Neurophobia: why, how much, consequences and solutions

Abstract

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 overprescription 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. DefinitionThe term neurophobia was first used by Poser in 1959(Poser, 1959, though we owe its durable definition to Jozefowicz: "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" (Jozefowicz, 1994). Neuroscience truly does engender anxiety in medical students, and this continues when on starting their clinical activity they are faced with neurological patients; if doctors are not trained in neurology, neurological examination and its interpretation will remain a real mystery.Hernando-Requejo V MedEdPublish https://doi. CausesIn this section we will consider what give rise to neurophobia. Notable among its multiple causes are how basic and clinical neurosciences are taught, the peculiarities of neurological patient history, examination and differential diagnosis in the specialty, and how neurology and neurologists are perceived from outside the field. Basic neuroscienceA common denominator in studies is to regard the separation of clinical and basic disciplines as the chief cause of neurophobia, especially if the latter are separated into neuroanatomy, neurophysiology, neuropathology and neuropharmacology (Fantaneanu et al., 2014;Pakpoor et al., 2014), for these subjects are normally taught by different specialists not linked to each other or to clinical practice. Moreover a lack of knowledge of basic neuroscience is one of the main reasons why medical students would reject a neurology residency (Gupta et al., 2013). In his 1994 paper, Jozefowicz asserts that for students, separating the (basic) "science" and the (clinical) "art" makes the former irrelevant and the latter mystical (Jozefowicz, 1994).A 2018 study by Tarolli et al. with a sa...

Exploring effectiveness in brain removal techniques: A comparison of approaches

“…Additionally, the wedge cut was significantly more difficult than the C1/C2 spinal cord cut, potentially due to the reasons above. There was little difference in average difficulty ratings between the occipital wedge method and the base technique of a cut through the cranial cavity at the foramen magnum (Loukas et al, 2013;Detton & Tank, 2017, 2020. This was due in part to the wide variation of ratings for the base technique which obscured any difference that may have been present.…”

“…To describe this phenomenon, Jozefowicz (1994) introduced the term “neurophobia” which is defined as fear of neuroscience due to students' inability to apply their knowledge of basic sciences to clinical situations. Almost 30 years later, neurophobia remains prevalent among health professional students today (Giles, 2010; Hernando‐Requejo, 2020; Abasıyanık et al, 2022). To overcome these challenges and facilitate students' learning of neuroanatomy, educators have adopted a number of teaching methodologies and teaching tools including 3D computer models, computer‐assisted learning tools, flipped classroom modules, near‐peer teaching, virtual reality, and augmented reality (Arantes et al, 2018; Nicolosi et al, 2021).…”

“…Steps for brain removal can be found in dissection manuals and these instructions often vary across resources. To begin, most dissection manuals instruct dissectors to remove the calvaria using a saw to make a circumferential cut around the skull (Clemente, 2007;Morton et al, 2007;Tank & Grant, 2009;Loukas et al, 2013;Detton & Tank, 2017, 2020. Some manuals encourage making an additional coronal cut from ear to ear, or a median cut, dividing the calvaria into approximate halves (Glasgow, 1996;Tank & Grant, 2009;Loukas et al, 2013).…”

“…After severing the arteries and cranial nerves connecting the brain to the cranial vault, the brainstem must be freed from the spinal cord. Most dissection manuals recommend reaching down through the cranial vault to the foramen magnum to cut the spinal cord as inferiorly as possible (Loukas et al, 2013;Detton & Tank, 2017, 2020. An alternative approach is releasing the brainstem from the spinal cord via a posterior approach by a cut between C1 and the occiput, or between two of the upper vertebrae (Felle et al, 1995;Hansen, 2002).…”

Improved delayed recall of neurological knowledge with greater satisfaction using visual mnemonics

“…Although the onus is on a problem-based, conceptual approach versus rote memorisation, a large body of factual knowledge remains a prerequisite to completing medical school successfully 1 . Additionally, neurophobia is rampant -where every second student suffers from this, which may lead to an overreliance on rote resources to ll this knowledge gap 2,3 .…”