Neurophobia and its implications

Historically, neurology and neurosciences in general have been regarded as one of the more difficult components of the traditional medical curriculum. While such perceptions were anecdotal for many years, the last 10–15 years have seen attempts to test and describe these assertions.

In 1994 the term neurophobia was coined by Jozefowicz to describe 'the fear of neural sciences and neurology' among medical students and even doctors [1]. While Jozefowicz did not present scientific data to support his claim, evidence for neurophobia has now been reported from different sources. Most recently it was noted that among medical students and junior doctors in Ireland neurology was perceived as the most difficult of eight medical sub-specialties assessed [2]. Similar data was observed in a 2002 report that reviewed medical students from two London medical schools, general practitioners and senior house officers. This latter study concluded that neurology was perceived as the most difficult of the sub-specialties, students felt they were least knowledgeable about this subject and doctors had least confidence in themselves when managing neurological cases [3].

The reasons for neurophobia are not clear. It has been suggested that the manner in which neuroscience and neurology are taught may be the cause. Another UK study seeking to explore this observed no evidence of neurophobia when: (i) a modified delivery platform that focused upon increasing the length of time spent on neurology was used and (ii) focusing of the course deliverables took place [4]. Other factors responsible for neurophobia may include the complex subject matter, its sometimes abstract nature, the length of time that must be devoted in order to elicit clinical signs and possibly the fact that neurologists themselves may enjoy the perceived notion that theirs is a difficult subject only suited for the most brilliant [3,5].

Neurophobia, if it does exist, has profound implications for the practice of health care in any nation. The World Health Organization (WHO) estimates that neurological conditions contribute approximately 6.3% to the global health burden [6] and are responsible for 12% of global mortality. In Britain it was estimated that about 10% of all persons presenting to general practioners (GP) had a neurological complaint [7] and 28% of disability among the general population is secondary to neurological or psychiatric problems. Thus there is a significant burden of neurological disease globally and this may be exaggerated among populations in certain parts of the world, like the Caribbean, where a number of neurological diseases, including epilepsy and psychiatric disorders, are misunderstood and even subject to stigmatization.

Another consequence of neurophobia may be its impact on the number of persons who chose to specialize in neurology and other neuroscience based sub-specialties. In the UK there are less neurologists practising than in other disciplines and though hard evidence is lacking in the Caribbean, a review of the yellow pages in Trinidad & Tobago tends to suggest this may also be the case. Interestingly a recent report from Trinidad & Tobago observed that first year medical students are least inclined to chose psychiatry as their preferred specialization [8].

Given the evidence of neurophobia from other medical schools, and its implication for public health, we have sought to assess the extent of neurophobia among the clinical medical students at our school, their perceptions towards neurology and suggestions for improvements in teaching neurology and neuroscience.