We have mapped the stars, descended into the ocean depths, yet the human brain remains one of the greatest mysteries humans have encountered.
While the first two inspire enthusiastic exploration amongst astrophysicists and marine scientists, the third can inspire apprehensive avoidance amongst various medical professionals. This hesitation contradicts clinical reality with 15 per cent of emergency department (ED) visits in some cases being related to neurology, and up to one-third of errors in the ED the result of missed neurological diagnoses.
If neurology is not a niche specialty but a cornerstone of acute and chronic care, what causes this discrepancy in interest?
The most exposure that medical students get to neurology often occurs prior to the start of clinical rotations. The curriculum often emphasizes learning intricate neuroanatomy and tract mapping, glossing over the degree of clinical applications the content might have. While this can play an important role in ensuring that students have a basic understanding of some neurological concepts, it can reduce the degree of clinical exposure and leads to neurology turning into a set of disjointed facts. It also misses just how much impact neurologists can have on a patient’s recovery from a neurological illness or in adapting to the symptoms of a chronic condition. Additionally, it creates a perception of the specialty being “too hard” and learners not feeling confident in their abilities to apply themselves or engage with it. This acts as the basis of a lifetime of fear from neurological presentations and further perpetuates the concept of “neurophobia,” a term coined by Ralph Jozefowicz in 1994 to describe a “fear of neural sciences and clinical neurology resulting from students’ inability to apply their knowledge of basic sciences to clinical scenarios.”
The reputation of neurology portrayed in pre-clerkship and clerkship as a bleak specialty in which patients receive devastating diagnoses and little in the way of treatment increasingly is becoming an outdated narrative. While this might have been the case decades ago, the advancements made in the field are often neglected. Thus, the onus is placed on interest groups and post-graduate neurology programs to actively promote the specialty to students in creative ways. Unlike core rotations such as internal medicine, surgery, pediatrics, psychiatry, and family medicine, dedicated neurology clinical experiences are not universally required across Canadian medical schools, with some programs instead incorporating neurology exposure through internal medicine, longitudinal integrated clerkship experiences, or selective experiences. This limits the opportunities for students to get into neurology and reduces the chances of students finding their calling in neurology.
A dedicated neurology rotation could serve an important role not only for students considering the specialty but also for all future physicians regardless of their career path. Neurological complaints are encountered across nearly every area of medicine, from EDs and internal medicine wards to family medicine clinics and surgical services. Exposure to neurology during core training would provide students with the opportunity to develop confidence in neurological history-taking, lesion localization and physical examination skills in a supervised clinical environment. Whether implemented as a standalone core rotation or as a selective component within internal medicine, such an experience would help bridge the gap between pre-clerkship neuroscience education and real-world patient care. More importantly, it would ensure that all graduating physicians possess a stronger foundation for recognizing and managing common neurological presentations.
A meta-analysis identified several educational factors that may contribute to neurophobia among medical students. Programs that rely heavily on theoretical teaching and pre-clinical instruction are more likely to be associated with fear and lack of confidence in neurology, while earlier clinical exposure, case-based learning and greater integration between neuroscience and patient care are associated with more positive perceptions of the specialty. These findings suggest that reducing neurophobia requires moving beyond memorization-based approaches toward clinically integrated neurological training.
Neurological complications and conditions are incredibly common, though it is easy to understand why there is such a strong hesitancy towards this field by non-neurology specialists. There is often a lack of emphasis on maintaining skills in neurology, whether it is lesion localization, adequate neurological physical exams or approaches to common disorders. This perpetuates the prevalent “neurophobia” within our medical system.
One of the important aspects of residency is to provide trainees with the opportunity to experience “off-service” rotations, rotations that take place in various other specialties. This provides residents with necessary education on topics they might not be exposed to in their specialties. An emergency medicine resident would benefit from being exposed to cardiology in the form of a rotation off-service to have the essential foundations that would facilitate treatment of a patient presenting with a possible myocardial infarction or congestive heart failure exacerbation. However, do emergency medicine residents gain a sufficient degree of exposure to neurology during their training?
A review of the 2025 Canadian Medical Protective Association’s (CMPA) database made clear some of the most commonly missed diagnoses in the emergency setting include strokes, traumatic intracranial injuries, central nervous system (CNS) infections and cauda equina syndrome.
Based on publicly available information on the time spent by residents on off-service rotations during their training, emergency medicine residents at McGill University spend a total of eight weeks on neurology consults and neurology ICU compared to 24 weeks on internal medicine. Toronto Metropolitan University emergency medicine residents spend even less time on neurology with a total of four weeks compared to 20 weeks on internal medicine.
As neurological disease continues to rise in prevalence across Canada, the persistence of neurophobia represents not only a barrier to recruitment into the specialty but also a systems-level issue that can affect diagnostic confidence, delays in care and patient outcomes. Patients may wait up to several hours to see a neurologist in the ED, though many could have been triaged to either out-patient referrals or managed by their family physician. This overreliance on neurology consultants can backlog a system already packed and deter attention from more acute presentations. Addressing this challenge requires more than encouraging students to “not be afraid” of neurology. It demands meaningful curricular reform, earlier and more clinically integrated exposure to neurological education and greater investment in accessible teaching tools that make the field approachable rather than intimidating.
If Canadian medical education hopes to prepare future physicians for the realities of modern health care, overcoming neurophobia can no longer remain an afterthought. It must become a priority.
Mohamed Elsayed Elghobashy
Kanish Baskaran is a medical student at the University of Toronto with interests in neurology, social medicine and medical education.
Edwin Wong (MD, M.Sc.) is a neurology resident physician at the University of Toronto with interests in obstetrics neurology and medical education.
