Neurophobia- can we overcome it to teach neurology in primary care?

Problem

Community based teaching has often taken on the challenge of teaching undergraduate specialty subjects from a community perspective. Neurology is a subject that embraces many aspects of community medicine- being associated with chronic disease, causing disability, and managed by GPs long term and yet it is rarely taught as a specific course by GPs.

Approach

A pragmatic retrospective evaluation using routine data (student evaluation questionnaires [SEQs]), module management minutes and course documentation. Qualitative data was analysed using critical interpretive synthesis. Quantitative data was analysed using descriptive statistics.

Findings

A GP neurology module (2 days in GP) ran 9 times for 12 months complementing a hospital neurology firm in the 1st clinical year at a UK (London) medical school. The 380 students were polled, contributing in excess of 300 SEQs (although not 300 separate students). Students rated GP teaching highly (GP rating of satisfactory to excellent) was (116/134) 86% vs Hospital rating (85/125) 68%. Chi sq 12.83 p=0.0003). From the qualitative data students valued time to practice neurological skills with patients, GPs produced a supportive learning environment and they identified that GPs provided enhanced access to suitable patients compared to hospital firms. Some students identified that seeing patients at home improved their holistic understanding of the impact of these diseases. Some (but not all) GPs commented that they felt uncomfortable teaching aspects of neurology, particularly the highly technical aspects of the neurological exam. Some students felt it inappropriate for GPs to teach neurology and questioned their tutor’s capacity to teach the subject. Neurologists and faculty were generally supportive although some resented students being “elsewhere”.

Consequences

GP teaching of neurology seems to add considerably to the capacity in a medical school to teach with neurological patients and to do so in a safe environment to learn, with the time available for students to acquire their basic neurology skills and knowledge. Some GPs felt they were outside their teaching comfort zone with this course. This teaching should be complementary to a specialist neurology firm.