Bio

Bio


Rebecca Miller-Kuhlmann, MD is board certified in Neurology and in Electrodiagnostic Medicine and practices as a Clinical Assistant Professor of Neurology & Neurological Sciences at Stanford University. She earned her MD from UCSF School of Medicine and completed residency and fellowship training at Stanford University. Her fellowship training in Comprehensive Clinical Neurology focused on movement disorders, memory/cognitive disorders neuromuscular medicine/EMG/NCS studies, and therapeutic applications of botulinum toxin with supplementary training in headache, epilepsy and neuroimmunology. Her clinical focus is diagnosis and treatment of neurologic conditions with commitment to maintaining a wide-breadth of knowledge in order to best treat complex patients with multiple neurologic issues.

Academically, Dr Miller-Kuhlmann is passionate about medical education and physician wellbeing. Prior to her career in medicine, Dr Miller-Kuhlmann was a public school teacher in Oakland, CA. She completed the UCSF health professions education pathway with a dean's award for research in medical student reflection during medical school. During residency she served as education chief resident and earned an honors certificate in medical education at Stanford, She continues to enjoy working with medical students and residents in the clinic as well as the classroom. She associate-directs the Neurology Block for second year medical students and in 2020 has had the privilege to begin directing the Science of Medicine course which covers physiology and pathology of each organ system for first and second year medical students. At the residency level, she serves as the associate-director for a novel communication coaching program within the Stanford Neurology Residency.

Dr. Miller-Kuhlmann is the Wellbeing Director for the Department of Neurology and interested in multi-level strategies for promotion of professional fulfillment and mitigation of physician burnout. Nationally, she was an inaugural graduate of the American Academy of Neurology's Live Well Lead Well Leadership programs, serves on the AAN physician wellness subcommittee, and has had the opportunity to speak on physician wellbeing at the AAN annual meeting. Locally, she has co-developed and directs a wellbeing program for neurology residents and fellows, steers the neurology department wellness committee, and through close partnership with department quality improvement leaders serves on projects to improve physician wellbeing through a focus on system supports and efficiencies. To this end, she is also a graduate of the Stanford Clinical Effectiveness Leadership Program which develops skills in quality improvement and change management. She also co-developed and annually teaches a project-based novel quality improvement curriculum for residents with an eye toward empowering and supporting trainees in becoming agents of change within the system.

Clinical Focus


  • Neurology

Academic Appointments


Honors & Awards


  • Outstanding Lecture Award, Stanford School of Medicine (2020)
  • AAN Live Well Lead Well Leadership Program Graduate, American Academy of Neurology (2018)
  • Alpha Omega Alpha Honor Society, Stanford University (2017)
  • Christine Wijman Humanism in Medicine Award, Stanford University (2017)
  • Fisher's & Dunn Teaching Award, Stanford University (2017)
  • Neurology Clerkship Teaching Award, Stanford University (2014)
  • Dean's Award for Student Research (Health Profession's Education Pathway), UCSF (2013)
  • Phi Beta Kappa Honor Society, Duke University (2007)

Professional Education


  • Board Certification: American Board of Psychiatry and Neurology, Electrodiagnostic Medicine (2020)
  • Board Certification, American Board of Electrodiagnostic Medicine (2020)
  • Board Certification: American Board of Psychiatry and Neurology, Neurology (2017)
  • Fellowship, Clinical Neurology, Stanford University (2018)
  • Residency: Stanford University Neurology Residency (2017) CA
  • Internship: Santa Clara Valley Medical Center Internal Medicine Residency (2014) CA
  • Medical Education: University of California at San Francisco School of Medicine (2013) CA

Teaching

2020-21 Courses


Publications

All Publications


  • Accelerated launch of video visits in ambulatory neurology during COVID-19: Key lessons from the Stanford experience. Neurology Yang, L., Brown-Johnson, C. G., Miller-Kuhlmann, R., Kling, S. M., Saliba-Gustafsson, E. A., Shaw, J. G., Gold, C. A., Winget, M. 2020

    Abstract

    The COVID-19 pandemic has rapidly moved telemedicine from discretionary to necessary. Here we describe how the Stanford Neurology Department: 1) rapidly adapted to the COVID-19 pandemic, resulting in over 1000 video visits within four weeks and 2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to: equipment/software, provider engagement, workflow/triage, and training. Upon reflection, the key drivers of our success were provider engagement and a supportive physician champion. The physician champion played a critical role understanding stakeholder needs, including staff and physicians' needs, and creating workflows to coordinate both stakeholder groups. Prior to COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated post-pandemic era.

    View details for DOI 10.1212/WNL.0000000000010015

    View details for PubMedID 32611634

  • Education Research: A novel resident-driven neurology quality improvement curriculum. Neurology Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C. A., Kvam, K. A. 2020; 94 (3): 137–42

    Abstract

    OBJECTIVE: To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience.METHODS: We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study.RESULTS: Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively.CONCLUSIONS: Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.

    View details for DOI 10.1212/WNL.0000000000008752

    View details for PubMedID 31959682

  • Rapid implementation of video visits in neurology during COVID-19: a mixed methods evaluation. Journal of medical Internet research Saliba-Gustafsson, E. A., Miller-Kuhlmann, R. n., Kling, S. M., Garvert, D. W., Brown-Johnson, C. G., Lestoquoy, A. S., Verano, M. R., Yang, L. n., Falco-Walter, J. n., Shaw, J. G., Asch, S. M., Gold, C. A., Winget, M. n. 2020

    Abstract

    Telemedicine has been used for decades; yet, despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology's ambulatory subspecialties has been sparse. The SARS-CoV-2 (COVID-19) pandemic however, prompted healthcare systems worldwide to reconsider traditional healthcare delivery. To safeguard healthcare workers and patients many healthcare systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care.To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess the adoption, acceptability, appropriateness, and perceptions of potential sustainability.Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semi-structured interviews with providers (n=30) completed between March and May 2020.Video visits were adopted rapidly; 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted satisfaction. Video visits were reported to be more convenient for patients, families, and/or caregivers than in-person visits; however, access to technology, the patient's technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination.Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

    View details for DOI 10.2196/24328

    View details for PubMedID 33245699

  • Making Well Neurologists: A Multifaceted Program for Neurology Trainee and Faculty Wellbeing Miller-Kuhlmann, R., Murray, N., Dujari, S., Karamian, A., Hamidi, M., Su, E., Bozinov, N., McGranahan, T. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • A Quality Improvement Curriculum for Neurology Residents Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C., Kvam, K. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • Essential steps in developing best practices to assess reflective skill: A comparison of two rubrics MEDICAL TEACHER Miller-Kuhlmann, R., O'Sullivan, P. S., Aronson, L. 2016; 38 (1): 75-81

    Abstract

    Medical education lacks best practices for evaluating reflective writing skill. Reflection assessment rubrics include the holistic, reflection theory-based Reflection-on-Action and the analytic REFLECT developed from both reflection and narrative-medicine literatures. To help educators move toward best practices, we evaluated these rubrics to determine (1) rater requirements; (2) score comparability; and (3) response to an intervention.One-hundred and forty-nine third-year medical students wrote reflections in response to identical prompts. Trained raters used each rubric to score 56 reflections, half written with structured guidelines and half without. We used Pearson's correlation coefficients to associate overall rubric levels and independent t-tests to compare structured and unstructured reflections.Reflection-on-Action training required for two hours; two raters attained an interrater-reliability = 0.91. REFLECT training required six hours; three raters achieved an interrater-reliability = 0.84. Overall rubric correlation was 0.53. Students given structured guidelines scored significantly higher (p < 0.05) on both rubrics.Reflection-on-Action and REFLECT offer unique educational benefits and training challenges. Reflection-on-Action may be preferred for measuring overall quality of reflection given its ease of use. Training on REFLECT takes longer but it yields detailed data on multiple dimensions of reflection that faculty can reference when providing feedback.

    View details for DOI 10.3109/0142159X.2015.1034662

    View details for PubMedID 25923234

  • The regulatory easy street: Self-regulation below the self-control threshold does not consume regulatory resources PERSONALITY AND INDIVIDUAL DIFFERENCES Vandellen, M. R., Hoyle, R. H., Miller, R. 2012; 52 (8): 898-902

    Abstract

    We present and test a theory in which self-control is distinguished from broader acts of self-regulation when it is both effortful and conscious. In two studies, we examined whether acts of behavioral management that do not require effort are exempt from resource depletion. In Study 1, we found that a self-regulation task only reduced subsequent self-control for participants who had previously indicated that completing the task would require effort. In Study 2, we found that participants who completed a self-regulation task for two minutes did not evidence the subsequent impairment in self-control evident for participants who had completed the task for four or more minutes. Our results support the notion that self-regulation without effort falls below the self-control threshold and has different downstream consequences than self-control.

    View details for DOI 10.1016/j.paid.2012.01.028

    View details for Web of Science ID 000303084800007

    View details for PubMedID 22711963

    View details for PubMedCentralID PMC3375861

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