Attitudes of US medical trainees towards neurology education: "Neurophobia" - a global issue

Abstract

Background: Several studies in the United Kingdom and Asia have suggested that medical students and residents have particular difficulty in diagnosing and managing patients with neurological problems. Little recent information is available for US trainees. We examined whether students and residents at a US university have difficulty in dealing with patients with neurological problems, identified the perceived sources of these difficulties and provide suggestions for the development of an effective educational experience in neurology.

Methods: A questionnaire was administered to third and fourth year medical students at a US school of medicine and to residents of an internal medicine residency program affiliated with that school. Perceived difficulties with eight medical specialties, including neurology, were examined. Methods considered to be most useful for learning medicine were documented. Reasons why neurology is perceived as difficult and ways to improve neurological teaching were assessed.

Results: 152 surveys were completed. Participation rates varied, with medical students having higher response rates (> 50%) than medical residents (27%-48%). Respondents felt that neurology was the medical specialty they had least knowledge in (p < 0.001) and was most difficult (p < 0.001). Trainees also felt they had the least confidence when dealing with patients with neurological complaints (p < 0.001). Residents felt more competent in neurology than students (p < 0.001). The paramount reasons for perceived difficulties with neurology were the complexity of neuroanatomy, limited patient exposure and insufficient teaching. Transition from pre-clinical to clinical medicine led to a doubling of "poor" ratings for neurological teaching. Over 80% of the respondents felt that neurology teaching could be improved through greater exposure to patients and more bedside tutorials.

Conclusions: Medical students and residents at this US medical university found neurology difficult. Although this is consistent with prior reports from Europe and Asia, studies in other universities are needed to confirm generalizability of these findings. The optimal opportunity for improvement is during the transition from preclinical to clinical years. Enhanced integration of basic neurosciences and clinical neurology with emphasis on increased bedside tutorials and patient exposure should improve teaching. Studies are needed to quantify the effect of these interventions on confidence of trainees when dealing with patients presenting with neurological complaints.

Figure 1

Reasons contributing to why trainees find neurology difficult. (Mean values, error bars indicate standard error; 1 = not at all, 2 = a minor contributor, 3 = a major contributor). * p value for comparison = 0.01, ** p value for comparison < 0.001, p = 0.008 denotes threshold for significance). N-atan - neuroanatomy; N-sci - neuroscience; Dx Complx - diagnostic complexity; Limited Pt expos - limited patient exposure; Insuff teach - insufficient teaching; Poor teach - poor teaching; N-exam - neurological examination.

Figure 2

Percentage of respondents rating each method to improve teaching as helpful or very helpful. More Pt. Exposure = more patient exposure, More Bedside Teach - more bedside teaching, Improv N-ana Teach - improved neuroanatomy teaching, Online Resources - availability of online resources, Improv N-sci Teach - improved neuroscience teaching.