Is clinical neurology really so difficult?

Neurology Undergraduate Medical Education: A Scoping Review

PURPOSE

To map the current literature on undergraduate neurology medical education and research. Recommendations for future undergraduate neurology education and research are described.

METHOD

PRISMA-Scoping Review guidelines and Arksey and O'Malley's methodological framework are followed. Four databases and gray literature was searched with Oxford Evidence-Based Medicine level of evidence applied. A thematic framework was used to identify the main study outcomes. A narrative description and quantitative frequency analysis were used for results.

RESULTS

Nine-hundred and twenty-two articles were retrieved, 102 studies met the inclusion criteria. We identified four main study outcomes using a thematic framework. Our review found that (1) the main undergraduate neurology teaching styles are didactic and experiential teaching methods. (2) Research design of undergraduate neurology teaching is heterogenous. (3) The outcome measures most frequently used in undergraduate neurology research are student perception and knowledge.

CONCLUSION

Undergraduate neurology education research is challenging due to the heterogeneity in research design and teaching methodology. Evidence-based guidelines are limited. This gap in the literature represents an opportunity to develop tailored guidelines for undergraduate neurology education and research.

White Matter Dissection: Lessons from the United Kingdom National Neuroanatomy Undergraduate Competition 2023

Objective  This narrative highlights a student-led initiative that explored white matter dissection techniques within the framework of the National Undergraduate Neuroanatomy Competition 2023. Materials and Methods  The project aimed to enhance neuroanatomical education by developing a novel approach to dissection that deviates from the traditional Klingler's method. Instead, it incorporated contemporary techniques, including diffusion tensor imaging and other radiological tools, to ensure greater anatomical precision and enrich the learning experience. Results  The dissections focused on key white matter structures, such as the uncinate fasciculus and the inferior longitudinal fasciculus, and outlined a step-by-step methodology for creating high-quality specimens. These specimens are designed to serve as educational resources, particularly for students with limited access to formal neuroanatomy courses. Conclusion  This study emphasizes the critical role of hands-on dissection in neuroanatomy education, showcasing its ability to enhance student engagement, deepen anatomical understanding, and inspire interest in clinical neuroscience careers. By introducing innovative educational tools and methodologies, this initiative makes a meaningful contribution to addressing the issue of "neurophobia" in medical education.

Investigation of Neurophobia amongst North American Veterinary Students and Development of a Veterinary Neurophobia Scoring Tool (VetNeuroQ)

"Neurophobia" is a phenomenon in human medical education where students develop negative attitudes towards neurology, impeding student learning and future clinical practice. While suspected to exist in veterinary medical education, it remains unstudied. The main objectives of this study were to examine North American veterinary student attitudes towards neurology and neurology education and explore elements that might contribute to neurophobia. Additional objectives were to evaluate veterinary educators' perceptions of student neurophobia and to develop and validate a scoring tool (VetNeuroQ) to quantify veterinary neurophobia. Veterinary students and faculty at North American veterinary schools were surveyed. A scoring tool was developed from a subset of questions and validated using confirmatory factor analysis. Six hundred six anonymous responses were collected from students at all stages of veterinary education. Neurology training was reported as insufficient by 35.9% and most respondents perceived neurology to not be easy to learn. Neuroanatomy/physiology and neurolocalization were considered difficult concepts. Students rated low confidence in neurology (vs. other topics), and low interest in the Neurology/Neurosurgery specialty. 61.7% of educators reported neurophobia amongst their students. The proposed VetNeuroQ scale showed high reliability (Cronbach's alpha >0.7) and validity (p < .05; CFI >0.9, RMSEA <0.08). VetNeuroQ scores were low but improved over the course of veterinary education. These findings demonstrate low self-efficacy, interest, and confidence, along with perceptions of difficulty, amongst veterinary students, consistent with neurophobia. Contributing elements are discussed. The VetNeuroQ scale allows quantification of veterinary student neurophobia and may be useful for screening students and assessing the impact of educational interventions.

Prevalence of neurophobia among medical students and young doctors: a systematic review and meta-analysis

BACKGROUND

Neurophobia is a global phenomenon, that influences both medical students and postgraduate trainees. We aimed to analyze the prevalence of neurophobia by conducting a systematic review and meta-analysis of studies on neurophobia, and potential associated risk factors.

METHODS

The search was done in the PubMed, EMBASE, and Scopus databases for studies reporting neurophobia among medical students and young doctors for the period up to March 18, 2024. The overall prevalence and scores of four subcomponents of neurophobia were pooled. The potential heterogeneity was tested through meta-regression/subgroup analyses/influence analysis.

RESULTS

Twenty-four studies from 30 countries met the inclusion criteria and involved 10,395 responding individuals. The estimated overall pooled prevalence of neurophobia was 46% (95%CI, 35-57%; I2 = 98%). The result of the meta-regression revealed that geographic region was significantly associated with the prevalence (p = 0.006). The pooled scores of the four subcomponents of neurophobia were: difficulty 3.79 (95%CI, 3.47-4.12, I2 = 99%), confidence 2.81 (95%CI, 2.39-3.24, I2 = 99.5%), interest 3.22 (95%CI, 2.84-3.61, I2 = 99.6%), and knowledge 2.73 (95%CI, 2.39-3.06, I2 = 98.1%).

CONCLUSIONS

Neurophobia was widely prevalent among medical students and young doctors. The high prevalence and severity highlight the need for targeted interventions to reduce neurophobia.

Creating evidence-based engaging online learning resources in neuroanatomy

Online anatomical resources are rising in popularity since the COVID-19 pandemic, but the pedagogical principles and effectiveness of their use remain unclear. This article aims to demonstrate evidence-informed ways in which fellow educators can create engaging online learning resources in clinical neuroanatomy and compare the effectiveness of text-based and online learning resources. Data were analyzed from the Soton Brain Hub (SBH) YouTube page. Separately, a cross-sectional study comparing the learning gain of using text-based and video resources was done. The knowledge gain and retention were compared between groups using a pre-teaching and post-teaching multiple choice questions. YouTube analytics showed the average time a viewer spends on a video was found to be highly correlated to the length of the video, r = 0.77, p < 0.001 (0.69-0.82). The cross-sectional study indicated a significant difference in mean normalized learning gain of video resources 61.9% (n = 53, CI 56.0-67.7%) versus text resources 49.6% (n = 23, CI 39.1-60.1%) (p = 0.030). However, there was no difference in retained learning gain between video resources 39.1% (n = 29, CI 29.2-49.0%) versus text-based 40.0% (n = 13, CI 23.9-56.1%) (p = 0.919). Students engage most with short videos less than 5 min which reduces the intrinsic load of learning. Online resources are as effective as text-based resources in providing learning gain and retention. In the future, the continued rise in popularity of online learning resources may result in further reduction in traditional face-to-face teaching.

Accuracy of ChatGPT in Neurolocalization

Introduction ChatGPT (OpenAI Incorporated, Mission District, San Francisco, United States) is an artificial intelligence (AI) chatbot with advanced communication skills and a massive knowledge database. However, its application in medicine, specifically in neurolocalization, necessitates clinical reasoning in addition to deep neuroanatomical knowledge. This article examines ChatGPT's capabilities in neurolocalization. Methods Forty-six text-based neurolocalization case scenarios were presented to ChatGPT-3.5 from November 6th, 2023, to November 16th, 2023. Seven neurosurgeons evaluated ChatGPT's responses to these cases, utilizing a 5-point scoring system recommended by ChatGPT, to score the accuracy of these responses. Results ChatGPT-3.5 achieved an accuracy score of 84.8% in generating "completely correct" and "mostly correct" responses. ANOVA analysis suggested a consistent scoring approach between different evaluators. The mean length of the case text was 69.8 tokens (SD 20.8). Conclusion While this accuracy score is promising, it is not yet reliable for routine patient care. We recommend keeping interactions with ChatGPT concise, precise, and simple to improve response accuracy. As AI continues to evolve, it will hold significant and innovative breakthroughs in medicine.

Attitudes of physiotherapy students toward neurology: does "neurophobia" exist among physiotherapy students?

BACKGROUND

Evidence is accumulating that medical students and practitioners have particular difficulty in neurology and have neurophobia. However, little is known about attitudes toward neurology in physiotherapy students.

PURPOSE

This study aimed to assess the attitudes of physiotherapy students toward neurology and compare it with other core specialties, identify contributors to difficulties of neurology, and obtain feedback for improving the quality of neurology and neurological rehabilitation education.

METHODS

A structured survey was distributed to final-year physiotherapy students in different universities across Turkey. Perceived level of knowledge, confidence, interest, difficulty, and desire to pursue a career in four main physiotherapy specialty areas (neurology, musculoskeletal, cardiopulmonary, and pediatric) were assessed. Reasons for perceived difficulty and ways to improve neurological physiotherapy education were asked by Likert-type and open-ended questions.

RESULTS

Three hundred ninety-one students participated from 12 universities. Neurology was perceived as the most challenging discipline (p < .001), but a lack of knowledge, interest, and confidence were not reported. The reasons for perceived difficulties with neurology were the need-to-know basic neuroanatomy and neurophysiology, difficulty integrating information into the clinic, and the complexity of the subject. To improve learning, most students recommended increasing clinical teaching, including bedside tutorials, exposure to more patients, and case discussions.

CONCLUSION

Physiotherapy students considered neurology as the most challenging discipline. Improving the integration of basic neurosciences into the clinic may improve neurology learning along with increased clinical teaching.

Neurophobia Among Medical Students: Is Virtual Teaching the Answer?

OBJECTIVE

Neurophobia is well recognized as dissuading medical students from neurocentric specialties and limiting the success of neurology and neurosurgery teaching at medical school. Past studies have associated neurophobia with deficiencies in medical education. We performed a cross-sectional analysis of medical students' confidence and perceived level of knowledge in recognizing the following neurosurgical and neurological emergencies: ischemic stroke, hemorrhagic stroke, status epilepticus, subarachnoid hemorrhage, increased intracranial pressure, acute hydrocephalus, spinal cord injury, cauda equina syndrome, and traumatic brain injury. In addition, we assessed the usefulness of virtual seminars in neurosurgery and neurology teaching.

METHODS

Medical students from King's College London were invited to a virtual teaching session. We obtained preteaching and postteaching scores for students' subjective ability to recognize specific neurologic and neurosurgical emergencies, along with their confidence in the subject.

RESULTS

Ninety-seven medical students attended the teaching session. For our sample group's subjective rating on their confidence in neurology or neurosurgery as a subject, we obtained a mean score of 3.87 and a median score of 4. Across all domains, there was a significant forward shift in the distribution curve of scores after teaching. We obtained statistically significant differences for all 9 neurologic and neurosurgical emergencies evaluated in our questionnaire (asymptotic significance <0.001). Median scores for all 9 conditions improved after the teaching session, with >50% positive ranks seen within each group. Across the teaching modalities compared, placement teaching was the highest scoring, whereas online lectures received a better rating than in-person lectures.

CONCLUSIONS

In neurosurgery teaching, virtual seminars may compensate for deficiencies that exist within medical education, hence limiting the effects of neurophobia.

Team-based learning (TBL) in clinical disciplines for undergraduate medical students-a scoping review

BACKGROUND

Team-based learning (TBL) is an evidence-based pedagogical method that has been used in undergraduate medical education since 2001. However, its use in clinical disciplines is rarely reported, and the impact of its implementation is not known. The aim of this study was to explore and map the published literature on the impact of implementing TBL in clinical disciplines in undergraduate medical education.

METHODS

A comprehensive search of Medline, Education Resources Information Center (ERIC), and Web of Science databases was performed on November 24, 2021 and updated April 6, 2023, using relevant Medical Subject Headings (MeSH) and free-text terms. Original research studies reporting on the implementation of TBL in clinical disciplines in undergraduate medical education published in peer-reviewed English language journals were included irrespective of their methodological design.

RESULTS

The initial search identified 2,383 records. Of these, 49 met the inclusion criteria. Most of the studies (n = 44, 90%) described the implementation of a modified version of TBL in which one or more TBL steps were missing, and one study had undefined protocol for the implementation. The most reported outcomes were knowledge acquisition (n = 38, 78%) and students' satisfaction or attitudes toward TBL (n = 34, 69%). Despite some differences in their results, the studies found that implementing TBL is associated with increased knowledge acquisition (n = 19, 39%), student engagement (n = 6, 12%), and student satisfaction (n = 31, 63%).

CONCLUSIONS

Most of the studies reported positive results in students' satisfaction and students' engagement, whilst the results on knowledge acquisition and retention were more contradictory. In most of the studies, TBL was implemented in a modified form and diverse comparators were used. The methodological quality also varied. Thus, no unequivocal conclusions could be drawn regarding the value of implementing TBL in clinical disciplines. More studies with rigorous methodologies are needed in this field.

Improvement of Confidence and Knowledge Retention for Stroke Management Among Internal Medicine Trainees During an Institution-Specific, Protocol-Oriented Lecture Based Intervention

Background

Acute stroke management is an essential component of neurology residency education. Internal medicine trainees are less likely to receive dedicated training in acute stroke care despite having to care for hospitalized patients with a stroke diagnosis.

Objective

The objectives of this survey-based quality improvement study were to: 1) assess pre-existing confidence and knowledge about acute stroke care among internal medicine trainees and 2) measure change after an institution-specific, protocol-oriented "value added lecture" (intervention).

Methods

Pre-intervention survey and knowledge assessment was given to internal medicine physicians, residents, and students, followed by the intervention on acute stroke management, during academic year 2019-2020. Post-intervention assessment was administered immediately post-intervention, and again at end of rotation. A 10-point Likert scale was used to indicate confidence. Statistics were performed using Student's T-Test.

Results

Fifty-one respondents participated, out of a possible 162 (31% participation rate); 13 (25%) of the 51 respondents completed the delayed post-intervention survey. Only twenty-six (51%) participants had previously received a lecture on acute stroke management. Respondents' knowledge and confidence on acute stroke management improved after intervention (p<0.0001), with no change in these scores by end of rotation (p=0.31). Forty-five (88%) respondents agreed or strongly agreed that a targeted stroke didactic was a useful part of internal medicine training.

Conclusions

An institution-specific, protocol-oriented lecture improved stroke management knowledge and confidence among internal medicine trainees, particularly among earlier trainees. A dedicated stroke management lecture should be considered as an addition to internal medicine training programs' curricula.

Neurophobia among medical students and resident trainees in a tertiary comprehensive hospital in China

BACKGROUND

Medical students and residents have been revealed to have extraordinary difficulties in managing patients with neurological complaints. However, specific information on Chinese trainees is scarce. Herein, we aimed to uncover the presence of, contributing factors for, and potential solutions to neurophobia among medical students and resident trainees in China.

METHODS

Questionnaires were administered to the medical students of Peking Union Medical College and residents of the Internal Medicine Residency Training Program at Peking Union Medical College Hospital. We asked about perceived difficulty, knowledge, interest, and confidence in neurology in contrast to six other specialties. The reasons why neurology is regarded as difficult and approaches for improving neurological teaching have been appraised.

RESULTS

A total of 351 surveys were completed by 218 medical students and 133 residents. The response rate exceeded 70% in both groups. The prevalence of neurophobia was 66.1% and 58.6% among medical students and residents, respectively. Respondents declared that greater difficulty was observed in neurology than in other specialties, and the management of patients with neurological problems was the least comfortable (p < 0.0001). Neurophobia has various perceived causes, and neuroanatomy is regarded as the most important contributor. Nearly 80% of medical students felt that improvements in neurology teaching could be achieved through further integration of preclinical and clinical neurological teaching.

CONCLUSIONS

The findings of the first survey on neurophobia in China are in accordance with those of previous studies. Neurophobia is highly prevalent in Chinese medical students and residents. Strategies to improve teaching, including enhanced integration of teaching and more online resources, are needed to prevent neurophobia.

Education Research: Monitoring and Tracking Neurophobia: Evidence From a Temporal Analysis of Brazilian Medical Schools

Background and Objectives

Neurologic disorders are common medical conditions. However, even with a higher demand for neurologic care, the capacity to train neurologists is impaired. The fear of neurosciences/neurology by medical students, known as neurophobia, may cause multiple adverse effects in neurologic assistance. The objectives of this study were to estimate the current prevalence and characteristics of neurophobia in medical students in Brazil and to compare neurophobic symptoms at 2 time points.

Methods

This is a cross-sectional study conducted with students from 4 medical schools in Pará, Brazil, who matriculated into the preclinical stage, clinical stage, and internship were submitted to a questionnaire to assess the perception of clinical specialties, including neurology. Reasons for neurophobia, probable strategies to improve neurologic education, and a specific scale to detect neurophobia were also evaluated. Furthermore, we performed a temporal comparison of current results with those from a previous study from 2015.

Results

Neurophobia was detected in 63.3% of medical students. The perception of the difficulty in neurology/neurosciences was very high in all stages, and the perception of interest and quality of teaching worsened during the internship. The need to understand neuroanatomy and neurophysiology was cited as the most important reason for neurophobia. More and better bedside tutorials were the most mentioned suggestion to improve neurologic education. The temporal comparison between 2015 and 2022 showed that the level of knowledge, quality of teaching, and likelihood of pursuing a career in neurology has become more favorable in 2022.

Discussion

The prevalence of neurophobia in Brazil was higher than that in high-income countries. Unfavorable opinions about neurology tended to increase throughout the medical course, but the temporal comparison showed that the impact of neurophobia has decreased. Surveillance systems for monitoring and tracking neurophobia should be implemented in medical schools.

A new portable Fresnel magnifying loupe for nystagmus observation: a clinical education and clinical practice setting study

BACKGROUND

Dizziness is a common complaint of patients treated by primary care physicians. It is predominantly caused by peripheral vestibular disorders; however, central nervous system disorders should be excluded. Examination of the eye movements and nystagmus can help differentiate the disorders of the central nervous system from the peripheral vestibular disorders; however, it is often not performed appropriately. In medical education practice, nystagmus observation may facilitate an understanding of vestibular function and nystagmus characteristics. Thus, we proposed a medical education practice to master nystagmus observation using a recently developed portable Fresnel magnifying loupe that could be shielded by one eye.

METHODS

Thirty-three students from the Department of Physical Therapy and the Department of Speech, Language, and Hearing Therapy of the Mejiro University participated in this study. Postrotatory nystagmus was measured and compared using the new loupe and control methods, namely the naked eye and Frenzel goggles; we rated the ease of visibility using a five-point scale.

RESULTS

The number of detected cases of nystagmus was significantly higher with the new loupe than with the naked eye (p = 0.001). In addition, there were no significant differences in the nystagmus counts between the observations using the new loupe and Frenzel goggles (p = 0.087). No significant difference was observed in the visibility of eye movements between the loupe and naked eye (p = 1.00). The Frenzel goggles provided better visibility compared to that by the loupe (p = 0.034); however, none of the participants reported poor visibility using any of these methods.

CONCLUSIONS

Our newly developed Fresnel loupe allows for the observation of nystagmus counts a level of reduction in fixation suppression similar to that of Frenzel goggles in an educational practice setting. Furthermore, it enables the detection of significantly more nystagmus counts compared to that by the naked eye. It offers several advantages over Frenzel goggles, including its lightweight, thin, durable, and portable design. Additionally, the loupe does not rely on a power source and can be used under normal room lighting conditions.

TRIAL REGISTRATION

This study was approved by the Medical Research Ethics Committee of Mejiro University (approval number: 21medicine-021).

Perception of neurology among undergraduate medical students - what can be done to counter neurophobia during clinical studies?

BACKGROUND AND PURPOSE

With a global increase in the burden of neurological diseases, the aversion towards neurology (neurophobia) may challenge the sufficient provision of new specialists in this field. We investigated the possible determinants of neurophobia among medical students and its influence on the intent to pursue neurology residency.

METHODS

From September 2021 to March 2022, an online questionnaire was distributed to medical students in Lithuania. It included questions about knowledge, confidence, interest, and teaching quality of various medical specialties (including neurology), as well as the willingness to choose neurology for residency.

RESULTS

Eight hundred fifty-two students responded to the survey (77.2% female) - they rated neurology as significantly more difficult than other medical areas and lacked confidence in assessing patients with neurological problems (p < 0.001). However, neurology was selected as one of the most interesting subjects and was reportedly well-taught. The prevalence of neurophobia among respondents was 58.9%. Most of them (207, 87.7%) indicated that neurology professors positively affected their outlook towards this medical specialty - such experience was associated with lower odds of neurophobia (odds ratio (OR) = 0.383, 95% confidence interval (CI) = 0.223 to 0.658). Being less neurophobic (OR = 1.785, 95% CI = 1.152 to 2.767) and having conducted neurology research (OR = 2.072, 95% CI = 1.145 to 3.747) increased the odds of a student being willing to pursue a career in neurology.

CONCLUSION

Neurophobia was frequent among students in Lithuania and was inversely related to the positive influence by neurology professors. Together with previous research experience in the field, low levels of neurophobia were associated with the inclination to enter neurology residency.

Neurophobia among undergraduate medical students: a European experience beyond the Anglosphere

INTRODUCTION

Neurophobia is defined as the fear of the neural sciences and clinical neurology that is due to the students' inability to apply their knowledge of basic sciences to clinical situations. This phenomenon, well documented in the Anglosphere, has seldom been studied in other European countries and never in our country. Our study aimed to determine whether said fear existed among Spanish medical students.

MATERIAL AND METHODS

A self-administered questionnaire with 18 items was sent to medical students in the second, fourth and sixth years of medical school at a Spanish university during the academic years 2020-2021 and 2021-2022. They were questioned about their fears regarding neurology and neurosciences, causes and potential solutions.

RESULTS

Out of 320 responses, 34.1% suffered from neurophobia and only 31.2% felt confident they knew what neurologists do. Despite Neurology being considered the most difficult discipline, it did also arouse the most interest among the students. Main reasons identified for neurophobia were too theoretical lectures (59.4%), neuroanatomy (47.8%), and a lack of integration between neuroscience subjects (39.5%). Solutions considered most important by the students to reverse this situation went along those lines.

CONCLUSION

Neurophobia is prevalent among Spanish medical students too. Having identified the teaching methodology as one of its fundamental causes, neurologists have the opportunity and obligation to reverse this situation. We should strive for more proactive involvement of neurologists at earlier stages of medical education.

Twelve tips for teaching neuroanatomy, from the medical students' perspective

Neuroanatomy is a complex and fascinating subject that is often a daunting prospect for medical students. In fact, the fear of learning neuroanatomy has gained its own name - "neurophobia." This widespread phenomenon among medical students poses a challenge to medical teachers and educators. To tackle "neurophobia" by summarising tips for dynamic and engaging neuroanatomy teaching formulated based on our experiences as medical students and evidence-based techniques.Focusing on the anatomical, physiological, and clinical aspects of neurology and their integration, here we present 12 tips which are [1] Teach the basic structure before fine details, [2] Supplement teaching with annotated diagrams, [3] Use dissections for haptic learning, [4] Teach form and function together, [5] Group anatomy into systems, [6] Familiarise students with neuroimaging, [7] Teach from clinical cases, [8] Let the patient become the teacher, [9] Build from first principles, [10] Try working in reverse, [11] Let the student become the teacher, [12] Let the student become the examiner. These 12 tips can be used by teachers and students alike to provide a high-yield learning experience.

A Survey of Greek Primary Care Physicians on Their Likeability in Treating Migraines and Other Common Diseases

Background and objectives: Migraine is considered the most clinically important primary headache due to its high prevalence and significant burden. Although globally categorized as one of the leading causes of disability, it is still largely underdiagnosed and undertreated. Worldwide, migraine care is in most cases provided by primary care physicians. The aim of our study was to assess the attitudes of Greek primary care physicians toward treating migraine compared to other common neurological and general medical disorders. Methods: We surveyed 182 primary care physicians with the use of a 5-point questionnaire regarding their preference in treating ten common medical conditions, including migraine, hypertension, hyperlipidemia, upper respiratory tract infections, diabetes mellitus, lower back pain, dizziness, transient ischemic attack, diabetic peripheral neuropathy, and fibromyalgia. Results: Overall, with regards to preference to treat, migraine scored very low (3.6 ± 1.0), next to diabetic peripheral neuropathy (3.6 ± 1.0), and third from the bottom to fibromyalgia (3.25 ± 1.06). In contrast, physicians reported a much higher preference to treat hypertension (4.66 ± 0.60) and hyperlipidemia (4.6 ± 1.0). Conclusions: Our results indicate that Greek primary care physicians dislike treating migraines but also other neurological diseases. Topics for further investigation include the reasons for this dislike, any associations with poor patient satisfaction, treatment results, or both.

Curriculum Innovations: "Eye"-ing Enhanced Educational Methods for Neurology Trainees: Pilot of an Online, Case-based Neuro-ophthalmology Interactive Workshop

Introduction and Problem Statement

Common and potentially life-threatening neurologic conditions often present with neuro-ophthalmologic manifestations. Given the growing shortage of neurologists, and specifically neuro-ophthalmologists, it is important that students who will be at the front lines of these complaints are comfortable assessing such patients. We developed a neuro-ophthalmology learning intervention composed of an interactive workshop that discussed novel, online case-based modules. We assessed (1) the subjective and objective improvement in the understanding of neuro-ophthalmologic manifestations of common neurologic conditions and (2) satisfaction with the educational tool.

Objectives

The objectives of this study were to identify and describe common neuro-ophthalmologic manifestations of neurologic conditions, to explain the differential diagnosis, diagnostic workup, and evidence-based treatment of common neuro-ophthalmologic conditions, and to use interactive, case-based discussion to foster an enjoyable, student-focused e-learning environment via the 20/20 SIM platform.

Methods and Curriculum Description

Our study team, composed of ophthalmology and neurology faculty, developed cases for 5 common and high-stake neurologic conditions with neuro-ophthalmologic manifestations and published them on 2020SIM.com. The cases served as the basis of our educational intervention, a 1-hour virtual interactive workshop for neurology clerkship students. Students completed optional, anonymous pretests and posttests and an exit survey to assess subjective and objective neuro-ophthalmology knowledge improvement and satisfaction with the educational tool.

Results and Assessment Data

A total of 145 students participated; 86% (n = 125), 70% (n = 102), and 61% (n = 88) completed at least part of the pretest, posttest, and exit survey, respectively. The mean knowledge score increased from 7.5 to 8.5/10, p = 0.00014. Students reported a subjective increase in knowledge of neuro-ophthalmology (70%, n = 62) and wished to see a similar learning tool for other specialties (92%, n = 81). More than half (64%, n = 56) enjoyed the workshop, approximately three-quarters (73%, n = 64) preferred the interactive session to traditional didactics, and almost all (92%, n = 81) students recommended the learning sessions in the future.

Discussion and Lessons Learned

Medical students experienced subjective and objective improvement in their understanding of neuro-ophthalmologic manifestations of common neurologic conditions. In addition, they rated the intervention favorably in relation to traditional didactics and recommended a similar platform in other specialties. The integration of interactive online learning tools, such as the SIM platform, into curricular workshops may offer a favorable and effective strategy to increase exposure to topics with less curricular time.

Neurophobia and its Correlates among Undergraduate Clinical Students in a Nigerian Private University

Background

The fear of neurology and neurosciences has been referred to as neurophobia. Neurophobia is a global phenomenon, that is worse in sub-Saharan Africa due to its impact on the already established huge gap in the neurologist-to-population ratio. The need to identify modifiable factors that could curb neurophobia stirred the current study, which aimed to determine the correlates of neurophobia among undergraduate clinical students.

Methodology

A cross-sectional design was adopted involving 173 undergraduate clinical students selected via stratified sampling. Content validated, self-administered questionnaire was utilized to obtain data on the perception of neurology, neurophobia, and demographic/academic-related characteristics. Bivariate and multivariate analyses were performed at the 0.05 significant level.

Results

The mean age (±SD) of the participants was 25.8(±2.2) years with a male-to-female ratio of 1:1.2. More than half of the undergraduate clinical students perceived neurology as being badly taught (77.5%), difficult to learn (83.2%), and with complex clinical examination (85.5%). The prevalence of neurophobia was 76.3% (n=132). The significant correlate of neurophobia was perceived poor knowledge of neurology. Students with poor perceived knowledge of neurology were about two times more likely to have neurophobia than those with perceived good knowledge (AOR=2.14; 95%CI: 1.04-4.41).

Conclusion

Approximately 8 in 10 undergraduate clinical students in Nigeria have neurophobia and the significant determining factor is their perceived poor knowledge. The need to adopt educational models that would strengthen academic prowess in neurology is strongly advocated as most of the students felt that the course was being badly taught.

Key Messages

Neurophobia among clinical undergraduate students is rampant, and without timely educational intervention, the existing wide gap in the neurologist-to-population ratio could worsen. Our findings highlight the dire need to institute educational models tailored to attaining better teaching aids, peer discussions, and bedside teaching among clinical undergraduate students.

Perception of challenges in management of neurological cases in the emergency room

OBJECTIVE

To investigate emergency clinicians' comfort level in assessing neurological emergencies and to identify opportunities to foster enhanced training of clinical neurology in the emergency room.

DESIGN

Internet-based survey.

SETTING

University teaching hospitals and private referral centers.

SUBJECTS

One hundred and ninety-two emergency and critical care specialists and resident trainees (ECC) and 104 neurology specialists and resident trainees (NEUR) in clinical practice.

INTERVENTIONS

An internet-based survey was distributed via veterinary professional organizations' listserves and message boards and responses were collected between March and April 2020. ECC completed a survey evaluating stress levels associated with neurological emergencies, confidence with neurological examinations, and neuroanatomical localization. NEUR completed a similar survey to report their perception of their ECC colleagues' confidence in the assessment of neurological cases. Chi-square and Mann-Whitney U-tests were used to compare categorical responses and confidence scores between groups. P < 0.002 was considered significant.

MEASUREMENTS AND MAIN RESULTS

Fifty-two percent of ECC found neurological emergencies slightly challenging, whereas 85% of NEUR found them moderately to extremely challenging for ECC (P < 0.0001). ECC's median self-reported confidence score in performing a neurologic examination on a scale of 0-100 was 75 (interquartile range [IQR], 27), while NEUR reported a median ECC confidence of 44 (IQR, 25; P < 0.0001). Median self-reported ECC confidence in localizing intracranial, spinal, and neuromuscular disease was 67 (IQR, 40), 88 (IQR, 21), and 60 (IQR, 37), respectively, which was significantly higher than median NEUR-reported ECC confidence of 35 (IQR, 38), 51 (IQR, 31), and 18 (IQR, 20), respectively (all P < 0.0001). Following case transfer, 34% of ECC received NEUR feedback in >75% of cases.

CONCLUSIONS

Noticeable discrepancies between ECC and NEUR perceptions of ECC clinical confidence were seen, while no firm evidence of neurophobia could be inferred. Improvements in interdepartmental communication and teaching of clinical neurology may be warranted.

New virtual platform for teaching comparative animal neuroanatomy based on metameric slices of the central nervous system

With the limitations imposed by the COVID-19 pandemic, new technologies were used as methods to continue teaching and learning activities. This scenario brought forth the need to develop online tools for teaching. Therefore, this research aimed to develop a digital platform linking the knowledge about the central nervous system (CNS) anatomy from feline, equine, and sheep models. The platform was produced from the analysis of a collection of mesoscopic slides made from the sequenced cross-section of the CNS of a feline, an equine, and a sheep. All sections were analysed and stained using the Paul-Wiegert modified technique. The platform was organized in four modules: (1) Neuroanatomy of the Central Nervous System; (2) Neuroanatomy of Feline; (3) Neuroanatomy of Equine; and (4) Neuroanatomy of sheep. For each module, an explanatory document in PDF was developed, as well as video lectures and a descriptive atlas identifying the structures present in the encephalon and in the cervical part of the spinal cord. Even though there are numerous online platforms that allow the study of veterinary anatomy of different species and organs, the veterinary neuroanatomy platform presented here is the first platform that conjointly addresses the CNS anatomy of felines, equines, and sheep. Future research applying this platform as an aid to the study of neuroanatomy by students, teachers, and veterinary professionals should validate its use as a complementary tool for teaching and learning animal neuroanatomy.

A novel 3D surgical neuroanatomy course for medical students: Outcomes from a pilot 6-week elective

BACKGROUND

Developing and maintaining a three-dimensional working knowledge of neuroanatomy is an essential skill in neurosurgery. However, conventional 2D head, neck, and neuroanatomy education is typically characterized by the separate rote learning of constituent tissues and often fails to provide learners with a contextual understanding of the relationships between these highly complex and interconnected structures. This can pose a significant challenge to medical students entering neurosurgery who lack a topographic understanding of intracranial anatomy.

METHODS

We report on the design and efficacy of a novel 6-part 3D surgical neuroanatomy pilot elective for medical students that utilized a navigation-based pedagogical technique with the goal of providing students with a framework for developing a 3D mental map of the skull base, neurovasculature, ventricular system, and associated brain regions. Students took on the perspective of physically traveling along the paths of key structures with a 360-degree view of surrounding anatomy such that they could appreciate the integration and relative spatial relationships of the varying tissues within the cranium. Mental navigation exercises and pre- and post-course surveys were used to assess students' baseline and learned familiarity with the different anatomical regions covered.

RESULTS

At the conclusion of the course, all students were able to successfully complete all of the multifaceted mental navigation exercises. Post-course survey data indicated that respondents perceived significant increases in their knowledge of cranial nerves; anterior, middle, and posterior skull base anatomy; anterior and posterior cranial circulation; and the ventricular system.

CONCLUSION

3D navigation-based fly-through instruction is a novel and effective technique for teaching complex anatomy and can provide learners with the foundational skills for developing and maintaining a 3D mental map of intracranial anatomy.

Lost in translation: Telephone referrals to a tertiary neurology referral centre

BACKGROUND

Cork University Hospital acts as the tertiary referral centre for the HSE southern area, with a catchment population of 1.2 million [1]. The neurology registrars receive telephone consultations from hospitals and primary care practices in the region. While there have been a number of studies examining inpatient neurology consultations in Irish hospitals [2-6], there is a paucity of data examining the support provided by tertiary referral centres to other acute hospitals and primary care centres in their region.

AIMS

The aim of this study is to define the workload of the neurology registrar with respect to telephone consultations and to examine the quality of these referrals.

METHODS

All calls received from the 19th of October 2021 to the 25th of February 2022 were logged by the receiving registrar. Information collected pertained to the nature of the consult and completeness of the referral.

RESULTS

The average volume of calls during the study period was six per week. The median call duration was 8 min. The cumulative time spent resolving outside calls during the study period was at least 41.25 hours. Sixty-three per cent of calls were from other acute hospitals in the region. Thirty-nine per cent of referrals were deemed incomplete with respect to either history, collateral history or examination.

CONCLUSIONS

This is a necessary service in a system that is not adequately resourced to provide specialist led care in all hospitals. A greater emphasis on complete and accurate referrals, along with robust communication and documentation, could reduce the inherent risk associated with such consultations.

Technology enhanced neuroanatomy teaching techniques: A focused BEME systematic review of current evidence: BEME Guide No. 75

BACKGROUND

In response to growing curriculum pressures and reduced time dedicated to teaching anatomy, research has been conducted into developing innovative teaching techniques. This raises important questions for neuroanatomy education regarding which teaching techniques are most beneficial for knowledge acquisition and long-term retention, and how they are best implemented. This focused systematic review aims to provide a review of technology-enhanced teaching methods available to neuroanatomy educators, particularly in knowledge acquisition and long-term retention, compared to traditional didactic techniques, and proposes reasons for why they work in some contexts.

METHODS

Electronic databases were searched from January 2015 to June 2020 with keywords that included combinations of 'neuroanatomy,' 'technology,' 'teaching,' and 'effectiveness' combined with Boolean phrases 'AND' and 'OR.' The contexts and outcomes for all studies were summarised while coding, and theories for why particular interventions worked were discussed.

RESULTS

There were 4287 articles identified for screening, with 13 studies included for final analysis. There were four technologies of interest: stereoscopic views of videos, stereoscopic views of images, augmented reality (AR), and virtual reality (VR). No recommendation for a particular teaching method was made in six studies (46%) while recommendations (from weak to moderate) were made in seven studies (54%). There was weak to moderate evidence for the efficacy of stereoscopic images and AR, and no difference in the use of stereoscopic videos or VR compared to controls.

CONCLUSIONS

To date, technology-enhanced teaching is not inferior to teaching by conventional didactic methods. There are promising results for these methods in complex spatial anatomy and reducing cognitive load. Possible reasons for why interventions worked were described including students' engagement with the object, cognitive load theory, complex spatial relationships, and the technology learning curve. Future research may build on the theorised explanations proposed here and develop and test innovative technologies that build on prior research.

Effectiveness of Supplementary Materials in Teaching the Veterinary Neurologic Examination

Clinical neurology can be difficult for veterinary students to comprehend, and part of understanding the clinical aspect is performing a proper neurologic examination. In this study, first-year veterinary students in a Small Animal Physical Exam and Anatomy rotation were given supplemental learning activities to determine their effect on student procedural knowledge and motivation in performing a neurologic examination. Students were randomly assigned to one of three groups: the first watched a video of a clinician performing the neurologic examination, the second read a handout about the neurologic exam, and the third was the control group, where students were not provided any supplemental activities. At the start and end of the rotation, students participated in a survey assessing their overall procedural knowledge and motivation to learn about the neurologic exam. No notable improvement occurred in overall student knowledge from the beginning to end of the rotation, nor when using supplemental material (p > .05). However, there was a significant difference in quiz scores between the three condition groups (p < .01), suggesting the type of learning activity did influence student learning. Additionally, students in the video and reading groups showed a significant increase in motivational scores compared with those in the control group (p < .05), demonstrating supplemental learning activities do improve student motivation in learning about the neurologic examination. This study provides evidence that while supplemental materials may not immediately help veterinary students learn to perform the neurologic examination, they do have a positive impact on students' learning motivation.

Comparing computer-assisted learning activities for learning clinical neuroscience: a randomized control trial

BACKGROUND

Computer-assisted learning has been suggested to improve enjoyment and learning efficacy in medical education and more specifically, in neuroscience. These range from text-based websites to interactive electronic modules (eModules). It remains uncertain how these can best be implemented. To assess the effects of interactivity on learning perceptions and efficacy, we compared the utility of an eModule using virtual clinical cases and graphics against a Wikipedia-like page of matching content to teach clinical neuroscience: fundamentals of stroke and cerebrovascular anatomy.

METHODS

A randomized control trial of using an interactive eModule versus a Wikipedia-like page without interactivity was performed. Participants remotely accessed their allocated learning activity once, for approximately 30 min. The primary outcome was the difference in perceptions on enjoyability, engagement and usefulness. The secondary outcome was the difference in learning efficacy between the two learning activities. These were assessed using a Likert-scale survey and two knowledge quizzes: one immediately after the learning activity and one repeated eight weeks later. Assessments were analysed using Mann-Whitney U and T-tests respectively.

RESULTS

Thirty-two medical students participated: allocated evenly between the two groups through randomisation. The eModule was perceived as significantly more engaging (p = 0.0005), useful (p = 0.01) and enjoyable (p = 0.001) by students, with the main contributing factors being interactivity and clinical cases. After both learning activities, there was a significant decrease between the first and second quiz scores for both the eModule group (-16%, p = 0.001) and Wikipedia group (-17%, p = 0.003). There was no significant difference in quiz scores between the eModule and Wikipedia groups immediately afterwards (86% vs 85%, p = 0.8) or after eight weeks (71% vs 68%, p = 0.7).

CONCLUSION

Our study shows that increased student satisfaction associated with interactive computer-assisted learning in the form of an eModule does not translate into increased learning efficacy as compared to using a Wikipedia-like webpage. This suggests the matched content of the passive webpage provides a similar learning efficacy. Still, eModules can help motivate self-directed learners and overcome the perceived difficulty associated with neuroscience. As computer assisted learning continues to rapidly expand among medical schools, we suggest educators critically evaluate the usage and cost-benefit of eModules.

Are UK medical schools using recommended national curricula for the teaching of clinical neuroscience?

BACKGROUND

Medical schools are responsible for training medical students to recognise and commence management for a broad spectrum of diseases, including clinical neuroscience conditions. To guide medical schools on topics that should be taught, speciality bodies have produced speciality-based core curricula. It is unknown to what extent these guidelines are used in designing each medical school's curriculum. This survey aimed at assessing the use of these guidelines in designing clinical neuroscience curricula.

METHODS

This is a national survey. A 21-item questionnaire was sent to faculty members involved in the development of the clinical neuroscience curriculum in each medical school in the UK. Data collection occurred from1st September 2020-31 st August 2021. The Association of British Neurologists (ABN) and the Royal College of Surgeons England (RCSEng) guidelines were used as a benchmark. Descriptive statistics are reported.

RESULTS

Data was collected from 91.9% of eligible UK medical schools. 61.8% respondents were aware of ABN guidelines and 35.3% were aware of RCSEng guidelines. 17/28 (60.7%) topics recommended by the guidelines were taught in the neuroscience curricula of over 90% of the medical schools. Neurologists were involved in the design of the clinical neuroscience curriculum in 94.1% (n = 32/34) of medical schools, and neurosurgeons in 61.8%. Tutorials/seminars were used by all medical schools to teach clinical neuroscience content. Neurologists were involved in teaching at all schools and neurosurgeons in 70.6%. Objective Structured Clinical Examination (OSCE)/oral examinations and single best answer (SBA)/multiple-choice question (MCQ) tests were used in all medical schools as methods of assessment.

CONCLUSIONS

There is variation between medical schools on what clinical neuroscience topics are taught and by whom. Multi-modality educational delivery was evident. Some medical schools did not currently use, advertise, or recommend external clinical neuroscience educational resources; but there was support for future use of external resources including guidelines.

'Building Your Neurology Acumen': A Flipped Classroom Approach for Internal Medicine Residents

Globally, internal medicine (IM) residents often feel they lack the knowledge and skills to approach patients presenting with neurologic issues. We conducted a multiple method needs assessment to determine the feasibility of a novel neurology flipped classroom (FC) curriculum for internal medicine residents. Our primary findings include participants: (1) finding neurology a useful rotation; (2) feeling uncomfortable with the neurological examination; and (3) endorsing flipped classroom as a potential alternative but with significant barriers. Our findings elucidate upon the various extrinsic/intrinsic motivators for resident education and illustrate the need to re-examine the way in which neurology is being taught to off-service residents.

The "Neurospeed" game: a fun tool to learn the neurological semiology

BACKGROUND

Neurological semiology is often considered by medical students as particularly difficult to learn. Finding alternative teaching methods may improve students' motivation and understanding of this field.

METHODS

We developed the "Neurospeed", a game to learn neurological syndromes. We assessed its efficiency on short-term learning of neurological syndromes in third-year medical students, through Multiple Choice Questions (MCQs) before and after the game session. Students' satisfaction was evaluated by a satisfaction survey.

RESULTS

Out of the 199 third-year medical students of the Faculty of Medicine Sorbonne Paris Nord, 180 attended the Neurospeed in December 2020, and 148 answered 20 Multiple Choice Questions before and after the game, with significant improvement of their score (p < 0.001). Most of the participants agreed that the game was playful, stimulating, and helpful to learn neurological semiology.

CONCLUSIONS

Overall, our results show that the Neurospeed game is an interesting tool as a complement to traditional lectures. Further studies are necessary to compare the efficacy of different types of serious games on short-term and long-term learning of neurological semiology.

Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1]

STUDY DESIGN

Literature Review (Narrative).

OBJECTIVE

To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness.

METHODS

Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority. This article reviews the evidence that awareness is low, the potential drivers, and why this must be addressed. Case studies of success from other diseases are also reviewed, drawing potential parallels and opportunities for DCM.

RESULTS

DCM may affect as many as 1 in 50 adults, yet few will receive a diagnosis and those that do will wait many years for it. This leads to poorer outcomes from surgery and greater disability. DCM is rarely featured in healthcare professional training programs and has received relatively little research funding (<2% of Amyotrophic Lateral Sclerosis or Multiple Sclerosis over the last 25 years). The transformation of stroke and acute coronary syndrome services, from a position of best supportive care with occasional surgery over 50 years ago, to avoidable disability today, represents transferable examples of success and potential opportunities for DCM. Central to this is raising awareness.

CONCLUSION

Despite the devastating burden on the patient, recognition across research, clinical practice, and healthcare policy are limited. DCM represents a significant unmet need that must become an international public health priority.

The active feedback program: bringing medical students out of the shadows

Despite many advances in medical education, medical students continue to mostly shadow on inpatient rotations like Neurology. They seldom receive face-to-face feedback or mentorship from attending physicians. This results from not training attending physicians how to integrate medical students into clinical activities in a way that does not detract from patient rounds. The 'active feedback program' is a framework for inpatient rotations that immerses medical students in clinical activities with the attending physician providing mentorship and feedback that emphasizes brevity. Expectations are laid out early. Students pick up 2-3 patients, performing daily oral reports and focused neurological exams with immediate feedback. Feedback includes items to not only correct the treatment plan, but also improve the student's oral presentation and neurological exam skills. Students also receive formal individual feedback twice during the rotation that includes constructive criticism and specific task-oriented praise. The active feedback program awaits formal testing, but seems to result in medical students learning at an accelerated rate. Neurology residents also appear to benefit by learning from critiques of the medical students and taking on higher level responsibilities. Patient rounds move quickly, leaving time for the attending physician to keep up with other obligations. As academic Neurologists we have a duty to transfer our skills to the next generation of physicians. If proven in future studies, wide adoption of the active feedback program will allow us to finally move medical students out of the shadows and come closer to achieving this noble goal.

Introduction of the Modified Neuroanatomy Motivation Questionnaire and Its Role in Comparing Medical Student Attitudes Towards Learning Neuroanatomy Between Neuro-enthusiasts and Standard Students

BACKGROUND

Neurophobia has been identified as a potential barrier to adequate knowledge of neurology in the medical community, and therefore to patient safety. There is a drive to identify the source of neurophobia, in the hope of tackling it. Comparing the learning motivations of standard medical students with those who enjoy neuroanatomy may be a way of doing this.

METHODS

The science motivation questionnaire (SMQ) was modified for neuroanatomy. It was distributed to three cohorts of second year medical students and students attending the extracurricular National Undergraduate Neuroanatomy Competition (NUNC). Cohen's D test for effect size was used to compare standard medical students and those attending the NUNC.

RESULTS

Five hundred ninety-seven questionnaires were completed by second year students, and 320 by NUNC attendees. The differences in motivation to learn neuroanatomy between the 2 groups mainly fell into themes of career motivation, personal relevance, intrinsic motivation and assessment anxiety.

CONCLUSION

This study has demonstrated the use of the SMQ in neuroanatomy, and found differences in motivators to learn neuroanatomy between self-selecting "neurophiles" and standard medical students, mainly relating to intrinsic motivation and its role in their lives. More research is needed to further explore these differences and how they might apply to interventions in medical school curricula.

Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

We aimed to evaluate the overall clinical characteristics of patients treated by a neuro-emergency expert dedicated to the emergency department (ED) as an attending neurologist during the COVID-19 pandemic. We included adult patients who visited the ED between 1 January and 31 December 2020 and were treated by a neuro-emergency expert. We retrospectively obtained and analyzed the data on patients’ clinical characteristics and outcome. The neuro-emergency expert treated 1155 patients (mean age, 62.9 years). The proportion of aged 18–40 years was the lowest, and the most common modes of arrival were public ambulance (50.6%) and walk-in (42.3%). CT and MRI examinations were performed in 94.4 and 33.1% of cases, respectively. The most frequent complaints were dizziness (31.8%), motor weakness (24.2%), and altered mental status (15.8%). The ED diagnoses were acute ischemic stroke (19.8%), benign paroxysmal positional vertigo (14.2%), vestibular neuritis (9.9%), and seizure (8.8%). The mean length of stay in the ED was 207 min. Of the patients, 55.0% were admitted to the hospital, and 41.8% were discharged for outpatient follow-up. Despite the longer stay and the complexity and difficulty of neurological diseases during the COVID-19 pandemic, the accurate diagnosis and treatment provided by a neuro-emergency expert can be presented as a good model in the ED.

Advancing neurosurgery education in junior doctors and medical students - A neurosurgery virtual lecture series

BACKGROUND

Exposure to neurosciences, especially neurosurgery, in UK medical schools is limited and variable. This combined with the fact that neurology and neurosurgery have been perceived as notoriously difficult subjects could negatively affect confidence and efficiency in junior doctors when assessing and managing patients with neurosurgical conditions. This study aims to assess the impact of a neurosurgery virtual lecture series on foundation doctors' and medical students' confidence and knowledge in the assessment and management of neurosurgical patients.

METHODS

Six virtual lectures were delivered via Zoom weekly between October and November 2020 covering lesion localisation, neuroradiology, neurosurgical emergencies, trauma assessment, and neuro-ICU. Data was collected relating to participants' pre- and post-lecture self-perceived confidence levels and performance of five SBA questions, lecture series satisfaction, and feedback.

RESULTS

31 participants in a district general hospital attended the virtual lecture series (17 foundation doctors and 14 medical students). Pre-lecture, foundation doctors felt significantly more confident than medical students in trauma assessment, spinal emergencies and neurointensive care medicine. In all lectures, participants' median confidence levels improved significantly post-lecture (p < 0.05). There was no significant difference in the performance of pre-lecture SBA questions between foundation doctors and medical students in all but one lecture, which was the neuro-ICU lecture where foundation doctors scored better (3.0 vs 1.0, p = 0.012). In both cohorts, the participants' median scores in SBA questions (objective marker of knowledge improvement) increased significantly post-lecture in all lectures.

CONCLUSION

This study has shown that this neurosurgery virtual lecture series that was focused and low-cost was well received, improved knowledge and confidence of junior doctors and medical students in assessing and managing neurosurgical patients. Future expansion of this lecture series into regional or national initiative can further increase exposure to neurosurgery, ultimately improving the care of neurosurgical patients.

Improved care and management of paediatric neurological patients evaluated at a paediatric Rapid Access Neurology clinic: A pilot study

AIM

Referral wait times for paediatric neurological patients are increasing, leading to an increased burden on the emergency department (ED). The paediatric Rapid Access Neurology (pRAN) clinic was created for paediatric patients who are clinically stable, but require an urgent paediatric neurology consultation. The objectives were to evaluate the pathways of referral, accuracy of referring diagnoses, adherence to clinic appointments, impact of clinic visitation on ED visits and patient satisfaction.

METHODS

Data were collected from the pRAN clinic from March 2018 until April 2019. Information was obtained from patient charts including the referring and final diagnosis, management plan and the number of visits made to the ED before and after visiting the pRAN clinic.

RESULTS

Of the 256 referred patients, 91 met inclusion criteria. The most frequent referral diagnosis was a seizure. Referring physicians and pRAN clinic neurologists differed significantly in the level of diagnostic agreement for patients <2 years of age (P = 0.03; 95% confidence interval (CI) -0.294, 0.373). There was a significant reduction in visits to the ED made by patients 3 months after the pRAN appointment compared with before the visit (P < 0.001; 95% CI -0.9070, -0.4088). The majority of patients felt that the clinic had high value and were satisfied with their follow-up plan.

CONCLUSION

This pilot study showed that a pRAN clinic can improve the accuracy of neurological diagnoses and management, especially for children <2 years of age. In addition, pRAN clinic patients make fewer subsequent visits to the ED and express high satisfaction with their care.

A survey of teaching undergraduate neuroanatomy in the United Kingdom and Ireland

BACKGROUND

Medical students' perception of neuroanatomy as a challenging topic has implications for referrals and interaction with specialists in the clinical neurosciences. Given plans to introduce a standardised Medical Licensing Assessment by 2023, it is important to understand the current framework of neuroanatomy education. This study aims to describe how neuroanatomy is taught and assessed in the UK and Ireland.

METHODS

A structured questionnaire capturing data about the timing, methods, materials, assessment and content of the 2019/2020 neuroanatomy curriculum in the UK and Ireland medical schools.

RESULTS

We received 24/34 responses. Lectures (96%) were the most widely used teaching method, followed by prosection (80%), e-learning (75%), tutorials/seminars (67%), problem-based learning (50%), case-based learning (38%), and dissection (30%). The mean amount of core neuroanatomy teaching was 29.3 hours. The most common formats of assessing neuroanatomical knowledge were multiple-choice exams, spot tests, and objective structured clinical exams. Only 37.5% schools required demonstration of core clinical competency relating to neuroanatomy.

CONCLUSIONS

Our survey demonstrates variability in how undergraduate neuroanatomy is taught and assessed across the UK and Ireland. There is a role for development and standardisation of national undergraduate neuroanatomy curricula in order to improve confidence and attainment.

Neuroanatomy Teaching in Australian and New Zealand Medical Schools

BACKGROUND

Graduate doctors' knowledge of central and peripheral nervous system anatomy is below an acceptable level. New technologies have been introduced to enhance education in the context of integrated curricula and reduced anatomy teaching hours in medical schools. However, it is unknown how varied this instruction has become between universities. This mixed methods study aimed to describe neuroanatomy teaching in medicine across Australia and New Zealand.

METHODS

An electronic survey was sent to Australian (n = 22) and New Zealand (n = 2) medical schools, endorsed by the Royal Australasian College of Surgeons. Academics were asked to comment on the course, content, instruction, and assessment of neuroanatomy for the 2019 academic year.

RESULTS

Ninety-two percent (22/24) of medical schools responded. Neuroanatomy content and instructional methodology was highly variable between institutions. The average time dedicated to teaching neuroanatomy was 46.0 hours (±38.1) with a range of 12-160 hours. Prosections (77%) and models (77%) were used at most universities. Dissection was utilized at 13 of 22 (59%) universities. Incorporation of new technologies was highly variable, the most common being 3-dimensional software (59%) and eBook (55%). Adoption of any virtual reality technologies was low (36%). Seven universities used an established curriculum (29%), whereas most did not (61%). Academics indicated anxiety and motivation were key elements of student engagement.

CONCLUSIONS

Results demonstrate widespread heterogeneity in the way neuroanatomy is taught to medical students. A standardized curriculum may improve collaboration between universities and facilitate translation of future research in the area into practice.

NeuroQ: A neurophobia screening tool assesses how roleplay challenges neurophobia

BACKGROUND

Neurophobia is a chronic disease of medical students and junior doctors. Early detection is needed to facilitate prevention and management as this fear can negatively impact patient care.

METHODS

We conducted a two-part mono-centric study at the faculty of Medicine, Sorbonne University, in Paris. Part one: a cross-sectional study to validate a newly constructed neurophobia scale, NeuroQ. Part two: a prospective longitudinal study to assess the impact of The Move on student neurophobia using NeuroQ. A population-based sample of second-year medical students of the 2019 and 2020 class of the Faculty of Medicine of Sorbonne University were invited to participate.

RESULTS

NeuroQ incorporates the main themes of the neurophobia definition and demonstrates uni-dimensionality. Three hundred and ninety-five medical students participated in the study (mean age was 20.0 years, SD: 2.1 years) assessing the effect of The Move teaching on neurophobia. Two hundred and eighty-eight (72.9%) students were female. After the Move teaching the mean NeuroQ score was significantly lower compared to the baseline NeuroQ score (mean [SD] variation, -1.1 [2.6], p < 0.001). There was a 22.3% relative reduction in the number of neurophobic students after The Move teaching.

CONCLUSION

Our results highlight the utility of NeuroQ in assessing (i) baseline neurophobia and (ii) the impact of pre-clinical educational interventions on neurophobia. Furthermore, we have shown the importance of pre-clinical educational interventions, such as The Move, in tackling neurophobia.

An evaluation of optimal tutorial methodologies for neurology teaching at undergraduate level : Optimal tutorial methods for neurology

AIM

We aim to determine the efficacy of an intensive week of large group tutorials in the teaching of neurology to medical students. We also look to compare teaching methods within our centre.

METHODS

Students were asked to complete a questionnaire before and after large group tutorials ranking their confidence in neurology. Students from two consecutive years were studied, each using a different tutorial method. An 'intensive week' approach was then compared to a 'once a week' approach.

RESULTS

Responses from pre and post the tutorial week were compared. Students reported an improvement in all domains following either method of delivering tutorials. There was no statistically significant difference between the two approaches.

CONCLUSION

Large group tutorials are an effective way of delivering neurology teaching to undergraduate medical students.

"The Brain Society": The First Two Years of an Undergraduate Neuroscience Society in Northern Ireland

The Queen's University Belfast Brain Society was set up in September 2018 to promote interest in the human brain. There were three main goals: firstly to provide opportunities for medical students to learn from neurologists and neurosurgeons outside their formal curriculum; secondly the Brain Society aimed to organise events that included students from other disciplines and to members of the general public who were interested in learning about aspects of neuroscience; thirdly to tackle neurophobia. In the last two years, there have been 14 events, ranging from formal lectures, to practical sessions and to patient-focused information evenings. We have sold over 1,600 tickets. This article covers how the Brain Society was set up, to inform students in other universities about the Belfast experience.

Using Photogrammetry to Create a Realistic 3D Anatomy Learning Aid with Unity Game Engine

Learning and processing complex 3D structures can be challenging for students, particularly if relying on 2D images or if there is limited access to the study material. This applies to many fields including anatomy, where students report difficulty visualising complex structures such as the nervous system. We aimed to address this by creating a realistic model of part of the nervous system-the sympathetic nervous system which is known for the 'fight or flight' response. Photogrammetry was chosen to create a 3D digital model of a dissection of the sympathetic nervous system. The 3D model was then incorporated into an interactive learning aid that allowed users to manipulate the model and provided relevant text information and labels. Evaluation of the learning aid by students (n = 7) was positive with 71.4% strongly agreeing that using this application improved their understanding of the anatomy. The majority of students (85.7%) also agreed or strongly agreed that this application provided them with a view of the sympathetic nervous system that they had not seen before. Photogrammetry is a relatively simple and inexpensive method to create realistic 3D digital models that can promote self-directed learning and a greater understanding of complex structures.

Simulation in Neurocritical Care: Past, Present, and Future

Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient. Despite its origins as a teaching tool for neurological diseases, simulation-based medical education has been historically abandoned by neurocritical care educators. In contrast, other critical care educators have embraced the technique and built an impressive foundation of literature supporting its use. Slowly, neurocritical care educators have started experimenting with simulation-based medical education and sharing their results. In this review, we will investigate the historical origins of simulation in the neurosciences, the conceptual framework supporting the technique, current applications, and future directions.

Neurophobia: why, how much, consequences and solutions

This article was migrated. The article was marked as recommended. The term neurophobia was defined by Jozefowicz as "a fear of the neural sciences and clinical neurology that is due to the students' inability to apply their knowledge of basic sciences to clinical situations, leading to a paralysis of thought or action". In this paper we review what we see as the key aspects of neurophobia. What gives rise to it? Notable among multiple causes are how basic and clinical neurosciences are taught, the peculiarities of neurological patient history, examination and differential diagnosis in the field, and how neurology and neurologists are seen from outside the field. We will also review the extent of the issue, for in view of its prevalence, many students will reject a specialty in increasing demand (as the incidence of neurological disorders will not cease to grow), along with its consequences: more patient referrals to neurology (owing to neurophobia or defensive medicine), or over-prescription of ancillary tests for diagnosis. Finally we will look at the solutions proposed, especially those aiming to bring about changes in the form and content of teaching, how the teaching of neurological examination and of new technologies is to be approached, and the use of those technologies as teaching aids.

Neuroanatomy, the Achille's Heel of Medical Students. A Systematic Analysis of Educational Strategies for the Teaching of Neuroanatomy

Neuroanatomy has been deemed crucial for clinical neurosciences. It has been one of the most challenging parts of the anatomical curriculum and is one of the causes of "neurophobia," whose main implication is a negative influence on the choice of neurology in the near future. In the last decades, several educational strategies have been identified to improve the skills of students and to promote a deep learning. The aim of this study was to systematically review the literature to identify the most effective method/s to teach human neuroanatomy. The search was restricted to publications written in English language and to articles describing teaching tools in undergraduate medical courses from January 2006 through December 2017. The primary outcome was the observation of improvement of anatomical knowledge in undergraduate medical students. Secondary outcomes were the amelioration of long-term retention knowledge and the grade of satisfaction of students. Among 18 selected studies, 44.4% have used three-dimensional (3D) teaching tools, 16.6% near peer teaching tool, 5.55% flipped classroom tool, 5.55% applied neuroanatomy elective course, 5.55% equivalence-based instruction-rote learning, 5.55% mobile augmented reality, 5.55% inquiry-based clinical case, 5.55% cadaver dissection, and 5.55% Twitter. The high in-between study heterogeneity was the main issue to identify the most helpful teaching tool to improve neuroanatomical knowledge among medical students. Data from this study suggest that a combination of multiple pedagogical resources seems to be the more advantageous for teaching neuroanatomy.

A novel longitudinal framework aimed at improving the teaching of the neurologic examination

Objective

To develop an educational framework basis for improving the teaching of the neurologic examination (NE) by asking German neurologists to (1) identify the basic elements of the screening NE and (2) nominate the steps they would deem mandatory for medical students to master.

Methods

We conducted a questionnaire-based survey among neurologists working in a hospital or ambulatory setting in southwest Germany. To define the screening NE, neurologists were asked to list the NE components they normally use in clinical encounters with patients in whom neurologic findings are unlikely. Furthermore, they were asked to identify additional elements of the NE which they would consider mandatory for students to master.

Results

Our neurologists nominated a set of 23 elements as being essential for a screening NE. There was high consensus among the 2 groups, and the results were concordant with international data. Furthermore, nearly 60 additional maneuvers of the NE were deemed obligatory for students to master.

Conclusion

Our results reinforce the international consensus for screening NE components and confirm a large set of additional examination steps that medical students should master, thereby indicating the need for an educational NE teaching concept. To solve this educational challenge, we propose a longitudinal curriculum that incorporates the “core + clusters” framework, thus combining the screening NE (core) with hypothesis-driven sets of maneuvers (clusters). Based on our data, we provide an initial proposal for the core and neurologic diagnostic clusters which is applicable to both novice and advanced learners across the continuum of training.

Validation and perception of a key feature problem examination in neurology

OBJECTIVE

To validate a newly-developed Key Feature Problem Examination (KFPE) in neurology, and to examine how it is perceived by students.

METHODS

We have developed a formative KFPE containing 12 key feature problems and 44 key feature items. The key feature problems covered four typical clinical situations. The items were presented in short- and long-menu question formats. Third- and fourth-year medical students undergoing the Neurology Course at our department participated in this study. The students' perception of the KFPE was assessed via a questionnaire. Students also had to pass a summative multiple-choice question examination (MCQE) containing 39 Type-A questions. All key feature and multiple-choice questions were classified using a modified Bloom's taxonomy.

RESULTS

The results from 81 KFPE participants were analyzed. The average score was 6.7/12 points. Cronbach's alpha for the 12 key-feature problems was 0.53. Item difficulty level scores were between 0.39 and 0.77, and item-total correlations between 0.05 and 0.36. Thirty-two key feature items of the KFPE were categorized as testers of comprehension, application and problem-solving, and 12 questions as testers of knowledge (MCQE: 15 comprehension and 24 knowledge, respectively). Overall correlations between the KFPE and the MCQE were intermediate. The KFPE was perceived well by the students.

CONCLUSIONS

Adherence to previously-established principles enables the creation of a valid KFPE in the field of Neurology.

Breaking a Cycle of Dependence to Improve Neurology Education: A Qualitative Study Exploring Pediatric Residents' Perspectives

Objective. To understand pediatric residents' experiences and attitudes toward learning neurology; and to identify facilitators and barriers to learning neurology during residency. Study Design. Qualitative study using focus groups of pediatric residents at Stanford during November 2017. Focus groups were audio-recorded and transcribed verbatim. Investigators independently coded the transcripts and reconciled codes to develop themes using constant comparison associated with grounded theory. Results. Eighteen pediatric residents participated in 3 focus groups. Four themes emerged: (1) residents feel unprepared and uncomfortable; (2) intrinsic and extrinsic factors contribute to residents' dependence on neurologists; (3) residents desire more teaching; and (4) residents are motivated to overcome their dependence on neurologists and optimize their learning. Conclusion. Pediatric residents are motivated to acquire more skills to assess and manage patients with neurological conditions. They recognize key factors that contribute to a cycle of dependence that impedes their learning and offer strategies to overcome these barriers.