Neurophobia: why, how much, consequences and solutions

Curriculum Innovation: Neuro Day: An Innovative Educational Intervention to Enhance Interest in Neurology for Medical Trainees

Introduction and Problem Statement

Limited or delayed exposure to neurology decreases interest and reduces the likelihood of pursuing neurology as a career for medical trainees. Educational events that strengthen student-to-patient interactions may help dispel misinformation about neurologic treatments and outcomes. Innovative educational strategies such as the use of multimedia to teach the neurologic examination, incorporation of real patients, and integration of clinical neurology mentors were combined to create Neuro Day, an educational event designed to pique neurology interest for first-year medical students.

Objectives

The aim of this intervention was to provide early neurology exposure to medical students to increase interest in neurology and interest in pursuing neurology for residency, improve perceptions of neurologic disease and treatment, and enhance neuroscience knowledge, as well as to improve physician-educator enjoyment of teaching clinical neurology.

Methods and Curriculum

In 2023 and 2024, first-year medical students participated in Neuro Day. In part 1, students used an interactive video module to review neurology examination and pathophysiology. In part 2, student groups rotated to stations in a mock patient rounds format. Stations included patient-educators with real neurologic diseases paired with a physician-educator who moderated the discussion of the patient experience, pathophysiology, and examination findings. Students, patient-educators, and physician-educators were surveyed before and after Neuro Day. Statistical analysis included the paired t test with Cohen d, binomial test for difference in proportions, and thematic analysis.

Results and Assessment Data

After Neuro Day, 108 of 115 (94%) and 98 of 103 (95%) first-year medical students and 10 of 13 physician-educators (77%) completed both presurvey and postsurvey, revealing the following: (1) increased interest in neurology (d = 0.27-0.68), (2) increased interest in pursuing neurology for residency (d = 0.26-0.38), (3) improved perception of patient outcomes (d = 0.45-0.67) and treatment options (d = 0.87-1.09), (4) 35.5% improvement in knowledge quiz scores (95% CI 0.218-0.492, p < 0.001), and (5) improved professional fulfillment in physician-educators (d = 1.20). Thematic analysis revealed that Neuro Day helped to humanize medicine, reinforce course content, and positively change perceptions.

Discussion and Lessons Learned

Neuro Day is a feasible teaching paradigm to increase interest in neurology, reshape perceptions about neurology, improve confidence in performing a neurologic examination, reinforce neuroscience lecture content, encourage more students to pursue neurology residency, and improve physician-educator professional fulfillment.

Challenges in studying neuroanatomy in sub-Saharan Africa: The case of Cameroon

Introduction

Quality education is key in addressing the skilled neurological workforce gap in Africa. However, many medics are scared of the neurological sciences because of the challenges faced in medical schools in studying the neurosciences. Understanding its state and educational challenges is crucial for fostering interest in neurosurgery and related specialities on the continent.

Research question

What are the current state, challenges, and solutions to improve neuroanatomy education in Cameroon, Africa in miniature?

Materials and methods

A cross-sectional study using an 11-item electronic survey was conducted among medical students from all nine medical schools in Cameroon. Data were analysed using descriptive statistics and independent t-tests, with significance set at p < 0.05.

Results

Among 220 respondents, 40.1 % and 35.0 % respectively, reported cranial nerves/brainstem and neurovascular anatomy to be the most challenging, with a mean comprehension score of 5.83/10. Faculty predominantly relied on PowerPoint lectures (83.2 %), while most students supplemented learning with YouTube videos (77.7 %). 63.9 % of the respondents perceived classroom teaching alone to limit their understanding of neuroanatomy, and 85.8 % of students reported the time allocated for neuroanatomy teaching to be inadequate. The usage of cadaver dissection (69.5 %), and neurosimulation practicals (66.4 %) were the most recommended tools by students to improve neuroanatomy teaching.

Discussion and conclusion

Challenges in neuroanatomy education in Cameroon are perceived to arise from insufficient hands-on learning, time constraints, and limited access to specialised faculty. These suggest interactive teaching, increased curriculum time, and diverse resources as potential improvements, though further research is needed to assess their effectiveness and ultimately improve understanding, fostering a stronger neurological workforce.

Exploring emergency department providers' uncertainty in neurological clinical reasoning

OBJECTIVES

Diagnostic and management reasoning of neurological disorders may present unique challenges and uncertainty for clinicians, particularly in emergency department settings. This study aims to assess the level of uncertainty emergency department physicians experience when diagnosing neurological versus non-neurological conditions, and whether this uncertainty extends to the management of neurological conditions. Additionally, the study explores whether clinical experience is related to perceived diagnostic and/or management uncertainty.

METHODS

Fifty-three emergency department physicians completed a survey measuring diagnostic uncertainty, management uncertainty, and associated anxiety. The survey included clinical vignettes depicting neurological and non-neurological cases, as well as items which assessed perceived diagnostic and management uncertainty across eight different specialties. Statistical analyses included paired samples t-test for comparing uncertainty between neurology and non-neurology cases and a general linear model to assess relationship between clinical experience and uncertainty.

RESULTS

Emergency department physicians reported greater diagnostic uncertainty for neurological vignettes compared to non-neurological vignettes (Cohen's d=1.37), as well as greater management uncertainty (Cohen's d=1.41). They also reported greater anxiety when diagnosing neurological cases compared to non-neurological cases (Cohen's d=1.33), as well as greater anxiety when managing them (Cohen's d=0.69). Exploratory analyses indicated that with greater experience, management uncertainty of neurology cases decreased, while diagnostic uncertainty remained unchanged.

CONCLUSIONS

The results suggest unique diagnostic and management challenges posed by neurological cases in emergency departments, particularly for less experienced providers. Future research could focus on developing interventions to reduce diagnostic and management uncertainty in neurological conditions.

Exploring effectiveness in brain removal techniques: A comparison of approaches

Brain dissection is typically an important part of teaching neuroscience in health professional programs. This results in the need to effectively remove brains, which is often performed in a gross anatomy laboratory in the same curriculum. The aim of this study was to determine the most effective method of brain removal based on the time required for removal, difficulty of removal, and preservation of key brain structures for educational purposes. Six different dissectors performed each of the three calvaria removal approaches and three different spinal cord transection methods rating them for difficulty and tracking the time required. The combination of calvaria and brainstem approaches and the order of completion was randomized to control for fatigue and previous individual experience. After all brains were removed, each was evaluated by neuroscience faculty for utility in education contexts. The study found little difference between the individual approaches for both calvaria removal and spinal cord transection in regards to quality of outcome. The use of a circumferential cut only proved to be the most time-effective method for calvaria removal while a posterior cut between C1 and C2 was the most time-effective and least difficult method for brainstem release. There was no one technique that proved to be most beneficial across all three measures. However, different approaches resulted in a different combination of benefits across the time, difficulty, and outcome ratings that should be considered in light of the individual needs of any program or researcher.

Neurophobia among resident physicians in the emergency service

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.