Education in neurology contains important aspects of quality assurance and continuing improvement in the delivery of the best care to people with neurological disorders. Training in neurology does not refer only to postgraduate specialization but also the component of training offered to undergraduates, general physicians and primary health-care workers. To reduce the global burden of neurological disorders, an adequate focus is needed on training, especially of primary health workers in countries where neurologists are few or nonexistent.
As front line caregivers in many resource-poor countries, primary care providers need to receive basic training and regular continuing education in basic diagnostic skills and in treatment and rehabilitation protocols. Such training should cover general skills (such as interviewing the patient and recording the information), diagnosis and management of specific disorders (including the use of medications and monitoring of side-effects) and referral guidelines. Training manuals tailored to the needs of specific countries or regions must be developed. Primary care providers need to be trained to recognize the need for referral to more specialized treatment rather than trying to make a diagnosis.
Training of nurses is particularly important globally. In low income countries, where few physicians exist, nurses may be involved in making diagnostic and treatment decisions. They are also an important source of advice on promoting health and preventing disease, such as providing information on diet and immunization.
Training of physicians
The points to be taken into consideration in relation to education in neurology for physicians include:
■ core curricula (undergraduate, postgraduate and others);
■ continuous medical education;
■ accreditation of training courses;
■ open facilities and international exchange programmes;
■ use of innovative teaching methods;
■ training in the public health aspects of neurology.
Teaching of neurology at undergraduate level is important because 20-30% of the population are susceptible to neurological disorders (25). The postgraduate period of training is the most active and important for the development of a fully accredited neurologist. The following issues need consideration: mode of entry, core training programmes, evaluation of the training institutions, access to current literature, rotation of trainees between departments, and evaluation of the trainees during training and by a final examination. The central idea is to build both the curriculum and an examination system that ensure the achievement of professional competence and social values and not merely the retention and recall of information.
Neurological curricula vary considerably across countries. This is not necessarily undesirable because the curriculum must take into account local differences in the prevalence of neurological disorders. Some standardization in the core neurological teaching and training curricula and methods of demonstrating competency is desirable, however. The core curriculum should be designed to cover the practical aspects of neurological disorders and the range of educational settings should include all health resources in the community. The core curriculum also needs to reflect national health priorities and the availability of affordable resources.
Continuous medical education is an important way of updating the knowledge of specialists on an ongoing basis and providing specialist courses to primary care physicians. Specialist neurolo gists could be involved in training of primary care doctors, especially in those countries where few specialists in neurology exist. Regional and international neurological societies and organizations have an important role to play in providing training programmes: the emphasis should be on active problem-based learning. Guidelines for continuous medical education need to be set up to ensure that educational events and materials meet a high educational standard, remain free of the influence of the pharmaceutical industry and go through a peer review system. Linkage of continuous medical education programmes to promotion or other incentives could be a strategy for increasing the number of people attending such courses.
Neurologists play an increasingly important part in providing advice to government and advocating better resources for people with neurological disorders. Therefore training in public health, service delivery and economic aspects of neurological care need to be stressed in their curricula.
Most postgraduate neurology training programmes, especially those in developed countries, are resource intensive and lengthy — usually taking about six years to complete. Whether adequate specialist training in neurology might be undergone in less time in certain countries or regions would be a useful subject for study. The use of modern technology facilities and strategies such as distance-learning courses and telemedicine could be one way of decreasing the cost of training.
An important issue, as for other human health-care resources, is the "brain drain", where graduates sent abroad for training do not return to practise in their countries of origin. This public health challenge still needs to be faced with innovative means.
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