Education Research: The Complex Case Conference (CCC)

Background and Objectives Clinical neurology is becoming increasingly subspecialized, yet neurologists regularly encounter challenging, undifferentiated cases that span subspecialty boundaries. Few formalized opportunities exist for neurologists to present complex cases to peers with differing expertise, especially in multisite departments. Our study had 2 aims: (1) to assess whether there was a perceived need for a formalized mechanism for cross-specialty case discussion in a single multisite institution and (2) if so, whether a monthly, hybrid, structured case conference could meet this need. Methods To address our first aim, we completed a needs assessment by surveying neurology residents and attendings at a multisite academic medical center. We then addressed our second aim by implementing the Complex Case Conference (CCC); an 18-month follow-up survey was conducted to evaluate its utility and impact. We used a “Plan, Do, Study, Act” quality improvement approach and report changes across cycles. We report descriptive statistics; comparative analyses used the Fisher exact test and Wilcoxon rank-sum tests. Results Twelve respondents completed the needs assessment. In the preceding month, 75% (9/12) had at least 1 case where multispecialty input would have been helpful, yet 33% (4/12) reported having a good mechanism to discuss challenging cases with other subspecialties or within their own subspecialty (33% [4/12]). CCC was developed to address these needs. CCC was held monthly for 60 minutes, during protected Grand Rounds time, with 30 minutes dedicated to a preselected case and 30 minutes as an open forum. Twenty responses were included in the postimplementation survey. The proportion of respondents who felt they had a good mechanism to discuss challenging cases significantly increased, with other subspecialties (33% [4/12] to 80% [16/20] [ p = 0.036]) and within their own (33% [4/12] to 90% [18/20] [ p = 0.002]). Respondents also reported increased knowledge of existing institutional resources (17% [2/12] to 70% [14/20]) [ p = 0.009]). There was no significant change in intradepartmental referrals or recognition of cases where multispecialty input would be beneficial. Discussion After an institutional needs assessment, CCC was developed to foster multispecialty clinical collaboration within an academic department. It provides a dedicated forum for discussing cases that would benefit from multispecialty input and has proven valuable for complex patient discussion, supporting clinician growth, and sharing institutional knowledge.