Manual de Bienvenida y Descripción de puestos

The questionnaire provided a list of potential reasons for the difficulty in learning neurology which had been defined in previous medical student research (Schon et al 2002 and Flanagan et al 2007). The physiotherapy students could indicate if they felt each of these items was a major contributor, minor contributor, or not at all as a reason for the difficulty learning neurology, as seen in Table 9. There was also opportunity for the students to add to this list and provide additional reasons for any perceived difficulty. These suggestions could be personal reasons or

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reasons they perceive others find the subject difficult as the question was left quite open. Not at all A minor contributor A major contributor Neuroanatomy 3 12 7 Neuropathophysiology 1 10 7

Complexity of treatment approach 3 9 9

Poor teaching 8 5 7

Many complex diagnoses 0 12 9

Limited exposure to neurological

patients 2 4 15

Not enough teaching 3 12 5

Table 9. Reasons for perceived difficulty.

The most significant factor identified as a major contributor to the difficulty in learning neurology was the ‘limited exposure to neurological patients’. The exposure to patients during the university teaching block is very limited and therefore what the students are highlighting here again is the importance of

practice placement experiences. The other factors received mixed responses from the students and the only factor that every student felt was either a minor or major contributor was the ‘many complex diagnoses’. There is another link being

exposed here that was discussed earlier in the questionnaire results, as the

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significant issues. Previously it was suggested that the placement experience is most important for the more complex patients.

In addition to the factors identified in the questionnaire (Table 9) students also identified that barriers to communicating with patients influenced the perceived difficulty of the clinical area:

“Difficulty communicating with some patients (more so than any other area)”

“There are often a variety of communication difficulties to overcome when working with patients with neurological deficit, as well as the challenges that present when treating all patients”.

This could be linked to the complex diagnosis, but more specifically it is the

manifestation or presentation of the patient following the complex neuropathology. Communication disorders are a common occurrence following neurological

conditions, for stroke alone studies have found that the prevalence of dysphasia can be between 25-70% of all patients (ASPHA 2013), which can be challenging to work with. Another example of an aspect of the patient’s presentation adding additional pressure for the student learning neurology is their level of illness;

“Normally msk patients are a lot more medically stable than neuro or resp, so they are easier to sub and objectively examine”

It seems the amount of personal experience of people with neurological conditions is also significant;

“It’s difficult to grasp the concept if you have not experienced or lived with neuro patients before”

This comment seems to go beyond having practice placement experience and implies learning neurology is difficult if you are unable to empathise with patients

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through lack of personal experience. It could be suggested that students are much more likely to have experienced or know someone who has experienced a

musculoskeletal problem, whether that be a sprained ankle, broken bone or

arthritis. This might mean they are more able to make links and empathise with the situation. Neurology as a topic is not as familiar to students unless they have some experience through previous teaching, which it appears is quite limited;

“It’s an unknown topic, that you only have limited knowledge in from A levels and yr 1 HSY topics”

“limited experience prior to university and minimal hours dedicated to neuro”.

This is another example of reference to the amount of teaching which is allocated to each of the subjects and the fact that the neurology block of teaching is much shorter. Although the question does not ask for it, there is no acknowledgement of the transferable skills that are learned through the musculoskeletal block of

teaching that are also used within neurology.

The statement above has been highlighted from one of the questionnaires, not because it is saying that neuroanatomy is difficult because, the results already indicate that many students do find it a difficult subject, but because the student does not feel it was needed for practice placement.

“It got more confusing the more neuroanatomy you do – but I didn’t really need that for placement”.

This student’s comment could be implying something much more important, that actually they feel the teaching is being made more complex than it needs to be, and that the level of detail taught is not required clinically.

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One student identifies an additional reason for the difficulty learning neurology as;

“limited functional anatomy”.

The student is referring to the integration of the neuroanatomy with the function and presenting symptoms of patients. This is an interesting comment to make because this student is right by inadvertently acknowledging that none of the reasons given on the questionnaire identify the problems of integrating knowledge to make sense of the patient presentation, which is essential in order to perform effective clinical reasoning (Higgs et al 2008). Particularly as this is the essence of the initial definition of neurophobia provided by Jozefowicz (1994). The difficulty may well lie in the ability to link all of these individually difficult aspects of learning neurology together in order to assess, diagnose and treat patients.

In addition to the points illustrated above some students chose to elaborate on issues that made the subject more difficult to learn, in particular identifying the treatment approach and the terminology used;

“there is not one set treatment approach for the certain pathologies and educators/clinicians tend to use different ones”.

“lots of new anatomical language”.

Finally the questionnaire asked students to reflect on these difficulties and suggest ways that students could be better facilitated to learn neurology.