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August 16, 2021

Expanding Global Access to Neurology Education

Author Affiliations
  • 1Universidad Francisco Marroquin School of Medicine, Ciudad de Guatemala, Guatemala
  • 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
JAMA Neurol. 2021;78(10):1173-1174. doi:10.1001/jamaneurol.2021.2685

Neurological disorders are among the leading causes of death and disability worldwide.1 The burden of neurologic disease is expected to grow in the coming years as the population ages, leading to a worsening shortage of neurologists.1,2 Although there are nearly 5 neurologists per 100 000 population in high-income countries, there are just 3 per 10 million in low-income countries.2 This dearth of neurologists limits patient access to specialist care, overburdens neurologists, and relies on general practitioners to evaluate and treat patients with neurological conditions, despite limited neurology training.3 Improving access to neurologic care requires urgent pedagogical solutions to inspire and diversify the pipeline of future neurologists and to augment the neurology knowledge base of frontline nonneurologist clinicians globally. The emergence of freely available online educational initiatives holds promise for improving global access to engaging, clinically oriented neurology resources.

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    1 Comment for this article
    Expanding global access to neurology education with an online community
    Tim Young, BSc MBBS PhD FRCP | Queen Square Institute of Neurology, University College London (UCL), London, UK
    Dear Editors,

    We read with interest Alemán and colleagues’ article on expanding global access to neurology education [1]. We agree strongly with the authors’ eloquent case to improve both the reach and accessibility of neurology education with case-based discussions. However, we have two important practical points to add, based both on educational literature and on our experience of running global online neurology case discussions with participants from up to six different continents contributing simultaneously.

    Alemán and colleagues call for “urgent pedagogical solutions to inspire and diversify the pipeline of future neurologists” but could have elaborated further on the
    pedagogical evidence they base their case discussions on [1]. Their Virtual Morning Report (VMR) involves a case presented live to a broad audience of healthcare professionals, with a volunteer from the audience picked to talk through the case. Whilst this may seem very interactive, there is a danger that most attendees may passively watch from the sides-even allowing for occasional chat comments.

    Our distance learning neurology course at Queen Square Institute of Neurology has been running for nearly a decade with our students all being doctors, based globally. Even amongst doctors there will be significant difference on experience and confidence. This gap may be even greater when including non-medics such as with the VMRs, with less experienced members potentially feeling intimidated. We circumvented this danger in two main ways on our online neurology course case discussions-both based on pedagogy. The first of these is to add a preparatory phase utilising ‘pre-reading’ as a preview of the case prior to the actual case discussion [2]. This can then empower even relative novices to participate-and indeed, contribute to-the group discussion, resulting in Team Based Learning rather than traditional Problem Based Learning [2].

    Secondly, we encouraged all participants to contribute to our case discussions, ensuring first that the students felt safe to comment in line with Maslow’s hierarchy of needs [3]. We utilised the well-established pedagogical model of Lave and Wenger’s legitimate peripheral participation to encourage experienced members of the case discussions (‘old-timers’) to help the newer members (‘newcomers’) to feel safe and able to participate themselves [4]. The overwhelming majority of our student responders have affirmed that our resulting online case discussions represented a true ‘community’ online.

    Looking ahead to a post-Covid landscape it may be easy to view online neurology education as a second-best necessity in response to the pandemic. We do share the hope of Alemán and colleagues that online case-based discussions can be expanded, specifically we suggest with the building of online communities, as an exciting opportunity to further extend the reach and diversity of neurology education.

    Authors: Dr Tim Michael Young and Dr Salman Syed Haider
    Affiliations: Education Team, Queen Square Institute of Neurology, UCL, London, UK


    1) Alemán MJ, Nematollahi S, Berkowitz AL. Expanding Global Access to Neurology Education. JAMA Neurol. Published online August 16, 2021. doi:10.1001/jamaneurol.2021.2685
    2) Burgess, A. et al., 2020. Team-based learning replaces problem-based learning at a large medical school. BMC medical education, 20(1), p.492.
    3) Maslow, A. H. (1987). Motivation and personality (3rd ed.). Delhi, India: Pearson Education
    4) Lave J, Wenger E. 1978. Situated learning: Legitimate peripheral participation Cambridge
    CONFLICT OF INTEREST: I am a co-director, and both Dr Haider and I are course tutors, on an online Masters/Diploma/PG Certificate course at UCL, although this association with the course is stated in the Comment and indeed gives me the background relevant to make my comments. I do not think this is a true conflict of interest as we are actually explaining what goes well on our course so others could employ it if they wished. I am adding it here in line with the advice to err on the side of full disclosure.