We thank Dr. Meador for his interest in our paper. Our objective was to determine why medical students frequently report a lack of confidence in performing the neurological examination. Our hypothesis was that it may be because they have difficulty deciding which of the many different elements of the neurological examination are important to test for a given patient. This indecision would then lead to a lack of confidence.
To test our hypothesis, we compared the self-reported practice of graduating medical students to that of practicing neurologists (“the experts”) for one specific clinical scenario. We agree with Dr. Meador that the actual elements identified as being “essential” by either group would vary depending on the clinical scenario. However, the goal of our study was not to define the one, essential neurological examination that applies in all situations but to see if the two groups responded differently to the specific scenario we presented to them.
We did not find major differences between students and neurologists, and concluded that the source of students’ anxiety with the neurological examination must lie elsewhere. As Dr. Meador points out, among the potential factors may be the ability of students to anticipate which components of the examination to apply based on a given history, or whether they can perceive the patterns of abnormalities in the exam for common neurological disorders. These and other responsible factors are worthy of future investigation.
Finally, Dr. Meador also expresses concern about the absence of a formal mental status examination from the elements ranked most highly by our participants. We did include several elements of a mental status exam among the 46 elements from which students and neurologists could choose including: the Folstein mini-mental status exam, tests of language, tests of praxis, drawing, and executive function. Neither students nor neurologists ranked these elements highly in our clinical scenario. However, this should not be interpreted as a general statement about the value of the mental status exam.
The objective of our study was to try to determine what students and neurologists actually do when faced by our study’s scenario. We agree with Dr. Meador that, in many other clinical situations, the mental status exam may be extremely important.
Disclosure: Dr. Moore has received clinic support from EMD Serono; participated in MS clinical trials sponsored by EMD Serono, Bayer, and Teva; received funding to attend meetings from EMD Serono, Biogen, and Teva; received consulting fees from EMD Serono, Teva and Bayer. Dr. Chalk serves as a member of the editorial board of the Canadian Journal of Neurological Sciences.
We thank Dr. Meador for his interest in our paper. Our objective was to determine why medical students frequently report a lack of confidence in performing the neurological examination. Our hypothesis was that it may be because they have difficulty deciding which of the many different elements of the neurological examination are important to test for a given patient. This indecision would then lead to a lack of confidence.
To test our hypothesis, we compared the self-reported practice of graduating medical students to that of practicing neurologists (“the experts”) for one specific clinical scenario. We agree with Dr. Meador that the actual elements identified as being “essential” by either group would vary depending on the clinical scenario. However, the goal of our study was not to define the one, essential neurological examination that applies in all situations but to see if the two groups responded differently to the specific scenario we presented to them.
We did not find major differences between students and neurologists, and concluded that the source of students’ anxiety with the neurological examination must lie elsewhere. As Dr. Meador points out, among the potential factors may be the ability of students to anticipate which components of the examination to apply based on a given history, or whether they can perceive the patterns of abnormalities in the exam for common neurological disorders. These and other responsible factors are worthy of future investigation.
Finally, Dr. Meador also expresses concern about the absence of a formal mental status examination from the elements ranked most highly by our participants. We did include several elements of a mental status exam among the 46 elements from which students and neurologists could choose including: the Folstein mini-mental status exam, tests of language, tests of praxis, drawing, and executive function. Neither students nor neurologists ranked these elements highly in our clinical scenario. However, this should not be interpreted as a general statement about the value of the mental status exam.
The objective of our study was to try to determine what students and neurologists actually do when faced by our study’s scenario. We agree with Dr. Meador that, in many other clinical situations, the mental status exam may be extremely important.
Disclosure: Dr. Moore has received clinic support from EMD Serono; participated in MS clinical trials sponsored by EMD Serono, Bayer, and Teva; received funding to attend meetings from EMD Serono, Biogen, and Teva; received consulting fees from EMD Serono, Teva and Bayer. Dr. Chalk serves as a member of the editorial board of the Canadian Journal of Neurological Sciences.