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Is clinical neurology really so difficult?

According to this study published by The Journal of Neurology, Neurosurgery and Psychiatry, Neurology has developed a reputation of being reserved for the elite, a difficult career path among difficult career paths. This study narrows down on the factors that could be responsible for the spread of this reputation. Below, the graphs A, B and D are based on a survey of 345 replies from 101 are medical students from St George’s Hospital, 85 medical students from the Royal Free Hospital , 100 SHOs (Senior House Officers-junior doctors undergoing training in a certain specialty), and 59 general practitioners. While graph C is based on 159 responses from general practitioners and SHOs.

Histograms showing questionnaire results based on 159 replies. Car, cardiology; End, endocrinology; Gas, gastroenterology; Geri, geriatric medicine; Neu, neurology; Res, respiratory medicine; Rhe, rheumatology.

In Graph A, they depicted the responses to the question of what their current level of knowledge was in the areas; cardiology, endocrinology, gastroenterology, geriatrics, neurology, respiratory medicine, and rheumatology. They were given a chance to rate each area from 0-5. As you can see, Neurology was rated as one of the least known subjects.

0 = not known or other; 1 = little or none; 2 = some; 3 = moderate; 4 = fair; 5 = great.

In Graph B, they were asked to rate the difficulty of each subject from 0-5. As expected, Neurology was rated as the most difficult among the subjects.

0 = not known or other; 1 = very easy; 2 = quite easy; 3 = moderate; 4 = quite difficult; 5 = very difficult

Graph C is based on the responses of SHOs and general practitioners who were asked to rate there clinical confidence in diagnosing or performing surgery in each one of the areas from 0-5. Once again, Neurology was rated as the subject that doctors are least confident about.

1 = very uneasy; 2 = uneasy; 3 = averagely competent; 4 = confident; 5 = very confident.

However, in Graph D, when applicants were told to rate their interest from 0-5, 5 being the highest. Neurology turned out to be the 3rd most interested area of study.

As researchers dug deeper for the reasons of “neurophobia” (a fear of the neural sciences and clinical neurology held by medical students and doctors), they discovered that most of the applicants blamed poor teaching for the difficulty of the subject. They mention that the curriculum needs to emphasize on what is “simple, basic, straightforward, and important”.

Remember that this survey is based on how difficult neurology is FELT to be. It does not necessarily mean that students or doctors actually know less neurology, do worse in neurology questions in examinations, or handle neurology cases less adequately.

For more details on the study, check out the link below:

Is clinical neurology really so difficult? — Schon et al. 72 (5): 557 — Journal of Neurology, Neurosurgery & Psychiatry

Do any of you guys have any input on why neurology is percieved as so difficult?