Privilege
To my students
As you start your new University year I want you to reflect on how privileged you are to be a medical student in a top tier university, with dedicated and committed teachers, responsive support staff and access to NHS hospitals and patients. This is something you should not take for granted. Please don’t waste the opportunity you have been given to learn and to become a good doctor.
I am aware that many medical students are fixated with covering the curriculum and passing the examinations. I want to remind you that you are not at medical school to pass exams; you are here to become a good doctor. Passing your final examinations is only the minimum requirement for becoming a good doctor. This is why I encourage you to be inquisitive and to explore what interests you in-depth. Make your learning fun and enjoyable. Learning should not be a chore; if it is a chore you have likely chosen the wrong profession.
Neurology is one of the medical specialities that requires the application of basic science. This is why you will need to review your neuroanatomy and learn how to apply it in clinical practice. I also find that taking an evolutionary perspective to clinical problem solving makes it easier to understand and integrate your knowledge. For example, what is the evolutionary significance of binocular vision? Knowing this explains why people who have lost binocular vision have problems with depth perception.
I would urge you to train yourself to use the diagnostic pyramid with case studies, real or fictional, to structure your knowledge. Clinical medicine is based on pattern recognition, avoiding subconscious biases and learning from your mistakes. Yes, mistakes. If you don’t practice neurology you won’t make mistakes. My motto is “practice, practice, practice”. The more your practice the more you will learn. If you can’t find a patient, examine each other, your family members and friends. Knowing what is normal is essential to defining and understanding what is abnormal. You will soon realise that clinical medicine is not black and white, but a complex montage of different shades of grey. As you gain experience you will learn how to interpret subtle clues from the history and examination that will help you make sense of what is significant and what is not significant.
To learn clinical neurology efficiently you need to be an active learner. You can’t rely on your teachers to be there all the time. Medicine is a profession that requires dedication and commitment to becoming a lifelong learner. Neurology is also a clinical speciality that requires knowledge and skills. As with all specialities that need physical skills you need to practice them frequently and repetitively to become good at it. I find it very easy to spot students during the OSCEs (objective structured clinical examination) who have not done and practised many neurological examinations; they are simply cack-handed when it comes to doing the neurological examination.
It helps to make learning social and to do it in groups. I would recommend ‘buddying-up’ with a fellow student so that you can clerk and present cases to each other. Don’t be shy; by examining patients in front of each other you will be able to critique each other’s skills and learn from each other’s mistakes.
Although not essential it is good to carry around with you the necessary equipment that you need to perform a complete neurological examination. Although each medical ward is meant to have this equipment at hand it is often difficult and time-consuming to find the necessary equipment and often it is not in working order. A good analogy is a sport; it is rare for someone to take up playing tennis without possessing their own tennis racket and balls. Similarly, it is difficult to get good at doing the neurological examination if you don’t have the necessary equipment at hand.
The clinical curriculum builds on what you have learnt in the basic and preclinical sciences and the clinical skills taught within other learning modules. The objective of clinical teaching is to equip you with knowledge regarding the presentation and assessment of common neurological and neurosurgical conditions. At its core will be the ability to perform and interpret the neurological examination.
I am aware that many of you suffer from neurophobia; the fear of neural sciences and clinical neurology. The reason for this is that there is so much basic neuroscience and clinical knowledge that you are expected to learn. This is compounded by the fact that you don’t get enough time allocated to neuroscience in the curriculum and hence you never feel competent. This is why many medical students avoid patients with neurological problems. There is no magic cure for neurophobia, but the acquisition of knowledge and experience. If you engage and are prepared to really learn you will graduate as a neurophile. Trust me I was once a neurophobe.
Good luck and enjoy. I sincerely hope this is the beginning of an exciting journey and that many of you end-up choosing neurology as a profession.