[Current status and needs of the department of neurology as a specialized department of a general hospital]

K Yamane
Rinshō Shinkeigaku, Clinical Neurology 2000, 40 (12): 1301-4
In this report, I have summarized the current situation surrounding diagnosis, treatment and related needs in the department of neurology in relation to postgraduate neurology training considered from the standpoint of a specialized department within a general hospital. This summary is based on the responses to a questionnaire that was sent to the persons in charge of education and training at 180 institutions affiliated with the Japanese Society of Neurology and 478 education and training institutions among Japanese city hospitals, excluding university hospitals and special research institutions. Replies were received from 305 hospitals, amounting to a response rate of 63.8%. The number of doctors working in the department of neurology was found to be low at 2 in 84 hospitals and 3 in 65 hospitals. The majority of neurologists at general hospitals are fully engaged in examining outpatients as well as inpatients, and they do not have adequate time for research, education and training and participation in the activities of academic associations. Of the 10 items cited in the questionnaire relating to the types of postgraduate neurology training desired by neurologists employed in general hospitals, the most common selections in order of decreasing frequency were improvement in the capacity to manage common disorders (such as headache, dizziness, numbness, etc.) diagnosed in the outpatient clinic, improvement in the capacity to diagnose the acute phase of cerebral apoplexy, further education about EEG (electroencephalogram) and EMG (electromyogram), and medical ethical issues such as informed consent. The views about postgraduate neurological education and training described in detail in writing by the respondents were as follows. 1) Neurologists required by a city general hospital Numerous respondents commented that the capacity to diagnose medical neurological diseases associated with internal (systemic) medical disorders is needed since there are remarkably few doctors in general hospitals whose interest is confined only to neurological diseases ranging from rare to common complaints. In contrast, neurologists whose knowledge and training derives from a wide clinical base of internal medicine are in great demand. 2) Points of disparity between postgraduate neurology training in a university hospital and neurologists required by a city general hospital In addition, many respondents expressed the view that under the medical school system, neuroscience and research are given a higher priority than the cultivation of clinical medical skills and although there may be keen academic interest in the clinical diagnosis and treatment of rare diseases, there is not necessarily the same level of keen interest in common diseases, hence the universities may be educating researchers effectively, but are not necessarily producing capable clinicians. 3) Measures that should be taken to address this difference in postgraduate neurology training between university and city general hospitals The university hospital is separated into research and clinical groups and the time has now come for a system of management under which a professor leads the research group and another professor leads the clinical group. There should be a clear-cut clarification of the responsible roles of university and city general hospitals in the postgraduate education and training of neurologists. Furthermore, the professional staff and facilities of general hospitals that are affiliated with universities should be upgraded and expanded to enable them to serve more effectively as sites of clinical education and training. The position and status of neurologists at city general hospitals should be raised to the same level as that of university professors and institutions affiliated with the Japanese Society of Neurology.

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