Ethical Values and Principals in Neurology Departments, Medical School

WATCH TIME: 6 minutes

The Association of University Professors of Neurology (AUPN) began back in 1968 as an organization of neurology department chairs to inform and curate neurological education, clinical practice and research, and to be a combined voice for neurology leaders to influence policy. That year, the organization had its first formal meeting, where Maynard Cohen was selected as president. Since its formalization, the AUPN has supported department chairs through its educational offerings that are geared toward the leaders in neurology departments including program directors and clerkship directors.

Over time, there have been dramatic changes in all aspects of neurologic care, and along with this, neurology education has transformed. These changes have affected all aspects of education across the educational continuum, including learners, teachers, educators, content, delivery methods, assessments, and outcomes. Several in the field believe that unification of educations across professions and specialties will allow for increased leverage of resources, meta-data, skillsets, and perspectives to develop a core foundation for all health professions so that students in different professions learn with and from each other.

To gain a greater understanding about the changes in neurology, how its taught, and the impact the AUPN has had in neurology departments, NeurologyLive^® hosted a Roundtable Discussion featuring former AUPN presidents Robert Griggs, MD; Clifton Gooch, MD; and Henry Kaminski, MD. In this episode, the panel provided thoughts on some of the main values that should be taught in neurology going forward, while offering perspective on which traditional teaching methods may be here to stay. In addition, they stressed the patient-clinician relationship and the need to treat individuals with a holistic approach, trying to identify ways of improving quality of life.

Marco Meglio: Thank you all for taking the time to join this conversation. It's been truly enlightening to hear your diverse perspectives. I'd like to move towards a forward-thinking question now, focusing on what neurology department leaders should emphasize in teaching their students. We've touched on this a bit earlier, but let's delve deeper. What key values should neurology department leaders prioritize when educating their students? Additionally, looking ahead five to ten years, what should they continue to emphasize?

Robert Griggs, MD: I'll start by addressing this. One crucial aspect is the effective management of electronic health records. Currently, the United States is burdened with excessive and often irrelevant data in these records, far more so than other countries. This has had a detrimental impact, particularly on specialists. We've witnessed a decline in our ability to concisely communicate a patient's issue and the required course of action in the medical record, whether it's for the benefit of other physicians or primary care providers. The interference caused by the electronic health record has been significant. Recently, a notable clinic note by Lou Kaplan highlighted this problem, underlining our struggle to express the patient's problem and the necessary steps due to the influence of the electronic record. Addressing this challenge is imperative. A New England Journal paper also highlighted the importance of digital minimalism, suggesting that the U.S. is hasty in adopting new technologies without fully understanding their implications. We should resist this urge and work on eliminating digital elements that waste our time. Artificial Intelligence might offer solutions, potentially streamlining note-taking and reducing the excess that has turned medical records from a useful tool into a hindrance. This issue significantly contributes to burnout and even the decision to cease patient care. Personally, I stopped seeing patients because dealing with the electronic records became increasingly taxing than enjoyable. This stands as a major challenge—ensuring that we reclaim control from those dictating inefficient practices that impede our patient interactions.

Henry Kaminski, MD: I agree completely. Reflecting on the question of what we teach our students, I believe our approach is quite aligned. We all prioritize teaching students to focus on the patient's chief complaint, placing it in the context of their understanding of the nervous system. This is followed by layering the physical examination and determining the most suitable tests. The aim is to prevent ordering unnecessary tests, such as an MRI when a simple blood test for myasthenia gravis would suffice. When working with students, our emphasis remains on teaching about the brain and the nervous system. Now, speaking to the question's broader context and considering the next decades, I don't foresee this approach changing. Personal interactions with both students and patients remain the core. There's room for improvement, and technology will play a role, but the essential human aspect will persist.

Clifton Gooch, MD: I concur with my colleagues' points. I believe the most critical aspect to convey to our students is that everything we do revolves around helping the patients. This is the core reason we become physicians—to serve and improve the lives of our patients. Amidst the barrage of messages they receive, it's easy for students to lose sight of this. They encounter mixed messages, ranging from learning to navigate electronic records to managing resources. Amidst this, we must recenter their focus on the patient and their well-being. Furthermore, we must act as advocates for our patients, especially in a landscape where business interests often overshadow patient welfare. In some cases, we must be the voice that speaks out against decisions that might negatively impact our patients. It's a responsibility that stems from the heart of medicine—the commitment to patients' welfare. This commitment is sometimes lost amid administrative or business priorities. To our students, the message is clear: Be the champion for the patient within the system that may not always prioritize them. This notion has been an intrinsic part of medical practice, but it's been overshadowed in recent years by various pressures. Our task is to keep this core message at the forefront amidst all the challenges and noise.

Robert Griggs, MD: Exactly, Cliff has captured the essence perfectly. I'd also like to add the perspective of Bob Joint, a mentor of mine and the former chair of my training department. He advocated spending an hour with a patient, dedicating 40 minutes to listening, 20 minutes to the physical examination, and the remainder on appropriate laboratory studies. This philosophy underscores the importance of attentive patient care, which should continue to be a cornerstone of our teachings.