To better understand medical residents’ confidence in various neurological physical exam maneuvers and their willingness to perform a neurologic exam when indicated.

Neurophobia is the fear of clinical neurology. Numerous studies have evaluated ways to combat the fear of neuroanatomy, basic neuroscience, and how to improve classroom teaching, but little research has explored confidence in the physical exam and the reasons why medical learners may skip some or all aspects of the physical exam.

Internal Medicine and Family Medicine residents rated their confidence in different aspects of conducting a neurological exam (from deciding that a patient requires an exam up to forming a differential) and their confidence in conducting various neurological exam maneuvers. Participants also rated the likelihood of their peers skipping a relevant examination for patients with neurological, cardiac, respiratory, gastrointestinal, or musculoskeletal complaints.

Results were examined using Mann-Whitney U-Test, Freidman’s test, post-hoc analysis with Wilcoxon Rank-Sum, and thematic analysis for free text responses.

There were 96 respondents. Participants were least confident in localizing and forming a differential, and somewhat confident in identifying abnormal findings. They were also least confident in testing sensation and reflexes. Confidence on every measure did not significantly improve with additional residency years. Respondents felt more observed practice, exposure to patients with neurological findings, and teaching by neurologists would improve their confidence.

Participants felt their peers were most likely to skip a neurological or musculoskeletal exam. Respondents cited low confidence and lack of time as major contributors, which were rarely indicated as factors for skipping exams of other specialties.

Medical residents lack confidence in certain aspects of the physical exam and are more likely to skip the neurologic exam compared to most other exams.  More exposure to neurological patients with oversight and teaching from neurologists may help address this gap.