Undergraduate neurology teaching: comparison of an inpatient versus outpatient clinical setting.

Martins, Isabel Pavão; Fonseca, Ana Catarina; Pires, Luísa; Ferro, José M

BACKGROUND Neurology is often perceived as a difficult discipline by medical students, yet it is an essential part of medical training. While the most common disorders of the nervous system can be observed in the outpatient setting, positive neurological signs are more likely to be found in neurology wards. We aimed to compare the impact of a neurology outpatient versus inpatient rotation setting on the grades obtained by medical students as an a proxy measure of the learning outcomes. METHODS We compared the results obtained by 4th year medical students in a practical (OSCE) and a multiple choice question (MCQ) exams in Neurology, between students whose main (total of 24 hours contact) teaching allocation was either the outpatient or inpatient setting, controlling for students' gender, teacher, academic year and student' previous achievement (measured by their scores on practical evaluation). RESULTS A total of 1127 students were included, of whom 644 (57.14%) were allocated mainly to the neurology ward and 483 (42.86%) to the outpatient clinic. Students placed in the ward obtained significantly higher grades in the OSCE and MCQ exams than those placed in the outpatient clinic. Teaching setting was an independent predictor of both classifications after adjustment. CONCLUSIONS The teaching setting had a significant impact on the learning outcomes. This may be due to a higher likelihood of observing abnormal neurological signs or to a more student-centered teaching in the ward. These results highlight the importance of a balanced distribution of students by different clinical settings.