Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants

Diogo Reis-Carneiro^{1

2}, Magdalena Krbot Skoric³, Mario Habek^{3

4}, Ivan Adamec^{3

4}, Giovanna Calandra-Buonaura^{5

6}, Pietro Cortelli^{5

6}, J Gert van Dijk⁷, Cristian Falup-Pecurariu^{8

9}, Pietro Guaraldi⁵, Max J Hilz^{10

11}, Valeria Iodice^{12

13}, Jens Jordan^{14

15}, Isabel Rocha¹⁶, Walter Struhal¹⁷, Astrid Juhl Terkelsen^{18

19}, Roland Thijs^{6

20}, Beatriz Tijero^{21

22}, Thomas Berger^{23

24}, Irena Rektorova^{25

26}, Elena Moro^{27

28}, Anne Pavy-Le Traon²⁸, Gregor Wenning²⁹, Jalesh N Panicker^{30

31}, Alessandra Fanciulli²⁹

Affiliations

¹ Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
² Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³ Department of Neurology, University Hospital Centre, Zagreb, Croatia.
⁴ Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia.
⁵ IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
⁶ Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy.
⁷ Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
⁸ Faculty of Medicine, Transilvania University of Braşov, Romania.
⁹ Department of Neurology, County Clinic Hospital, Romania.
¹⁰ Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
¹¹ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹² Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
¹³ Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
¹⁴ Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.
¹⁵ Medical Faculty, University of Cologne, Cologne, Germany.
¹⁶ Cardiovascular Autonomic Function Lab, Institute of Physiology, CCUL, Faculty of Medicine of University of Lisbon, Lisbon, Portugal.
¹⁷ Karl Landsteiner University of Health Sciences, Department of Neurology, University Hospital Tulln, Tulln, Austria.
¹⁸ Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark.
¹⁹ Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
²⁰ Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
²¹ Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
²² Neurology Department, Cruces University Hospital, Barakaldo, Spain.
²³ Department of Neurology, Medical University of Vienna, Vienna, Austria.
²⁴ Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
²⁵ First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic.
²⁶ Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic.
²⁷ Division of Neurology, Grenoble Institute of Neuroscience, Grenoble Alpes University, CHU of Grenoble, Grenoble, France.
²⁸ Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
²⁹ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
³⁰ Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
³¹ Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK.

PMID: 39387467
PMCID: PMC11555144
DOI: 10.1111/ene.16515

Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants

Diogo Reis-Carneiro et al. Eur J Neurol. 2024 Dec.

. 2024 Dec;31(12):e16515.

doi: 10.1111/ene.16515. Epub 2024 Oct 10.

Authors

Affiliations

¹ Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
² Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³ Department of Neurology, University Hospital Centre, Zagreb, Croatia.
⁴ Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia.
⁵ IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
⁶ Biomedical and Neuromotor Sciences-DIBINEM, University of Bologna, Bologna, Italy.
⁷ Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
⁸ Faculty of Medicine, Transilvania University of Braşov, Romania.
⁹ Department of Neurology, County Clinic Hospital, Romania.
¹⁰ Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
¹¹ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹² Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
¹³ Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK.
¹⁴ Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.
¹⁵ Medical Faculty, University of Cologne, Cologne, Germany.
¹⁶ Cardiovascular Autonomic Function Lab, Institute of Physiology, CCUL, Faculty of Medicine of University of Lisbon, Lisbon, Portugal.
¹⁷ Karl Landsteiner University of Health Sciences, Department of Neurology, University Hospital Tulln, Tulln, Austria.
¹⁸ Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark.
¹⁹ Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
²⁰ Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
²¹ Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
²² Neurology Department, Cruces University Hospital, Barakaldo, Spain.
²³ Department of Neurology, Medical University of Vienna, Vienna, Austria.
²⁴ Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
²⁵ First Department of Neurology, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Brno, Czech Republic.
²⁶ Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC, Masaryk University Brno, Brno, Czech Republic.
²⁷ Division of Neurology, Grenoble Institute of Neuroscience, Grenoble Alpes University, CHU of Grenoble, Grenoble, France.
²⁸ Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
²⁹ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
³⁰ Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
³¹ Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK.

PMID: 39387467
PMCID: PMC11555144
DOI: 10.1111/ene.16515

Abstract

Background and purpose: Centers for training in autonomic nervous system (ANS) disorders are not widely available and the recent coronavirus 2019 pandemic temporarily reduced training opportunities in autonomic medicine across European countries. Here we evaluated the current state of education, clinical skills and postgraduate educational preferences on ANS disorders of European neurology residents and consultants.

Methods: A 23-item questionnaire was developed and distributed online amongst European neurology residents and consultants via mailing lists of the European Academy of Neurology. The questions assessed demographics, current training opportunities and learning preferences in ANS disorders. Six multiple-choice questions were used to self-evaluate knowledge of ANS disorders.

Results: In all, 285 individuals answered the survey (60% female, mostly 25-34 years of age). All respondents considered clinical autonomic skills necessary for good clinical neurological practice, and 92% would like to increase their ANS knowledge. Female respondents and those who trained in Southern/Eastern/Greater Europe more frequently judged ANS skills important for clinical practice than male respondents (p = 0.012) and respondents from Northern/Western Europe (p = 0.011). Female and younger respondents felt less confident in managing ANS disorders (p = 0.001 and p < 0.001, respectively). Respondents below 45 years of age (p < 0.001) and those with lower confidence in managing ANS disorders (p = 0.004) were more likely to recommend that ANS education is embedded in the residency curriculum.

Conclusions: Most European neurology residents and consultants reported a need for more autonomic education, with additional gender, age and regional differences. These findings underscore the importance of increasing the educational content on autonomic medicine in European medical and postgraduate curricula.

Keywords: autonomic nervous system disorders; clinical neurology; medical education; residency program.

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Conflict of interest statement

Diogo Reis‐Carneiro: reports speaker fees from BIAL and Zambon. Magdalena Krbot Skoric: participated as a clinical investigator and/or received speaker fees from Sanofi Genzyme, Merck, Novartis, Roche. Mario Habek: received speaker/consultation fees from Astra Zeneca, Biogen, CNSystems, Merck, Novartis, Roche, Sandoz and Zentiva. Received funding from the Croatian Science Foundation. Ivan Adamec: participated as a clinical investigator and/or received speaker/consultation fees from Actelion, Alexion Pharmaceuticals, Alvogen, Bayer, Biogen, Merck, Novartis, Pliva/Teva, Roche, Sanofi Genzyme, Sandoz and TGI Pharmaceuticals. Giovanna Calandra‐Buonaura: received speaker fees from Abbvie. Pietro Cortelli: reports no disclosures. J. Gert van Dijk: is a scientific consultant for Finapres since 2023. Cristian Falup Pecurariu: reports editor fees from Springer and Elsevier; speaker fees from Abbvie, Zentiva and from the International Parkinson and Movement Disorder Society (MDS), outside of the present work. Pietro Guaraldi: reports no disclosures. Max J. Hilz: reports no disclosures. Valeria Iodice: participated as a clinical investigator and/or received consultancy fees from Theravance, Takeda, Astra Zeneca outside the submitted work. Jens Jordan: reports no disclosures. Isabel Rocha: reports no disclosures. Walter Struhal: reports no disclosures. Astrid Juhl Terkelsen: reports consultancy fees for Alnylam Sweden AS, Novo Nordisk, Y‐mAbs Therapeutics A/S and AstraZeneca. Roland Thijs: reports lecture and consultancy fees from Medtronic, UCB, Angelini Pharma, Theravarance, Zogenix, Novartis, LivAssured and Arvelle, and grants from Medtronic and NewLife Wearables, outside the submitted work. Beatriz Tijero: reports no disclosures. Thomas Berger: reports no disclosures. Irena Rektorova: reports no disclosures. Elena Moro: reports no disclosures. Anne Pavy‐Le Traon: reports no disclosures. Gregor Wenning: author deceased. Jalesh N. Panicker: is supported in part by funding from the United Kingdom's Department of Health NIHR University College London Hospitals Biomedical Research Centres funding scheme and reports consultant fees (Idorsia, Coloplast, Medice), speaker honorarium (Coloplast, Wellspect) and royalties (Cambridge University Press). Alessandra Fanciulli: reports royalties from Springer Verlag, speaker fees and honoraria from Theravance Biopharma, Bial, CNSystems, Broadview Ventures, Antag Therapeutics, KABEG, Austrian Autonomic Society, Elsevier, International Parkinson Disease and Movement Disorders Society, Austrian Neurology Society, Austrian Autonomic Society and research grants from the FWF‐Austrian Science Fund, Medical University of Innsbruck, US MSA Coalition, Dr. Johannes and Hertha Tuba Foundation, outside of the present work.

Figures

**FIGURE 1**
Number of survey respondents per country. To analyze geographical differences, the United Nations' geoscheme for Europe (available under https://unstats.un.org/unsd/methodology/m49/) was applied in the following way: (1) Eastern Europe: Belarus, Bulgaria, Czech Republic, Hungary, Poland, Moldova, Romania, Russia, Slovakia, Ukraine; (2) Western Europe: Austria, Belgium, France, Germany, Liechtenstein, Luxembourg, Monaco, Netherlands, Switzerland; (3) Northern Europe: Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Lithuania, Norway, Sweden, United Kingdom; (4) Southern Europe: Albania, Andorra, Bosnia and Herzegovina, Croatia, Greece, Holy See, Italy, Kosovo, Malta, Montenegro, North Macedonia, Portugal, San Marino, Serbia, Slovenia, Spain; (5) Greater Europe: Turkey, Cyprus, Armenia, Georgia, Kazakhstan, Azerbaijan. There were no responders from the following countries: Andorra, Belarus, Bulgaria, Bosnia‐Herzegovina, Faroe Islands, Finland, Gibraltar, Iceland, Ireland, Liechtenstein, Luxembourg, Monaco, Montenegro, San Marino, Slovakia, Slovenia and Sweden. Created using https://mapchart.net/europe.html. This work is licensed under a Creative Commons Attribution‐ShareAlike 4.0 International License.

**FIGURE 2**
(a) Percentage of respondents who received training in specific ANS fields and percentage of respondents who had more than 25 h of training in that field. (b) Percentage of respondents who had a high level of confidence (i.e., rating their confidence >5 on a 1–10 scale) in managing different ANS disorders. (c) Preferred educational format of the survey respondents for improving their ANS skills.

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References

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Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants

Affiliations

Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources