Teaching medicalstudents clinicalneurology: a ‘youngthing’s’ viewHelen Ford, St James’s University Hospital, Leeds, UK

Professor Warlow makes theobservation that improvingthe teaching of clinical

neurology would involve muchmore involvement by NHSconsultants, and in some parts of

the UK this is already happening,from curriculum development toteaching and assessment.3

In the development of the newintegrated curriculum in Leeds we

used the Association of BritishNeurologists’ suggestions to helpto plan our neurology teaching.1

A group of basic neuroscientists,clinical neurologists, a generalpractitioner and a senior student

their teaching iswell received bystudents

Helen Ford.

Debate

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discussed the integration of basicneuroscience teaching with clin-ical neurology during the earlyyears of medical training. Thegroup focused on common condi-tions such as stroke, epilepsy andheadache, with our GP colleaguekeeping us away from the rarerdisorders. The neuroscientistswere losing significant amounts ofteaching time but we hoped thatthe integration would bring neu-roscience to life for the students.In the second year of the coursewe run clinical symposia with aclinician, neuroscientist andpatients. The clinicians involvedinclude neurologists, neurosur-geons, neuro-rehabilitationspecialists, specialist nurses andneuroradiologists. Although thisis a large group of tutors, theirteaching is well received by stu-dents. The most positive feedbackis usually for a colleague, a spe-cialist in movement disorders,who runs a symposium with apharmacologist and a range ofdifferent patients. The cliniciansinvolved in teaching also writeexamination questions for thesummative examinations.

In parallel with this course,the students learn basic history-taking and examination skills inthe major systems, includingneurology. They are taught insmall groups of five to sixstudents on the wards and in GPsurgeries. The teaching is deliv-ered by clinicians from differentspecialties within the hospital, byclinical education facilitators(ward-based teachers) and by GPsin primary care. Students have theopportunity to take histories,examine patients and beobserved. This course runs fromthe second year to the end of thethird year of medical training. Theintegration of clinical teachingand basic science continues withsymposia on medical emergencies,including meningitis, with aninfectious diseases consultant,microbiologist and public healthinvolvement. At the end of thethird year students are assessed in

The vastmajority of

examiners areNHS consultants

some of theplacements in

the districtgeneral

hospitalsinclude

neurologyteaching

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an Objective Structured ClinicalExamination that includesneurological history-taking andexamination. The vast majority ofexaminers are NHS consultants. Iam always encouraged when Iobserve the performance of thethird-year students at this stage,as I listen to them taking ahistory or examining a patient.

We meet up with the studentsagain in their fifth year (in theirfourth year they are taught neuro-rehabilitation as part of themedical specialties course, butneurology isn’t part of thatcourse). In the fifth year studentshave five integrated placements,and we have developed an integ-rated placement in neurology,neurosurgery and neuro-rehabilit-ation. We take a group of eightstudents for each placement, atotal of only 40 over the year,which is less than 20 per cent ofthe year group. However, some ofthe placements in the districtgeneral hospitals also includeneurology teaching delivered by

our regional neurology col-leagues. This gives the students achance to spend time with us onthe wards and in the outpatientdepartment. In our job plans wehave identified the teaching clin-ics and it is acknowledged thatthese clinics take more time. Oneof my colleagues books specificpatients into these teachingclinics.

Space has been a problem butwe are currently planning a newoutpatient site and from theearly planning stage have inclu-ded space for teaching students.We are keen to take more stu-dents for clinical attachments inthe neurosciences. There aren’tenough of us in the centre,however, to deliver small-groupclinical teaching to 260-plusstudents. Leeds has developed amodel of contracting NHS con-sultants for sessions on behalf ofthe School of Medicine. Withincreasing student numbers Ithink we shall need to increasethe involvement of the regional

network of neurologists ratherthan continue to teach a smallnumber of students in the neu-rosciences centres. The recentNational Service Framework forlong-term conditions emphasisesthe importance of clinical neu-roscience networks for servicedelivery and commissioning,2 andwe could use these networks toinvolve more NHS neurologists inteaching.

We also need to support otherteachers delivering neurologyteaching – for example, in primarycare. By ‘teaching the teachers’we can improve the students’understanding of clinical neurol-ogy in settings where so muchneurology is seen. It may betimely to review progress inteaching neurology in UK medicalschools ten years on from theAssociation of British Neurolo-gists’ guidelines.

ACKNOWLEDGEMENTS

All of my NHS neurologycolleagues contribute to theteaching programme.

REFERENCES

1. Association of British Neurologists.

Teaching neurology in the 21st

century: suggestions for UK medical

schools planning their core

curriculum. London: Association of

British Neurologists, 1994.

2. Department of Health. The national

service framework for long-term

conditions. London: Department of

Health, March 2005.

3. Warlow C. Teaching medical students

clinical neurology: an old codger’s

view. The Clinical Teacher

2005;2:111–114.

The NationalServiceFrameworkemphasises theimportance ofclinicalneuroscience

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