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Is neurological differential diagnosis training included in predominantly theoretical teaching?
¿Está el adiestramiento en el diagnóstico diferencial neurológico incluido en una enseñanza eminentemente teórica?
Virgilio Hernando-Requejoa,b,
Corresponding author
vhernando@hmhospitales.com

Corresponding author.
, Marta Ochoa Mulasa,b
a Faculty of Medicine, San Pablo CEU University, Madrid, Spain
b Grupo Hospitales Madrid, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Neurological differential diagnosis requires both medical knowledge and logic application&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> It&#39;s a learning process emphasized during neurology residency but not always in undergraduate education&#44; which could enhance general doctors&#39; diagnostic skills and reduce neurophobia&#46;<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> Our objective is to analyze if our predominantly theoretical teaching with lectures improves students&#39; ability to perform neurological differential diagnoses&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Materials and methods</span><p id="p0010" class="elsevierStylePara elsevierViewall">In the 2022&#8211;2023 academic year&#44; 165 students enrolled in the Faculty of Medicine at Universidad San Pablo CEU &#40;Madrid&#44; Spain&#41;&#46; Theoretical classes were given&#44; along with hospital practices&#59; those who chose could also do online continuous evaluation &#40;review topics&#44; exploration videos&#44; etc&#46;&#41;&#46; 83 students signed up for continuous evaluation&#46; For them&#44; the last exercise is explained later&#59; they did it after the final theory exam&#46; Of those who passed this exam&#44; a total of 63 did the exercise&#59; however&#44; only 61 answers were valid for analysis&#46; The exercise required developing a differential diagnosis for a patient presenting &#34;dysphagia<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>dysarthria<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>diplopia&#34;&#46; They had to provide &#34;possible diagnoses suitable for a discharge report&#34;&#46; They had 10 min to complete it&#46; To establish a &#34;gold-standard&#34;&#44; we performed the same test on 5 active and clinically experienced neurologists&#46; Based on these neurologists&#39; responses&#44; student answers were graded &#40;higher score for more diagnostic matches&#41;&#46; Then&#44; these results were compared with those obtained in the final theory exam &#40;maximum score of 10&#41;&#46; We used Pearson correlation test and SPSS version 27&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Results</span><p id="p0015" class="elsevierStylePara elsevierViewall">Average differential diagnosis score was 3&#46;6 &#40;1&#8211;8&#41;&#59; average theory exam score was 7&#46;6 &#40;5&#46;2&#8211;9&#46;2&#41;&#46; We do not find a correlation between the 2 scores&#46; Pearson correlation coefficient&#58; 0&#46;052 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;690&#41;&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Discussion</span><p id="p0020" class="elsevierStylePara elsevierViewall">Neurophobia is combated with knowledge&#44;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> but this will inevitably be limited in undergraduate education&#46; A uniform teaching&#44; where students are not given contradictory information from different teachers or different subjects&#44; and where the principles of anamnesis&#44; exploration&#44; localization&#44; and differential diagnosis &#40;in that order&#41; are followed&#44; will better equip them to make correct diagnoses&#46;<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Focusing on differential diagnosis&#44; it is also crucial to &#34;build bridges&#34; between the different topics of the subject so that they can interrelate when proposing a differential diagnosis&#46; We need general practitioners with a strong foundation in neurological differential diagnosis&#44; because given the existing gap between the number of patients with neurological pathology and the percentage of physicians who will specialize in neurology&#44; it is necessary to select which patients will go to specialized consultations&#44; and many will need to be diagnosed and treated in general practice settings&#46; Our data suggest that better theoretical grades were not associated with better neurological differential diagnosis skills&#46; Despite important limitations&#44; such as online format bias and selecting only students who chose continuous evaluation&#44; methodology used herein provides reasonable evidence that warrants concern&#59; mere theoretical classes are insufficient&#59; pre-graduate students should be specifically trained in neurological diagnostic differentiation processes from early stages of their education&#46;</p></span></span>"
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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Introduction</span><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">We evaluated whether an eminently theoretical undergraduate teaching of neurology includes adequate training to perform neurological differential diagnoses&#46;</p></span> <span id="as0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Methods</span><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">In 2023&#44; 165 students received theoretical and practical hospital classes&#46; They had the option of continuous evaluation&#44; and as part of it&#44; the final exercise&#44; conducted after the theoretical exam&#44; involved creating a list of differential diagnoses for a patient presenting with dysphagia<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>dysarthria<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>diplopia&#46; The responses were evaluated by comparing them with a &#34;gold-standard&#8221; &#40;the result of the same exercise performed by 5 experienced neurologists&#41;&#44; and these results were compared with the theoretical grade&#46;</p></span> <span id="as0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Results</span><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">61 students participated&#46; To analyze the relationship between the exercise grade and the theoretical exam&#44; we used the Pearson correlation coefficient&#44; which yielded a result of 0&#46;052 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;690&#41;&#46;</p></span> <span id="as0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Conclusion</span><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Our data suggest that an eminently theoretical undergraduate education may not be adequate for acquiring skills in neurological differential diagnosis&#46;</p></span>"
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Article information
ISSN: 15751813
Original language: English
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