NeuroVoices: Lawrence Robinson, MD, on Innovating Educational Approaches for Neuromuscular Specialists

Lawrence Robinson, MD

In the last decade, those in the neurology field have seen immense progress across several different areas, including improved imaging and technologies, as well as a greater understanding for the underlying pathologies of many neurological diseases. With these advances, the way neurology is taught has also changed too. This includes changes to the curriculum, new style of teaching methods, introduction of telehealth, and evolving roles of teachers, educators, and scholars, among others.

At the 2024 American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) meeting, held October 15-18, in Savannah, Georgia, Lawrence Robinson, MD, presented the Lambert Lecture, focusing his talk on educating the next generation of neuromuscular and electrodiagnostic practitioners. In the talk, Robinson, a senior scientist at Sunnybrook Research Institute in Toronto, Ontario, and noted Baby Boomer, discussed the differences in how neurology was previously taught vs the approach needed for today’s generation of learners. He noted several adaptive teaching styles, including web-based didactic methods, video-based presentations, storytelling, immediate feedback, coaching, and competence-based learning.

During the meeting, Robinson sat down with NeurologyLive to provide an overview of his presentation and why this was a topic of concern. As part of a new iteration of NeuroVoices, Robinson provided insight on some of the aforementioned adaptive teaching styles, such as using multimedia and the flipped classroom model, to engage students more effectively. In addition, he touched upon the increasing role of artificial intelligence and technology in clinical practice and how patients now arrive at appointments with more pre-existing knowledge, sometimes accurate and sometimes not. Furthermore, he stressed the importance of building strong, personal connections with trainees and using humor as a valuable tool in the educational process.

NeurologyLive: Why was this a topic of interest for you?

Lawrence Robinson, MD: I've been interested in education for a number of years since part of what I do is train people in electrodiagnostic medicine. And I've noticed that things have changed. When I went to medical school, we had three sources of information: textbooks, lectures, and our clinical supervisors. These were generally reliable, and we could trust that the institutions that vetted them ensured the information was true.

Today's learners are totally different. They have so many resources, and they expect immediate access to technology. They just pull out their phone and have access to hundreds or thousands of resources instantly. They can Google something or watch videos. They have countless social media resources. So while they have access to a lot more information, they're also facing conflicting information. How do they know if the first page of a Google search is really accurate? How do they avoid confirmation bias—finding an article or post that just confirms what they already think? Today's learners are also dealing with shorter attention spans. They're used to short TikTok videos, and that's not the same as reading a whole textbook chapter.

So, while they may have access to more information, they struggle with critical thinking—a skill that's really important for electrodiagnosis. As a baby boomer, I think we just have to learn to adapt to meet their needs. That means using multimedia resources, teaching critical thinking in ways we didn’t before, using standardized testing more, and ultimately adapting with the times.

What are some of the challenges with educating the next generation of neuromuscular and electrodiagnostic practitioners?

I think one of the biggest challenges is teaching critical thinking—how to sort through all the information and figure out what's relevant, appropriate, and reliable. We do have tools to help with this. One tool is the "one-minute preceptor" where you ask learners to commit to an answer, explain why, and then you probe for more supporting evidence. Finally, you give them feedback on what they did well and what they did wrong, while trying to teach them general principles.

Another challenge is teaching them how to process information. As teachers, we tend to think internally and not vocalize what we're thinking. If we can think out loud more—express our uncertainty, our decision-making process, how we gather information and come to conclusions—I think that would really help learners. It's a challenge, but one we can meet. It means being comfortable with uncertainty, like when we don't know a diagnosis yet, and expressing that uncertainty to our trainees.

On the flip side, what are some of the greatest opportunities for the next generation of clinicians?

One theme we've discussed at the conference is the confluence of two pipelines: the learners we've been talking about, and all the new technologies coming down the line. There are some great opportunities around artificial intelligence, especially in documentation and diagnosis.

Also, the way we learn is evolving. For instance, we were in a session about musculoskeletal mimics of radiculopathy, and there are so many physical exam findings to learn. In the old days, you'd need to find someone who knew how to do it and have them teach you in person. Now, you can go on YouTube and find someone demonstrating those exam techniques. The availability of information today is a huge opportunity. When I was training, you had to go to the library, find citations, and physically look up journals. Now, everything is available instantly online.

What is a flipped classroom, and why can it be an effective teaching style?

The flipped classroom is something that's developed over the last decade or two, and it's quite different from the conventional lecture. In a traditional lecture, the speaker prepares slides and talks for about an hour, while the learner listens, maybe takes notes, and probably thinks about other things like dinner plans or what their spouse meant when they said everything was fine. By the end, the learner might remember a few points, but they won't retain much.

In a flipped classroom, the order is reversed. The learner prepares ahead of time by reviewing materials—maybe a chapter, a review paper, or multimedia content. Then, the in-person time is spent discussing the main points, verifying that the learner understands, and answering their questions. This promotes self-directed learning, helps retain information, and gets learners more actively involved. Plus, it takes less time—you don’t need to spend an hour lecturing when they've already done the prep work.

How do you envision care for patients with neuromuscular disorders changing over the coming years?

It's an interesting question. One change I've seen is that patients are coming in with a lot more education. They've watched medical lectures on YouTube, looked up their disorder online, and come with a lot of pre-knowledge—some of it correct, some of it not. So, we're starting from a different point.

Another evolution is in medical imaging technology. It allows us to see things we couldn’t see before, which is helpful, but it also presents challenges. Imaging always shows some minor abnormality, and patients worry about those changes, like with lumbar or cervical spine imaging. We almost never get a completely normal MRI result. Patients come in concerned about degenerative changes, and we have to explain that they're normal. There's even a saying: don’t become a "VOMIT"—a victim of medical imaging technology. You see something on imaging, and then you go down the rabbit hole of further tests or treatments, which could lead to unnecessary complications.

Any last comments regarding the topic of conversation?

I'd advocate for building strong personal relationships with your trainees and your team around education. One way to do that is by setting clear expectations at the start. I ask trainees three questions: What did you major in during undergrad? What are your goals for the rotation? And what are your interests outside of medicine? This helps us connect and focus on their goals.

Another way to build a connection is through humor. Humor in education can relieve stress, build team camaraderie, and just make learning more fun. So, I'd encourage everyone to consider using humor in their teaching.