The essential neurologic examination: What should medical students be taught?
Kimford J.Meador, Emory University, 101 Woodruff Circle, Ste 6000, Mail Stop 1930-001-1AN, Atlanta, GA 30322kimford.meador@emory.edu
Submitted July 22, 2009
Moore and Chalk compared neurologists and medical students on their perception of the “essential” components of the neurological examination for a common clinical scenario. [1] They asked their participants to decide which components of the exam should be included to confirm the impression that the patient is neurologically normal if the history suggests that the patient is unlikely to have abnormal findings on the neurological exam.
Responses were mostly similar across neurologists and students yet, surprisingly, no components of the mental status exam were mentioned. There are at least three concerns raised by these findings. First, there are several common disorders where the neurological exam would likely be normal but a mental status exam should definitely be included. A mental status exam could detect recent confusion, recent hemispheric transient ischemic attack, or new onset seizure disorder.
Second, the absence of any mental status examination in a listing of essential neurological exam components promotes the view that cognitive and behavioral assessments are not important or even common elements of the neurological exam. This approach might work in a neuromuscular clinic but would result in inadequate neurological assessments in a general neurological practice.
Third, the neurological exam varies widely by disorder (e.g., dementia vs. low back pain), and the exam is directed by the history. Thus, there is no single, essential neurological exam. Understanding how students apply the neurological exam is important, but the most critical factors are whether they can anticipate which components to apply from the history and whether they can perceive the patterns of abnormalities in the exam for common neurological disorders.
References
1. Moore FG, Chalk C. The essential neurologic examination: what should medical students be taught? Neurology 2009;72:2020-2023.
Disclosure: Dr. Meador serves on the editorial boards of Neurology, Cognitive and Behavioral Neurology, Epilepsy and Behavior, Epilepsy Currents, and Journal of Clinical Neurophysiology; performs mental status exams in his practice (2%) has received research support from Schwarz Biosciences, UCB, Myriad, Marius, Esai Inc., NeuroPace, and GlaxoSmithKline; has received funding from the NIH [#2RO1-NS38455 (Principal Investigator); # N01-NS-5-2364 (Consultant); # R01-NSO31966-11A2 (Consultant); #R44AG17397 (Co-investigator); and #RO1-NS-039466 (Co-Investigator)]; has received research support from McKnight Brain Institute (Co-investigator) and the Epilepsy Foundation (Co-investigator).
Moore and Chalk compared neurologists and medical students on their perception of the “essential” components of the neurological examination for a common clinical scenario. [1] They asked their participants to decide which components of the exam should be included to confirm the impression that the patient is neurologically normal if the history suggests that the patient is unlikely to have abnormal findings on the neurological exam.
Responses were mostly similar across neurologists and students yet, surprisingly, no components of the mental status exam were mentioned. There are at least three concerns raised by these findings. First, there are several common disorders where the neurological exam would likely be normal but a mental status exam should definitely be included. A mental status exam could detect recent confusion, recent hemispheric transient ischemic attack, or new onset seizure disorder.
Second, the absence of any mental status examination in a listing of essential neurological exam components promotes the view that cognitive and behavioral assessments are not important or even common elements of the neurological exam. This approach might work in a neuromuscular clinic but would result in inadequate neurological assessments in a general neurological practice.
Third, the neurological exam varies widely by disorder (e.g., dementia vs. low back pain), and the exam is directed by the history. Thus, there is no single, essential neurological exam. Understanding how students apply the neurological exam is important, but the most critical factors are whether they can anticipate which components to apply from the history and whether they can perceive the patterns of abnormalities in the exam for common neurological disorders.
References
1. Moore FG, Chalk C. The essential neurologic examination: what should medical students be taught? Neurology 2009;72:2020-2023.
Disclosure: Dr. Meador serves on the editorial boards of Neurology, Cognitive and Behavioral Neurology, Epilepsy and Behavior, Epilepsy Currents, and Journal of Clinical Neurophysiology; performs mental status exams in his practice (2%) has received research support from Schwarz Biosciences, UCB, Myriad, Marius, Esai Inc., NeuroPace, and GlaxoSmithKline; has received funding from the NIH [#2RO1-NS38455 (Principal Investigator); # N01-NS-5-2364 (Consultant); # R01-NSO31966-11A2 (Consultant); #R44AG17397 (Co-investigator); and #RO1-NS-039466 (Co-Investigator)]; has received research support from McKnight Brain Institute (Co-investigator) and the Epilepsy Foundation (Co-investigator).