Neurology as career option among postgraduate medical students

Abstract

Background:In the context of inadequacy of neurology workforce in India, it is important to understand factors that post-graduate medical students consider for and against choosing neurology as their career option. Understanding these factors will help in planning strategies to encourage students to pursue a career in neurology. At present, there is a paucity of studies addressing this issue in India.Aims and Objectives:(1) To analyze factors, which post-graduate students consider for and against choosing neurology as a career specialty. (2) To access the level and quality of neurology exposure in the current MBBS and MD curricula.Materials and Methods:Statewide questionnaire based study was conducted in the state of Maharashtra for students eligible to take DM neurology entrance examination (MD Medicine and MD Pediatrics).Results:In this survey, 243 students were enrolled. Factors bringing students to neurology were - intellectual challenge and logical reasoning (72%), inspired by role model teachers (63%), better quality-of-life (51%) and scope for independent practice without expensive infrastructure (48%). Factors preventing students from taking neurology were - perception that most neurological diseases are degenerative (78%), neurology is mainly an academic specialty (40%), neurophobia (43%) and lack of procedures (57%). Inadequate exposure and resultant lack of self-confidence were common (31%, 70-80%). 84% of the students felt the need for a short term certification course in neurology after MD.Conclusions:To attract more students to neurology, “role model” teachers of neurology could interact and teach students extensively. Neurologists’ efforts to shed their diagnostician's image and to shift their focus to therapeutics will help change the image of neurology. Out-patient neurology clinics should be incorporated early in the student's career. Procedures attract students; hence, they should be made conversant with procedures and interventions. Increasing the level of neurological exposure in our current MBBS and MD curriculum is necessary. A case could be made for consideration of short certification course in neurology for physicians.

Neurophobia: why, how much, consequences and solutions

“…In a study by Gupta et al (2013), 70% of students thought the teaching of neuropharmacology was deficient, and 67% believed their exposure to neurological patients was insufficient. Pakpoor et al (2014) survey 2877 medical students (61.6% women and 38.4% men) at 25 of the 31 faculties in the UK, i.e.…”

“…And without this link, students do not know which parts of a detailed study of neuroanatomy are of clinical interest (Tarolli & Jozefowicz, 2018). Indeed, many details of basic neuroscience are often irrelevant to clinical neurology (Haines et al, 2002).It would be recommendable to consider developing a new approach in which the teaching of neurology to students begins with clinical signs and phenomenology, with explanations and reasons, rather than with basic disciplines lacking clinical focus (Menken, 2002;Gupta et al, 2013). If we could achieve a suitable vertical integration turning all these neuroscience disciplines into a single one, the problem would be mitigated (Shelley et al, 2018).But the issue may be approached more aggressively, as by Zinchuk et al: Is neuroanatomy really important?…”

Attitudes towards neurology among medical undergraduates

“…Negative aspects of neurology described in the survey included: difficulties in learning (especially basic neurosciences), specificity of neurological disorders (chronic, Positive aspects of neurology (similar to those perceived by participants in our study) have been addressed in studies on speciality choices [8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

“…The studies on 'neurophobia' have highlighted a low proportion of students planning a career in neurology [3, 11-13, 15, 22]. The results of an Indian survey [18] stand out from these, with almost one-third of undergraduates considering a choice of neurology, which might indicate some local context for its popularity. Polish research [7][8] showed a similarly low percentage of students choosing to specialise in neurology (8% and 5.7%) despite progress in neurology and evolution in the postgraduate training model which had occurred between the 1970s and 2000s.…”

“…The review of literature from various countries revealed similar perspectives on 'neurophobic' attitudes, and limited interest in a neurology career. However, the distinct findings from the UK [12] and Indian surveys [18], in which neurology was middle-ranked or high-ranked as a future speciality, may indicate the role of cultural and socio-economic background in shaping the students' approach.…”