Many neurosurgical disorders, if not properly recognized and treated early, can lead to less than desirable patient outcomes and increase the cost of care. Therefore, neurosurgical education beginning in medical school is important. It can improve medical professionals’ understanding of neurosurgical disorders, provide early recognition of neurosurgical disorders that may require referral or treatment and increase recognition of neurosurgical disorders by primary care physicians acting as “gate keepers” for neurosurgical care.
Yet, neurosurgeons have had difficulty gaining access to the medical school curriculum and as a result many physicians receive little or no educational training in neurosurgical disorders. This article will review surveys conducted to evaluate neurosurgery education in medical schools, review a successful neurosurgical curriculum currently in use, and outline a curriculum that neurosurgical educators can utilize.
Faculty Participation
Motivation for a neurosurgical curriculum in medical schools comes from the results of surveys conducted over the past 20 years. In 1982 Foltz, Kusske and Greenblat conducted a survey that looked at neurosurgery faculty participation in undergraduate medical education in american medical schools. They concluded that 32 percent of medical schools with neurosurgery programs have no required clinical neuroscience curriculum.1 In fact, one in three medical students had graduated with no formal clinical neuroscience course experience.
Almost 20 years later Daniel Resnick, MD, published an article in the Journal of Neurosurgery that identified the role of neurosurgeons as undergraduate medical educators. This article presented data from a survey sent to medical school deans and neurosurgery program directors. They were asked from whom does the average medical student at their institution learn about the management of head and spinal cord injury, headache, carotid disease, and low back pain and sciatica. The survey results found that neurosurgery ranked first in educating medical students about head and spinal cord injury. Neurosurgery ranked second behind neurology in the education of headaches, subarachnoid hemorrhage, and hydrocephalus. Neurosurgery ranked fourth behind neurology, internal medicine and vascular surgery in teaching about carotid disease. Neurosurgery came in only fifth in educating medical students concerning low back pain and sciatica.
Thus it is not surprising that much of the public and some medical professionals do not realize that neurosurgeons do spine surgery. When asked if neurosurgeons should teach undergraduate students, a majority of deans and program directors said yes; however, the participation of neurosurgeons in the medical school curriculum has increased only minimally from 53 percent to 57 percent over the 18 years between the two studies.
Concrete Action Needed to Gain Curriculum Access
Why has neurosurgery been unsuccessful in gaining access to the medical school curriculum? And more importantly, what can be done now and in the future to improve undergraduate neurosurgical education? Perhaps some insight lies in a second article published by Dr. Resnick in the Journal of Neurosurgery that sought to improve medical student exposure to neurosurgical issues by developing an effective neurosurgical course curriculum based on the AANS/CNS Education Committee’s core curriculum, which was sent to medical school deans https://www.neurosurgery.org/education/curriculum.html). The course is a compact, seven-lecture curriculum developed to teach third-year medical students about spine disease, carotid artery disease, hydrocephalus, head and spine injury and subarachnoid hemorrhage.
The key to this program’s success is emphasis on training primary care physicians and even specialists in the basic management of commonly seen neurological disorders. In adddition, the success of this program is dependent upon neurosurgeons continuing to develop and advance the curriculum by involvement in medical school administration, including education policy council and dean’s committee.
Resistance to change in the curriculum should always be anticipated since adding neurosurgical education may result in shortening or deleting other lectures in the curriculum. Finding allies in a combined neuroscience curriculum has helped to strengthen this program.
Improved medical student test scores for the recognition and management of common neurosurgical disorders demonstrates the effectiveness of the proposed curriculum. Students who went through the neuroscience curriculum were better able to recognize symptoms of obstructive hydrocephalus and spinal abscess and to interpret CT scans. These important and valuable skills learned from the medical school neuroscience core curriculum will likely improve the recognition and management of neurosurgical disease by practicing physicians.
How can a program of neurosurgical undergraduate medical educators be implemented? There needs to be a comprehensive and concise program that allows feedback to identify areas for improvement. There must be dedicated academic and private practice neurosurgeons willing to give these lectures. This effort must be supported by individual neurosurgery program directors to allow more faculty members the time and support to teach students. This program can be easily modified to educate primary care residents as well as community physicians who are currently in the position of identifying patients with neurosurgical disease and making appropriate referrals.
More specifically, a program package can be developed to include the following:
- A two-hour PowerPoint program on common neurosurgical disorders,
- Course evaluation forms that allow for student/instructor feedback to improve weaknesses and provide information to curriculum committees,
- A pocket-size plastic card containing information such as Glascow Coma Score, dermatome sensory pattern and basic muscle group innervations. The card could be prepared as a service from the AANS/CNS with appropriate contact information included.
Patient Care Will Improve
Why should we care about educating medical students about neurosurgical disorders?
- Patients will benefit by early recognition and appropriate treatment.
- Neurosurgery will benefit from the increased exposure which reflects favorably on the services that the profession provides.
- All medical students will now have exposure to the field of neurosurgery, and some of them may seek additional training or inquire about neurosurgical residencies.
- Interest in neurological disorders and their treatment will increase.
- Primary physicians will have more exposure to neurosurgical disorders and this will help them provide appropriate patient care and refer patients to specialists.
In conclusion, our goal should be to center discussion on how to effectively gain access to medical school curricula. We need a plan to get neurosurgeons involved in this process who have the energy, willingness and time to undertake these new tasks. We must develop a concise education program based on an effective and proven curriculum. Lastly, we need to emphasize that this program’s importance is ultimately improving patient care.
Although we have not been very successful at gaining access to the curriculum in the past, it is time to try again.
Mick Perez-Cruet, MD, MSc, is chairman, Ad Hoc Committee on Undergraduate Neurosurgical Education, Council of State Neurosurgical Societies.
1. Foltz EL, Kusske JA, Greenblatt S. Neurosurgery faculty participation in undergraduate medical education in American Medical Schools: A preliminary report by the Subcommittee on Undergraduate Education of the Joint Committee on Education of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Neurosurgery 10(1):122-125, 1982. 2. Resnick DK. Neuroscience education of under-graduate medical students. Part I. Role of neurosurgeons as educators. J Neurosurg 92:637-641, 2000. 3. Resnick DK. Ramirez LF. Neuroscience education of undergraduate medical students. Part II. Outcome improvement. J Neurosurg 92:642-645, 2000.