Neurophobia, Let's Talk About It
Jul 15, 2019 by Catherine Carragee
Neurology has a reputation as one of the toughest medical specialties to master, but what does it mean to fear it?
Four weeks into our twelve-week long neurology module, I had an unsettling realization, “I think my brain hates itself.” I had developed an intense distaste for learning neurology. There are many difficult topics in medicine, but none had ever seemed to be delivered so closely together or feel so complex.
Imagine my surprise to find that neurophobia is a well documented and researched phenomenon among medical students. Neurophobia, the fear of neural science and clinical neurology, was first coined 25 years ago by Jozefowicz in JAMA. This fear has been continuously documented worldwide and amongst students at varying levels of their education. The consensus seems to be that neurophobia primarily stems from lack of prior knowledge in neurology, poor teaching, complex examination techniques, and emotional difficulty in dealing with neurological patients. More info here.
On the up side, I was clearly not alone in my frustration and trepidation when studying neurology. Then again, medical educators have known neurology is a struggle for 25 years. How do you overcome such an overwhelming subject? Much of the research advocates for change on an institutional level – integrating clinical exposure early, including patient educators/standardized patients, and building simulation programs. So what can you do as a student?
Well, if your school does offer these resources, be sure to take advantage of them. They’ve been shown to ease neurophobia make learning neurology more enjoyable. If you don’t have such resources on hand, maybe write an email to your dean or module coordinator. Try not to stress. You have the Internet! YouTube is an amazing resource to find patient experience videos. Osmosis members can find many patient experience videos linked to the subject pages. I found it particularly helpful to work from pathology outwards. If you can get an image of a patient in your head, you can use their experience as a memory anchor for this disease. This can be someone you know personally or someone you’ve seen speaking about their condition.
If anatomy, physiology, and pharm seem overwhelming to you try working back from the disease. What’s a classic finding about Huntington’s? Chorea. Chorea is a movement disorder and what area of the brain controls this movement? The basal ganglia, specifically the caudate nucleus! From here you can work your way into the different parts of the basal ganglia. Now take the time to quiz yourself – what do the other areas of the basal ganglia do? Or consider the implications from a pharm perspective. If there are abnormal hyperkinetic movements, there’s likely an inappropriate balance of neuronal firing. One way to balance the firing is to use medications like tetrabenazine which is thought to inhibit VMAT. This decreases the release of dopamine and thus balances neuronal circuitry involved in movement.
Try not to become discouraged if things don’t come to you right away. Try looking for a different approach. For example, you can draw out and label a diagram of a brain hemisection while listing their functions. Try some flashcards. Find a way to engage your brain in discovering itself. Osmosis utilizes several techniques from learning science, and offers a music video about the brain to boot. There will be a method that works for you.
Organize a neurology exam session where you practice reflexes and explain what negative exams look like. Again, YouTube is your friend. There are a myriad of videos with standardized patients demonstrating Babinski sign or intention tremor.
Finally, if you’re thinking, “Do I really need to know neurology?” Yeah, you probably should. Neurology is important. According to the World Health Organization, neurological diseases constitute about 6.3% of global morbidity and contribute to about 12% of global mortality. With the increasing prevalence of neurological disorders, it is important that all physicians recognize the subtle signs of neurological illness and are comfortable with managing these complex conditions. Found here. You are going to see patients with neurological complaints, no matter what your specialty is. So by putting in the time and effort, you can master this subject too.
Cat Carragee is a second year medical student at the University College Dublin in Ireland. She is passionate about primary care, small animals and good books. A California native, she spends most of her time not in class chasing sunny days and looking for a pick up soccer game.