Neurophobia, the well-documented fear of neurology, may impede medicine residents’ confidence in managing neurologic complaints. This may be exacerbated by the national shortage of neurologists leading to many teaching hospitals relying on teleneurology services.

Our curricular intervention at an accredited community-based medicine residency program consisted of case discussions, noon conference lectures and simulated patient sessions covering neurologic emergencies. Twenty-two categorical residents completed validated surveys with Likert scales (1-5) at the beginning and end of the intervention year and the simulation sessions. Focus groups were held at the end of the intervention to qualitatively assess neurophobia and the effects of our study. Descriptive statistics are presented as mean±SD. Paired t-tests were performed to assess changes in neurophobia and comfort with neurologic concepts.

Residents strongly agree that neurology is important for general practitioners (4.90±0.32). They think neurology (4.00±0.67) and neuroanatomy (4.26±0.93) are difficult and would like more exposure to neurological patients (4.13±1.06), though they mostly deny a fear of neurology (2.75±1.21). They endorse discomfort at practicing in a hospital without an in-house neurologist (2.75±1.14). They were extremely satisfied (97.7%) with emergency simulation sessions. There was an increase in their comfort performing a focused neurologic exam (p=0.015), presenting a case to a consultant (p=0.034), differentiating between peripheral and central vertigo (p=0.021) and recognizing an acute seizure (p=0.038). 

We identified an educational and care gap in internal medicine residents who train and practice in community settings without in-house neurologists, as they do not receive in-person guidance to comfortably manage neurologic presentations in their future practice. While hybrid educational models with in-person exam and emergency teaching may mitigate that, long-term collaborations and robust clinical curricula are required.