Neurophobia among resident physicians in the emergency service

Abstract

Introduction: Neurophobia is defined as the fear towards clinical neurology caused by the inability to apply theoretical knowledge to practical clinical situations. This phenomenon is not restricted to medical students and has never been studied before in the Emergency Department. We aimed to study how resident doctors perceive their knowledge in neurology and urgent neurological conditions as well as possible causes for said fears.

Materials and methods: Cross-sectional multicentric study using self-administered surveys sent to medical residents within the Aragon Health Service. They were questioned about their fear of neurology and other medical specialties, possible causes, and perception of knowledge in neurological pathologies and subareas in the emergency service.

Results: We obtained 134 responses. 27.6% (37) suffered from neurophobia. Despite neurology being considered the most difficult discipline, it did also arouse the third most interest among the students. The areas where they showed the most confidence were headaches and vascular pathology. The areas where they felt the most insecure were neuromuscular diseases, neuro-ophthalmology, and spinal cord injury. In none of the areas surveyed, the percentage of respondents who felt secure exceeded 50%.

Conclusions: Neurophobia is prevalent among trainee doctors working in the emergency department. Their confidence correlates with the degree of exposure to patients. Neurologist must play an active role in the education of new specialist and promote the collaboration with emergency departments.

Figura 1

Motivos que identifican los médicos internos residentes (MIR) como la causa de sus dificultades, miedo o rechazo hacia la neurología. Diagrama de barras con respuesta de selección múltiple y opción abierta. Por ‘Integración de la enseñanza’ nos referimos a la fragmentación de las asignaturas de neurociencias durante los años universitarios y su impartición sin coordinación entre sí.

Figura 2

Autopercepción de conocimientos en distintas disciplinas de neurociencias. Diagrama de frecuencia de distribución de respuestas en escala Likert (1-5); en los extremos, porcentaje agregado de respuestas extremas: ‘muy escasos-escasos’ (1-2) y ‘altos-muy altos’ (4-5).

Figura 3

Diagrama de barras de la percepción residentes de Aragón acerca de las diferentes especialidades médicas en cuanto a dificultad percibida (a), interés en la materia (b), seguridad al emitir un diagnóstico diferencial (c) y comodidad al realizar una exploración dirigida (d). Puntuación media de respuestas en escala Likert de 1 a 5. Se ofrece una comparativa de la neurología frente a cardiología, endocrinología, gastroenterología, hematología, nefrología, neumología, neurología, psiquiatría y oncología; identificando con * cuando el valor de p es < 0,05 frente a neurología.

Figura 4

Seguridad al abordar a un paciente en urgencias en distintas subespecialidades neurológicas. Diagrama de frecuencia de distribución de respuestas en escala Likert (1-5); en los extremos, porcentaje agregado de respuestas extremas: ‘muy escasos-escasos’ (1-2) y ‘altos-muy altos’ (4-5).

Figure 1

Causes for neurophobia identified by medical residents as the cause of their difficulties, fear or rejection of neurology. Bar chart with multiple choice and open-ended answers. By ‘Integration of teaching’ we mean the fragmentation of neuroscience subjects during university years and their uncoordinated delivery.

Figure 2

Self-perception of knowledge in neurosciences. Likert scale chart (1 to 5). Extreme values are represented on the edges (‘very poor-below average’ [1-2] and ‘above average-very high’ [4-5]).

Figure 3

Bar chart of the perception medical interns regarding each medical specialty in terms of interest in the subject (a), perceived difficulty (b), confidence in making a diagnosis (c) and comfort in performing a focused physical exam (d). Mean score of responses on a Likert scale from 1 to 5. A comparison of neurology versus cardiology, endocrinology, gastroenterology (gastro), hematology, nephrology, pulmonology, neurology and psychiatry is provided; identifying with (*) when the p value is <0,05 versus neurology. The p value was calculated using the Mann-Whitney test between each pair of groups with significance correction.

Figure 4

Confidence in managing neurological pathologies. Likert scale chart of each Neurology subarea (1 to 5). Extreme values are represented on the edges: ‘very poor-below average’ [1-2] and ‘above average-very high’ [4-5].