{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:50:33Z","timestamp":1792788633264,"version":"4.5.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Medicine\u2019s Medical Education Scholarly Fund at the University of Alberta","id":[{"id":"https:\/\/ror.org\/0160cpw27","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Neurophobia is the fear of clinical neurology. Little research has explored how the neurological exam contributes to this fear. We wanted to better understand the confidence that medical residents have with the neurological exam and determine how confidence affects their examination of neurological patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a single-centre study in which Internal Medicine and Family Medicine residents rated their confidence in conducting different aspects of a neurological evaluation through a self-administered survey. Low confidence was defined as a score of \u22643 on a 5-point Likert scale. Participants also rated the likelihood of their peers skipping a relevant exam for patients presenting with neurological, cardiac, respiratory, gastrointestinal, or musculoskeletal complaints. Free form responses were sought to understand reasons for skipping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 97 respondents (35 IM; 61 FM), out of a total of 350 eligible participants. 36 were first year, 45 were second year, and 14 were third year residents. Participants were least confident in localizing (Median\u2009=\u20093; IQR 2\u20134) and forming a differential (Median 4; IQR 3\u20134). Confidence did not improve with additional years of training and respondents felt increased exposure to neurology and more teaching would improve their confidence. Participants felt their peers were most likely to skip a neurological (Median\u2009=\u20093; IQR 2\u20133) or musculoskeletal exam (Median 3; IQR 2\u20134). Likelihood of skipping part of a neurological exam increased from post-graduate year one to two. Low confidence and lack of time were cited as major contributors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Residents appear to be less confident in conducting the non-physical aspects of the neurological exam, including localizing and forming a differential. Low confidence was a major contributor to residents forgoing a neurological exam. More teaching and exposure to neurology were the most common self-reported factors that would improve resident confidence in the physical exam.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360249","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:51:26Z","timestamp":1791481886000},"page":"e0360249","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Confidence in the neurological examination and exam avoidance among medical residents"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8355-096X","authenticated-orcid":true,"given":"Alexa B.","family":"Keeling","sequence":"first","affiliation":[{"name":"University of Alberta","place":["Edmonton, Alberta, Canada"],"department":["Division of Neurology, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6350-3129","authenticated-orcid":true,"given":"Vijay J.","family":"Daniels","sequence":"additional","affiliation":[{"name":"University of Alberta","place":["Edmonton, Alberta, Canada"],"department":["Division of General Internal Medicine, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"issue":"4","key":"pone.0360249.ref001","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1001\/archneur.1994.00540160018003","article-title":"Neurophobia: the fear of neurology among medical students","volume":"51","author":"RF Jozefowicz","year":"1994","journal-title":"Arch Neurol"},{"issue":"5","key":"pone.0360249.ref002","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/jnnp.72.5.557","article-title":"Is clinical neurology really so difficult?","volume":"72","author":"F Schon","year":"2002","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"12","key":"pone.0360249.ref003","first-page":"285","article-title":"Neurophobia among resident physicians in the emergency service","volume":"77","author":"I Salda\u00f1a-Inda","year":"2023","journal-title":"Rev Neurol"},{"key":"pone.0360249.ref004","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.clineuro.2014.03.021","article-title":"Neurophobia among general practice trainees: the evidence, perceived causes and solutions","volume":"122","author":"MO McCarron","year":"2014","journal-title":"Clin Neurol Neurosurg"},{"issue":"10","key":"pone.0360249.ref005","first-page":"4610","article-title":"Neurophobia: a myth or an unpleasant fact for primary care physicians","volume":"28","author":"O Midik","year":"2017","journal-title":"Biomed Res"},{"issue":"1","key":"pone.0360249.ref006","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1186\/s12887-022-03616-4","article-title":"Attitudes towards the neurological examination in an unwell neonate: a mixed methods approach","volume":"22","author":"A Fadilah","year":"2022","journal-title":"BMC Pediatr"},{"issue":"11","key":"pone.0360249.ref007","doi-asserted-by":"crossref","first-page":"351","DOI":"10.33588\/rn.7611.2023102","article-title":"Neurofobia entre los estudiantes de medicina de una universidad espa\u00f1ola: experiencias m\u00e1s all\u00e1 de la anglosfera","volume":"67","author":"\u00c1 Lambea-Gil","year":"2023","journal-title":"Rev Neurol"},{"key":"pone.0360249.ref008","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/1472-6920-13-164","article-title":"Neurophobia among medical students and non-specialist doctors in Sri Lanka","volume":"13","author":"AT Matthias","year":"2013","journal-title":"BMC Med Educ"},{"issue":"3","key":"pone.0360249.ref009","doi-asserted-by":"crossref","DOI":"10.1212\/NE9.0000000000200076","article-title":"Education Research: Monitoring and Tracking Neurophobia","volume":"2","author":"AN Rodrigues","year":"2023","journal-title":"Neurol Educ"},{"issue":"23","key":"pone.0360249.ref010","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1212\/WNL.0b013e3181a92be6","article-title":"The essential neurologic examination: what should medical students be taught?","volume":"72","author":"FGA Moore","year":"2009","journal-title":"Neurology"},{"key":"pone.0360249.ref011","article-title":"Measuring internal medicine resident\u2019s confidence and knowledge in neurologic diagnosis, testing, and management","author":"S Conway","year":"2022","journal-title":"Neurol J"},{"key":"pone.0360249.ref012","first-page":"1","article-title":"Chapter 1: Diagnosis of neurological disease","volume-title":"Neurology in clinical practice","author":"J Jankovic","year":"2022","edition":"8"},{"key":"pone.0360249.ref013","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/1472-6920-10-49","article-title":"Attitudes of US medical trainees towards neurology education: \u201cNeurophobia\u201d - 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