurology pipeline programs and their overall effectiveness.

Future directions

Future research is necessary to investigate interactions between mixed student populations and how this can help further deepen undergraduates’ interests in neurology. While this review discussed programs including students outside of undergraduates, they highlighted the benefit in fostering engagement and encouragement to undergraduates. Collaboration between trainees at different educational levels can provide a better scope on the effects of the neurology pipeline by facilitating undergraduate student interest in neurology, and thus provide a wider view of programs’ benefits. Emphasizing the importance of mentorship and networking between undergraduate trainees and physicians or graduate students can be integral in facilitating students’ interest and pursuit of neurology. Programs should work to actively connect students to neurology professionals and establish these bonds so that they can help guide students throughout their academic and professional careers (5). Current strategies in tracking the efficacy of neurology pipeline programs, from progress tracking, student feedback collection, and long-term impact assessments, can also shed insight into how students feel more assured in their academic and career choices if augmented with this developed connection and resource of a neurology professional with which they can turn to for guidance. Overall, these programs can be expanded to include programs specifically designed for undergraduates’ professional readiness in neurology, with mentorship and personal connections sustaining their interest and building relevant knowledge and skills for the workforce.

More importantly, future programs should target the inclusion of underrepresented minorities, as only 15% of programs in this review did so. Diversification within neurology not only introduces unique perspectives and problem-solving skills but also improves the workforce of practicing neurologists and promotes broader undergraduate interest, diminishing the gap within the workforce (6). To improve in fostering diversity and inclusion of underrepresented undergraduate students in neurology pipeline programs, programs should actively prioritize the recruitment of students from underrepresented backgrounds and advocate for the support and guidance of these students into neurology-related careers, thus contributing to a more inclusive and representative workforce, with people bringing to the table a wide array of expertise and unique talents that benefits the field as a whole.

To address the challenges posed by geographical and funding or institutional limitations, we must consider innovative approaches to improving neurology pipeline programs. As shown through some program outlines in this study, designing interdisciplinary programs that integrate neurology with other fields of student interests, such as psychology, art, or technology, can provide students with a more comprehensive view of neurology and its applications, but more importantly, it allows smaller institutions to implement programs still relevant to neurology, and utilize available resources to garner a broader student population (9). These institutions can also conduct collaborative efforts with local community colleges or high schools in designing pipeline programs that not only sustain undergraduates’ interests in neurology but also identify and encourage younger students’ excitement about neurology, broadening the reach of these programs and diminishing geographical disparities. Furthermore, embracing a hybrid or remote format for existing or prospective programs, as we have seen from the COVID-19 pandemic, also improves accessibility for students who may be unable to attend in person and even participate in programs that may not be offered at their institution (4). In closing, the need to improve undergraduate-targeted neurology pipeline programs lies not only in the recognition and mitigation of these discussed limitations but also in the pivotal role these programs can play in shaping a dynamic and equitable future for the field of neurology, driven by the talent and diversity of the next generation of neurologists.

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