Practice Current and Practice Buzz: Survey Design Guidelines

Practice Current (PC) and Practice Buzz (PB) are interactive platforms to exchange opinions on different topics in neurology around the world. Our goal is to assess different aspects of neurologic practice in diverse settings. Evidence-based medicine is the gold standard for medical decision-making. However, several additional factors can affect medical decisions. Insufficient evidence, access to treatments, community acceptability can have a high impact on neurologic day-to-day decisions. Our surveys are not intended to test medical knowledge but to be used as a lens to real-life neurologic practice.

Practice Current and Practice Buzz surveys are designed to incentivize a discussion on hot topics in neurology practice and to understand variations in practice patterns on complex treatment-related questions. We do not endorse any specific drug choice. The choices listed are based on expert reviews of the available literature.

Our surveys are directed to busy clinicians, who often have limited time, and should be designed to be answered in less than 5 minutes. Here we provide some advice on how to create effective PC/PB submissions.

Jump to Topic

Identifying your Research Topic

First, identify the specific topic to be covered in the survey and avoid overly broad topics. For example, “Management of autonomic symptoms in Parkinson disease” instead of “Management of Parkinson disease.”

Identifying your Research Team

While we are happy to receive submissions from individuals, we find that the best projects have input from at least two authors. We encourage the involvement of medical students, residents, and fellows in these projects as well. For Practice Current submissions, having team members will also help you meet the expectations of interviewing experts for the affiliated commentary (see below).

Selecting the Section – Practice Current vs Practice Buzz

Use the following criteria about your research question and the submission requirements and expectations of Practice Current vs Practice Buzz, to choose the most appropriate section for your objectives (click the slide below to move forward in the presentation):

 

Designing Survey Questions

Using clinical cases is an effective way of increasing engagement. Keep the clinical vignettes short, including only the needed information, and include questions that relate to the presented clinical case. General questions without a clinical case can also be used, but we recommend including these questions towards the end of the survey.

Avoid survey fatigue and overburdening the respondents. Keep the surveys short (see above about question limits for PC and PB) and 3-4 cases. You can include multiple questions related to a single case. Longer surveys need to be clearly justified to the editors who may still request shortening. Avoid asking multiple difficult questions in a row (e.g., questions asking specific medication doses or requiring calculations).

PC/PB surveys are intended to assess practice patterns and NOT medical knowledge. If there is a specific interest in assessing the gap between regular practice and desired practice it is recommended to include different questions addressing each issue separately. For example: “What is the first-line preventative treatment that you USUALLY prescribe in your practice for migraine with aura?” (regular practice) and “What is the first-line preventative treatment that you would IDEALLY like to prescribe for migraine with aura?” (desired practice).

Writing the Survey Question Stems

The wording of your question stem can impact the response rate and the accuracy of the answers. Here are some recommendations to write effective questions:

  • Keep questions clear. Avoid using double negatives or phrases that could be interpreted in multiple ways. For example: “The patient developed side effects. Medications were adjusted.” The word “adjusted” could be interpreted as reducing the dose, stopping the medication, or even increasing the dose.
  • PC/PB surveys are answered by clinicians around the world. Avoid using abbreviations, jargon, or medication brand names that are unlikely to be understood by the global neurology community. For example, “LVO” would likely be interpreted as “large vessel occlusion” by primarily English-speaking providers but may confuse other clinicians, even if they are fluent in English.
  • Avoid double-barreled questions. These are questions that evaluate more than one concept and can create confusion. For example: “What is your preferred medication to treat relapsing-remitting Multiple Sclerosis that is best tolerated by your patients?”. This question is asking about preferred medication (which may be more associated with efficacy) and patient acceptability (which may be more associated with the side effect profile). The preferred medication may not be the best tolerated.
  • Consider whether the wording of the question may be viewed as biased or potentially offensive to some respondents, as well as the emotional reaction that some words may provoke. This can affect the results.  For example, asking about prescription practices of tetrahydrocannabinol vs asking about prescription practices of marijuana in post-traumatic stress disorder could result in different responses. In general, we recommend using the most neutral wording possible.
  • Be aware of “social desirability bias.” Respondents are less likely to choose answers that they think would make them look bad, even in anonymous surveys. For example, when asking “How much experience do you have in managing functional neurologic disorders?” respondents may be more likely to rate themselves favorably. Asking “How many patients with functional neurologic disorders have you managed in the last year?” may provide more accurate responses.

Writing the Survey Question Answer Options

For PC/PB, most items should be closed questions with a limited number of answer options. Occasionally it is appropriate to use a free-text option. For example, including “other” as one of the responses and allowing to enter a free-text answer. The provided options can affect the accuracy of the results.

Define the most appropriate answer format for your questions. Here is a list of the most common types of formats:

  • Forced-choice: Only one answer is allowed. When using this format, it is critical that you include all reasonable answers and that these don’t overlap.
  • Choose-all-that-apply: Multiple answers are allowed. You can decide to allow a specific number of options (e.g., choose 3) or an unlimited number of options. Compared to forced-choice questions this format tends to provide less accurate responses. If a question can be presented as a forced-choice or choose-all-that-apply format we recommend using the former.
  • Agree-disagree: In this format, a statement is presented and respondents have to choose if they agree or disagree. For example, “All patients with Tourette syndrome should be seen by a psychiatrist.” This format can result in “acquiescence bias,” where respondents less familiar with the topic tend to agree with the statement.

People have a hard time keeping many answer options in mind at one time. Try to keep answer options to a minimum. However, if respondents can expect to see their preferred option within a long list of answers this might not be a problem. For example, “What is your preferred first-line anti-seizure medication for Dravet Syndrome?”. Most respondents will not evaluate each option. Instead, they will scan the options looking for their preferred answer.

If including questions about specific medication choices please include at least three answer options. This could be achieved by including different medications, different doses, or a combination of both. Authors should also include an "Other" option where respondents can free text their answers. In designing the question, please consider other drugs or formulations that may be in use for this condition in countries other than the one where you practice. For example, there may be only one approved medication for this indication in your country but a literature search may show that there are others in use off-label or approved in other countries.

Practice Current Instructions for Authors

Interested authors should submit a word document including the following information:

  • Title of the survey.
  • Author names and affiliations.
  • Short introduction giving context to the survey and justifying the importance of the survey topic. This introduction should not be longer than 250 words and include a maximum of 10 references.
  • Survey following the guidelines above with a maximum of 10 questions without including PC/PB standard demographic questions. Specify the answer format (e.g., choose-all-that-apply, forced-choice) and if there is a skip logic (e.g., skip question 4 if the answer to question 2 is “X”).
  • Names of at least three experts in the topic of the survey. We recommend including more than three in case one of the experts is unable to participate. Include each expert's name, institution, area of expertise, and email. These will be used to contact the experts to facilitate the interview for the commentary piece. Experts should be from different countries (ideally different continents) and represent diversity in gender and ethnicity. At least one of the experts should be from a low- or middle-income country.
  • Standard demographic questions (see below) will be added to Practice Current surveys at discretion of the editors. If the authors want to include specific demographic questions that are not part of the PC/PB standard demographic questions, these should be included in the initial submission and would count towards the max number of questions.

Practice Buzz Instructions for Authors

Interested authors should submit a word document including the following information:

  • Title of the survey.
  • Author names and affiliations.
  • Short paragraph giving context to the survey and justifying that the topic is time critical. This introduction should not be longer than 200 words and include a maximum of 5 references.
  • Survey following the guidelines above with a maximum of 6 questions without including PC/PB standard demographic questions. Specify the answer format (e.g., choose-all-that-apply, forced-choice) and if there is a skip logic (e.g., skip question 4 if the answer to question 2 is “X”).
  • Standard demographic questions (see below) will be added to Practice Buzz surveys at discretion of the editors. If the authors want to include specific demographic questions that are not part of the PC/PB standard demographic questions, these should be included in the initial submission and would count towards the max number of questions.

Standard Demographic Questions

The following is an example of typical standard PC/PB demographic questions.

How much of your clinical time is spent in the care of patients with neurological conditions?

a) Less than 20%
b) 20% to less than 50%
c) 50% or more

What is your current role?

a) Resident/Fellow
b) Attending, Consultant and/or Faculty Board-certified Physician.
c) Nurse Practitioner (NP)
d) Physician Assistant (PA)
e) Other

What patient population do you treat?

a) Adults (18 and older)
b) Children (0 to 18 years)
c) Both (adult and children)

What is your primary work setting?

a) Hospital- or inpatient-based (including free-standing, academic, and government)
b) Outpatient-based (including neurology clinic, multi-specialty, and private practice)

How many years have you been in practice?

a) In training
b) Less than 10 years after finishing training
c) 10 years or more after finishing training

My neurology practice is primarily in:

a) General neurology
b) Epilepsy
c) Vascular Neurology
d) Movement Disorders
e) Neuromuscular
f) Neuro-oncology
g) Multiple Sclerosis/Neuro-Inflammatory diseases
h) Neuro Intensive Care
i) Neuropsychiatry, Behavioral Neurology, and/or Functional Neurological Disorders
j) Other: ______

On which continent do you currently practice?

a) Asia
b) Africa
c) North America
d) South America
e) Antarctica
f) Europe
g) Australia/Oceania

In what country your practice is located?

In what state is your practice located? [Logic: only if US is chosen]

Do not hesitate to contact the PC/PB team at digital@neurology.org if you have additional questions.

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