Aversion to neurology  – so-called ‘neurophobia’ – is widespread among Australian medical students and junior doctors because of a perception that it is a difficult and uncertain speciality.

The concept was coined in the 1990s to describe the fear held by medical students that neurosciences and clinical neurology belong in the ‘too hard’ basket  because of students’ perceived inability to apply their knowledge of basic sciences to clinical situations.

And those perceptions have been confirmed in a survey of 114 medical students and junior doctors (interns, basic physician trainees) in Victoria who nominated neurology as the most difficult among 11 different medical specialities.

The three main factors contributing to the perceived difficulties of neurology were lack of understanding of neuroanatomy, lack of diagnostic certainty and lack of clinical exposure.

And the fear and uncertainty relating to neurology was likely worsened by the fact that two thirds of students felt they had too little education in the subject at medical school and only a third (36%) had performed a neurology rotation during medical school.

The study, conducted by Dr Alex Yeung and Professor Tissa Wijeratne, of the neurology department, Western Health, Melbourne, found that students were least comfortable in drawing up a differential diagnosis for patients presenting with neurological symptoms when compared to most other medical specialties except haematology and nephrology.

Discomfort with the neurological examination was also greater for neurology than five other specialities (respiratory, gastroenterology, cardiology, geriatrics and endocrinology).

And while students rated the quality of teaching in neurology as generally high, almost 40% said they would like to have had more and/or improved bedside teaching. About half the students said they lacked the opportunity to carry out a research project in a topic related to neurology (49%).

The survey also revealed that junior doctors had poor perceptions of neurology in terms of financial rewards, career progression and prestige, and most were unlikely to choose it as a career.

The study investigators said the findings had confirmed those of previous US studies showing an aversion to neurology among students because of the complexity of neurological conditions, including their neuroanatomical and pathophysiological bases.

Similarly, concerns about lack of diagnostic certainty were common and attributed to factors, such as perceived subjectiveness of taking the history and performing the examination and integrating these clinical findings with the wide array of neurological conditions.

“Possible targeted interventions in combating neurophobia … would be a change to neurology education during clinical years including mandatory clinical neurology rotations and structured clinical/bedside tutorials,” the authors suggested

“[And] it would not be unreasonable to suggest that the education in clinical years should be taught by neurologists who would be able to simplify the perceived “complexity” of neurology due to their greater understanding of the subject matter.”

The findings are published in the medical pre-print site MedRxiv.