The teaching of neurologic examination: strategies and critical review

Abstract

Introduction: The neurological examination (NE) is a cornerstone in the training of medical residents in neurology and neurosurgery, as it is an essential component of the professional practice for future specialists. However, the teaching of NE faces challenges due to traditional methodologies and single-strategy approaches, which are often insufficient to achieve the deep learning required to master the complex and nuanced competencies involved.

Objective: To analyze the main strategies used in the teaching of NE and to propose an efficient, evidence-based system.

Method: A structured review of both traditional and unconventional strategies in NE teaching and learning was conducted. These findings were compared with currently accepted competencies for NE, and a methodology was proposed based on the results. MeSH terms and keywords such as “neurological examination”, “neurological semiology”, “neurologic exam”, “residents”, and “neurology” were used.

Results: Traditional strategies primarily include lectures, often supplemented by clinical case analysis and problem-solving exercises. Innovative strategies applied in NE teaching, as reported in the literature, serve as alternatives to lectures or are part of a multi-strategic approach combined with lectures. These include problem-based learning with virtual reality, tutoring and peer tutoring among residents, simulation, and gamification. Strategies must be individualized and contextualized depending on the specific domain of NE being taught.

Conclusion: Various teaching and learning strategies are available for NE; however, there is a significant lack of systematized studies measuring their comparative effectiveness. An effective curriculum design for NE should incorporate a diversification of strategies and consider the specific requirements of each domain within the NE. It is imperative to generate evidence that prioritizes the efficiency of each available strategy for this purpose.