Abstract
Background
A great variability exists in the clinical exposure of neurosurgery across all academic years in UK medical schools, although the effects of this on knowledge level and confidence in referring cases appropriately to specialists have not been reported.
Methods
A cross-sectional study was carried out involving students in years 1–5 across nine British medical schools. An electronic questionnaire was sent out which consisted of questions concerning the teaching of the subject; and questions assessing the knowledge of basic neurosurgery through mini clinical scenarios testing which specialty should receive a referral.
Results
Of 417 participants, 60 were excluded due to incomplete participation. Senior years outperformed students in junior years for correctly answered questions on five neurosurgical scenarios (mean score: years 1–3 (184/357) = 3.33/5, years 4–5 (173/357) = 3.79/5, p < 0.05). Participants in years 1–5 with prior clinical exposure in neurosurgery scored higher than participants who had no exposure (mean score: exposed (247/357) = 4.21/5, not-exposed (110/357) = 3 · 50/5, p < 0.05). Sixty-one percent prefer receiving neurosurgical teaching via increased exposure to operations. Students in years 4–5 with exposure in both classroom and operating theatre scored higher than students with classroom-only experience (mean classroom (69/131) = 3.62/5, mean classroom and operating theatre (62/131) = 4.21/5, p < 0.05); 33.3 % of final-year students reported difficulty in identifying patients that require neurosurgical referral.
Conclusions
Students with exposure to an operating theatre outperformed those students exposed to just classroom teaching. Students indicated an increased preference for teaching through the operating theatre scene. One in three final-year medical students had difficulty identifying the need for a neurosurgical referral.If neurosurgical teaching were further enhanced at medical school, it could lead to increased confidence and efficiency in junior-year doctors when facing the neurosurgical referral process. Increased exposure to clinical neurosurgery may significantly improve the ability of future doctors to tackle neurosurgical scenarios.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Akhidge T, Sattar M (2014) Attitudes and perceptions of medical students towards neurosurgery. World Neurosurg 81:226–228
BMA (2013) BMA fears training overhaul will create extra grade. http://bma.org.uk/news-views-analysis/news/2013/october/bma-fears-training-overhaul-will-create-extra-grade. Accessed 10 Aug 2015
Cutler EC (1935) Undergraduate teaching of surgery. Ann Surg 102:497–506
Donohoe CL, Sayana MK, Kennedy MT, Niall DM (2010) European working time directive: implications for surgical training. Ir Med J 103:57–59
Doshi J, Carrie S (2006) A survey of undergraduate otolaryngology experience at Newcastle University Medical School. J Laryngol Otol 120:770–773
Flannery T, Gormley G (2014) Evaluation of the contribution of theatre attendance to medical undergraduate neuroscience teaching-a pilot study. Br J Neurosurg 28:680–684
Goldacre MJ, Laxton L, Harrison EM, Richards J, Lambert TW, Parks RW (2010) Early career choices and successful career progression in surgery in the UK: prospective cohort studies. BMC Surg 10:32
Greenaway D (2013) Securing the future of excellent patient care. Final report of the independent review Led by Professor David Greenaway.. http://www.shapeoftraining.co.uk/static/documents/content/Shape_of_training_FINAL_Report.pdf_53977887.pdf Accessed 10 Aug 15
Hill CS, Dias L, Kitchen N (2011) Perceptions of neurosurgery: a survey of medical students and foundation doctors. Br J Neurosurg 25:261–267
Illing J, Morrow G, Kergon C (2008) How prepared are medical graduates to begin practice? A comparison of three diverse UK medical schools. Final Report for the GMC Education Committee. General Medical Council/Northern Deanery. http://www.gmcuk.org/FINAL_How_prepared_are_medical_graduates_to_begin_practice_September_08.df_29697834.pdf Accessed 10 Aug 15
Irby DM (1995) Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med 70:898–931
McGee J, Maghzi AH, Minagar A (2014) Neurophobia: a global and under-recognized phenomenon. Clin Neurol Neurosurg 122:iii–iv
Modernising medical careers (2004) The next steps: the future shape of foundation, specialist and general practice training programmes. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4079532.pdf. Accessed 10 Aug 15
Murphy M, Ghosh J (2006) Surgeon’s survival guide to foundation years. PasTest, Cheshire
Pakpoor J, Handel A, Disanto G, Davenport RJ, Giovannoni G, Ramagopalan SV (2014) National survey of UK medical students on the perception of neurology. BMC Med Educ 14:225
Resnick DK (2000) Neuroscience education of undergraduate medical students. Part I: role of neurosurgeons as educators. J Neurosurg 92:637–641
Schon F, Hart P, Fernandez C (2002) Is clinical neurology really so difficult? J Neurol Neurosurg Psychiatry 72:557–559
Sutton PA, Mason J, Vimalachandran D, McNally S (2014) Attitudes, motivators, and barriers to a career in surgery: a national study of UK undergraduate medical students. J Surg Educ 71:662–667
Sutkin G, Wagner E, Harris I, Schiffer R (2008) What makes a good clinical teacher in medicine? A review of the literature. Acad Med 83:452–466
Whitehouse KJ, Moore AJ (2015) Undergraduate teaching of neurosurgery—what is the current practice in the UK and is there a need for improvement? Br J Neurosurg 17:1–5
Williams N. (2013) RCS Response to the Shape of Training Review. https://www.rcseng.ac.uk/media/medianews/response-to-the-shape-of-training-review Accessed 10 Aug 15
Acknowledgments
We would like to thank the medical students participating in the study and the individual university administration offices for distributing the questionnaire. The corresponding author, Yiannis Skarparis, had full access to all the data in the study and had final responsibility of the decision to submit for publication. All authors contributed equally regarding the literature search, figure and study design, data collection, data analysis, data interpretation, and writing. This includes Yiannis Skarparis*1, Callum A. Findlay2, Andreas K. Demetriades3 1MBChB, FY1, General Surgery, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, United Kingdom AB25 2ZN 24th Year Medical Student, King’s College London School of Medicine, London, United Kingdom, WC2R 2LS 3 FRCSEd, Consultant Neurosurgeon, Department of Neurosurgery, Western General Hospital, Edinburgh, United Kingdom, EH4 2XU. None of the authors or their families received funding for this research and all authors declare no commercial associations that would cause a conflict of interest in the publication of this paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
Approved by the University of Dundee Research Ethics Committee: Application Number UREC 14116. Supplementary file attached.
Conflict of interest
The author(s) declare that they have no competing interests.
Additional information
Comment
This is a report on the level of pregraduate knowledge concerning neurosurgical problems. The authors sent a total of 417 questionnaires, each contains 26 MCQs, to undergraduate students of nine UK medical schools. Some questions concerned basic neurosurgical knowledge, others represented short clinical scenarios rather which required decision-making about referral, i.e., to neurosurgery or other specialties. A total of 357 questionnaires could be analyzed. Significance was found for the following results: senior-year students (years 4-5) scored better than junior students (years 1-3). Students of all years (years 1-5) scored better when they had been exposed to clinical neurosurgery during their pregraduate education. Most students (61 %) would like to spend some time as observers in the neurosurgical OR. As compared to other surgical fields, the insecurity to make appropriate decisions for referral to a specialized center (i.e., neurosurgery vs. vascular surgery), this insecurity is highest among the students when it comes to neurosurgical clinical problems. The authors discuss the relevance of neurosurgical clinical exposure during undergraduate education already, as a lot of insecurity exists among students when it comes to appropriate decision-making. Students should thus have more exposure to the real neurosurgical world during their undergraduate years. Early adherence and building of relationships between senior doctors and interested students may also enhance the likelihood of ensuring adequate numbers of neurosurgical offspring.
Karl Schaller
Geneva, Switzerland
Appendix
Appendix
1. At which medical school do you study? |
2. Year of study on medicine programme? |
3. Have you completed a surgical rotation or shadowed a surgeon? If yes, please select which specialty area(s). |
4. A patient presents with a black necrotic right leg with a clear demarcation between necrosed and healthy tissue consistent with dry gangrene. To which surgical specialty would you refer this patient? |
5. A 14-year-old boy presents in A&E with sudden-onset, localized pain in the testes, which are tender to palpate. Testicular torsion is suspected, to whom should the boy be referred? |
6. A 74-year-old woman presents having had a seizure. She complains of having had severe headaches for the last 3 weeks since she suffered a minor head injury. The suspected diagnosis is a chronic subdural haematoma; to which specialty should this patient be referred? |
7. A patient with coronary artery disease suffering angina and shortness of breath is indicated for a coronary bypass operation. Which specialty is appropriate to refer this patient? |
8. You are presented with an infant showing the stereotypical signs of hydrocephalus (fluid on the brain), resulting in cranial enlargement, which specialty would you refer the patient to? |
9. A patient is admitted with acute lower back pain, and motor/sensory deficit in the lower limbs following spinal disc herniation. To which specialty should the patient be referred? |
10. A teenager attends A&E presenting with displaced humeral fracture requiring surgical fixation, which specialty is most likely to manage this patient’s care? |
11. As a GP, you have a patient who has thyrotoxicosis due to Graves’ disease. Having already had treatment with carbimazole and radioactive iodine, the patient requires a subtotal thyroidectomy. To which specialty should you refer this patient? |
12. A young man presents at A&E with low right-sided abdominal pain lasting for 3 days and the consultant suspects this to be acute appendicitis. Which specialty is most likely to operate on this patient? |
13. A patient aged 50 has decided to go for a vasectomy. You are his GP; to which surgical specialty should this patient be referred? |
14. A patient comes to A&E with impaired flexion of his right proximal interphalangeal joints. The patient is suspected to have a tendon injury to the flexor digitorum superficialis; who should manage this patient? |
15. A friend has stroke-like symptoms, which is later found to be a blood vessel malformation known as a cavernous hemangioma, requiring removal. Which specialty would most likely manage the operation? |
16. You see a patient with osteoarthritis suffering with chronic pain; she needs a hip replacement operation. Which specialty is most likely to undertake this procedure? |
17. A patient presents to the GP having suffered recurring bouts of tonsillitis over the previous 12 months and you believe a tonsillectomy is the best course of action; to whom should this patient be referred? |
18. A patient comes to see you with terrible electric shock-like pain affecting the right cheek, consistent with trigeminal neuralgia, which is not responding to appropriate medication. Which of the following would be appropriate referrals? |
19. What exposure have you had in surgery, excluding neurosurgery? |
20. What exposure have you had in neurosurgery? |
21. How would you rate the quality of teaching in general surgery at your university? |
22. How would you rate the quality of teaching in neurosurgery at your university? |
23. How would you rate the teaching received (if any) regarding the referral process to neurosurgery? |
24. In your opinion, is/are there any surgical specialty(s) that require a greater degree of teaching within your medical school’s curriculum? |
25. By what method would you prefer to receive more surgical teaching? Please select the one option you feel is the most suitable. |
26. What surgical specialty would you find most difficult to know when to refer patients to? |
Rights and permissions
About this article
Cite this article
Skarparis, Y., Findlay, C.A. & Demetriades, A.K. The teaching of neurosurgery in UK medical schools: a message from British medical students. Acta Neurochir 158, 27–34 (2016). https://doi.org/10.1007/s00701-015-2651-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-015-2651-x