Traditionally, the purpose of undergraduate education at virtually all medical schools
has been to prepare students to enter practice immediately after graduation11 . Menken M., Sheps CG. Undergraduate education in the medical
specialties: the case of neurology. N Engl J Med. 1984;311(16):1045-8.
http://dx.doi.org/10.1056/NEJM198410183111610
https://doi.org/10.1056/NEJM198410183111...
.
The quality of medical teachings has been long discussed. In 1913 William Osler wrote:
“In every department of human knowledge men are asking guidance in the solution
of a world-old problem – how to train the mind and the heart of the
young”. Already at that time Osler recommended simplifying the medical curriculum
to give students more time to study and also emphasized the important role of teachers
in helping students to observe and reason22 . Osler W. An introductory address on examinations, examiners, and
examinees. Lancet. 1913;2:1047-50.. A major problem in medical education today is the lack of
integration of basic science and clinical information into a cohesive whole. If either
of these is taught in a vacuum, the medical student frequently is unable to reason
through clinical problems, and this can result in anxiety, dislike, and eventual
disinterest in the subject matter. These negative sentiments are applicable to the study
of neurology in medical schools. Students perceive that the neural sciences and clinical
neurology are overly complex, and many of them develop a fear of the neural sciences and
clinical neurology due the inability to apply their knowledge of basic sciences to
clinical situations, creating a "neurophobia syndrome”33 . Jozefowicz RF. Neurophobia: the fear of neurologyamong medical
students. Arch Neurol. 1994;51(4):328-3.
http://dx.doi.org/10.1001/archneur.1994.00540160018003
https://doi.org/10.1001/archneur.1994.00...
.
In our country, the Brazilian Academy of Neurology requested a survey that compared the panorama of neurology teaching in Brazil with that in other countries. The results of this well-prepared study were presented exactly a half century ago, at the first Brazilian Academy of Neurology Congress, and this document, alongside other recommendations stressed the importance of integrating clinical neurological education with neuroanatomy, neurophysiology, and the fundamentals of neuropathology44 . Pupo PP, Armbrust-Figueiredo J. Ensino da neurologia. Arq Neuropsiquiatr. 1965;23:205-19.. Aspects that remains fully valid until today.
Reflection and critique of teaching techniques are vital to propel medical schools
towards promoting and aiming for excellence in medical education55 . Ramani S. Twelve tips to promote excellence in medical teaching.
Med Teach. 2006;28(1):19-23.
http://dx.doi.org/10.1080/01421590500441786
https://doi.org/10.1080/0142159050044178...
. There needs to be a debate on whether major changes
are needed in the way neuroscience and neurology are taught to medical students, to make
the subject more accessible and more users friendly66 . Schon F, Hart P, Fernandez C. Is clinical neurology really so
difficult? [Editorial]. J Neurol Neuros Psych. 2002;72(5):557-9.
http://dx.doi.org/10.1136/jnnp.72.5.557
https://doi.org/10.1136/jnnp.72.5.557...
.
Along the last several decades, many new models of medicine curriculums have been created. The problem-based learning curriculum (PBLC) for example, adopted at McMaster University, Canada, in 196977 . Neufeld VR, Woodward CA, MacLeod SM. The McMaster M.D. programme: a case study of renewal in medical education. Acad Med. 1989;64:423-32., although costly has grown in popularity and spread to many parts of the world, reaching as far as Hong Kong88 . Nandi PL, Chan JNF, Chan CPK, Chan P, Chan LPK. Undergraduate medical education: comparison of problem-based learning and conventional teaching. Hong Kong Med J. 2000;6(3):301-6..
In this issue of Arquivos de Neuropsiquiatria, Magalhães et al.99 . Magalhães LVB, Fernandes PT, Magalhães DSF, Bastos RR, Min LL. A Brazilian original pedagogical approach to the teaching of neurology Arq Neuropsiquiatr. 2014;72:747-52., concerned about the neurological teaching in Brazil, publish the article “A Brazilian original pedagogical approach to the teaching of neurology,” in which they discuss survey results from students and teachers to compare his method of teaching neurology, Clinical Decision/Diagnostic Workshop (CD/DW), to traditional undergraduate teaching methods (lectures, seminars and traditional case-discussions). The authors highlight the needlessness to change curriculums, the low cost of the method implementation, and, primarily, the respect for the individual students’ learning needs and tempo, besides prioritization of the teaching of diagnostic abilities from minor symptoms. They consider that motivation is the main limiting factor for implementing his program, meanwhile correctly pointing out that motivation is necessary for implementation of any other innovative teaching method.
Offering a good medical education is knowingly a complex process that depends of many
things, including money, but which is always hostage to the method / teacher binomial. A
good neurological teaching method that is attractive, dynamic, and captivating to the
student is exceedingly important, but one can never forget the teacher's role66 . Schon F, Hart P, Fernandez C. Is clinical neurology really so
difficult? [Editorial]. J Neurol Neuros Psych. 2002;72(5):557-9.
http://dx.doi.org/10.1136/jnnp.72.5.557
https://doi.org/10.1136/jnnp.72.5.557...
. As an example, a survey was performed
in seven major medical specialties among British medical students, senior house
officers, and general practitioners. They were asked why they felt neurology was
perceived to be such a difficult subject. The 70 people who answered questions gave
eighty-one reasons, of which the most common was “poor teaching”. This
survey confirms just how difficult neurology is perceived to be, not only by students
but also by senior house officers and general practitioners.
The teacher’s main job is to equip students with an enthusiasm to learn. Good teachers inspire, entertain, and support their students in their learning. They encourage the student to actively acquire knowledge learning through problem solving rather than passively absorb information.
Considering the extremely competitive selection process for undergraduate medical student
slots in Brazil1010 . FUVEST. Relação candidato vaga inscritos. São
Paulo: FUVEST; 2014 [acesso em 14 ago 2014]. Disponível em:
http://download.uol.com.br/vestibular2/concorrencia/usp_relacao_candidato_vaga_2013.pdf
http://download.uol.com.br/vestibular2/c...
, teachers are
privileged to have students who are, at least theoretically, among the most intelligent
and highly motivated in the country; so a failure for them to learn must be more closely
associated to the teachers, and not the students1111 . Allen C. Teaching clinical neurology. Pract Neurol.
2012;12(2):97-102.
http://dx.doi.org/10.1136/practneurol-2011-000196
https://doi.org/10.1136/practneurol-2011...
.
In the university where I teach, we apply the regular theoretical course of neurology for students in the sixth semester. Our classes still use traditional methods. The students consistently consider the course “one of the best courses throughout medical school” in their class evaluations. Nevertheless, we unfortunately have few quality control processes in place, and performance feedback beyond the sixth semester is seldom given. A curriculum change is in course and scheduled to be implemented within the next two years.
The issue in question is not one that can be resolved quickly. Only time will tell
whether the methods presented here by Magalhães et al.99 . Magalhães LVB, Fernandes PT, Magalhães DSF, Bastos RR,
Min LL. A Brazilian original pedagogical approach to the teaching of neurology
Arq Neuropsiquiatr. 2014;72:747-52. can be a tool that will allow that the very common
“neurophobia syndrome” to become a “neurophilia
syndrome”1212 . Fuller GN. Neurophilia: a fascination for neurology: a new
syndrome. Pract Neurol. 2012;12(5):276-8.
http://dx.doi.org/10.1136/practneurol-2012-000400
https://doi.org/10.1136/practneurol-2012...
.
References
-
1Menken M., Sheps CG. Undergraduate education in the medical specialties: the case of neurology. N Engl J Med. 1984;311(16):1045-8. http://dx.doi.org/10.1056/NEJM198410183111610
» https://doi.org/10.1056/NEJM198410183111610 -
2Osler W. An introductory address on examinations, examiners, and examinees. Lancet. 1913;2:1047-50.
-
3Jozefowicz RF. Neurophobia: the fear of neurologyamong medical students. Arch Neurol. 1994;51(4):328-3. http://dx.doi.org/10.1001/archneur.1994.00540160018003
» https://doi.org/10.1001/archneur.1994.00540160018003 -
4Pupo PP, Armbrust-Figueiredo J. Ensino da neurologia. Arq Neuropsiquiatr. 1965;23:205-19.
-
5Ramani S. Twelve tips to promote excellence in medical teaching. Med Teach. 2006;28(1):19-23. http://dx.doi.org/10.1080/01421590500441786
» https://doi.org/10.1080/01421590500441786 -
6Schon F, Hart P, Fernandez C. Is clinical neurology really so difficult? [Editorial]. J Neurol Neuros Psych. 2002;72(5):557-9. http://dx.doi.org/10.1136/jnnp.72.5.557
» https://doi.org/10.1136/jnnp.72.5.557 -
7Neufeld VR, Woodward CA, MacLeod SM. The McMaster M.D. programme: a case study of renewal in medical education. Acad Med. 1989;64:423-32.
-
8Nandi PL, Chan JNF, Chan CPK, Chan P, Chan LPK. Undergraduate medical education: comparison of problem-based learning and conventional teaching. Hong Kong Med J. 2000;6(3):301-6.
-
9Magalhães LVB, Fernandes PT, Magalhães DSF, Bastos RR, Min LL. A Brazilian original pedagogical approach to the teaching of neurology Arq Neuropsiquiatr. 2014;72:747-52.
-
10FUVEST. Relação candidato vaga inscritos. São Paulo: FUVEST; 2014 [acesso em 14 ago 2014]. Disponível em: http://download.uol.com.br/vestibular2/concorrencia/usp_relacao_candidato_vaga_2013.pdf
» http://download.uol.com.br/vestibular2/concorrencia/usp _relacao_candidato_vaga_2013.pdf -
11Allen C. Teaching clinical neurology. Pract Neurol. 2012;12(2):97-102. http://dx.doi.org/10.1136/practneurol-2011-000196
» https://doi.org/10.1136/practneurol-2011-000196 -
12Fuller GN. Neurophilia: a fascination for neurology: a new syndrome. Pract Neurol. 2012;12(5):276-8. http://dx.doi.org/10.1136/practneurol-2012-000400
» https://doi.org/10.1136/practneurol-2012-000400
Publication Dates
-
Publication in this collection
Oct 2014
History
-
Received
17 Aug 2014 -
Reviewed
28 Aug 2014 -
Accepted
16 Sept 2014