To help medical students learn the neurologic clinical examination by establishing an evidence- and consensus-based structure.

Physical examination skills have declined as medicine has increasingly relied on diagnostic investigations. The majority of diagnoses, however, continue to be made from a patient’s history and physical examination. In ensuring medical students become competent in the neurologic examination, it is crucial to identify the appropriate examination components for them to learn.

This study initially reviewed the evidence behind the components of the neurologic examination. Key components were determined within the systematic examination of mental status, cranial nerves, motor system, coordination, gait, reflexes and sensation. The evidence for each component, including metrics such as sensitivity, specificity and interrater reliability, was then identified using Pubmed searches. The next phase will survey neurologic and non-neurologic clinicians; they will be presented with the evidence for each component and asked whether it should be taught to medical students.

The literature review has identified components of the examination that have strong evidence to support their use. Pronator drift, for example, has a sensitivity of 92% and specificity of 90% in determining patients with a hemispheric motor pathway lesion (Teitelbaum et al, 2002). There are, however, also parts of the examination with a weaker evidence base. The Weber tuning fork test has inferior positive and negative likelihood ratios compared to the whispered voice test or simply asking a patient if they have hearing impairment (Bagai et al, 2006).

There is an extensive evidence-base for many components of the neurologic examination. The next part of this project will survey clinicians, who are informed by this evidence, to establish the consensus on what medical students should be taught.