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Original Article
Exploring perceptions of neuroscience learning among medical students
of Universidad Nacional Autónoma de Honduras
Explorando la percepción sobre el aprendizaje de neurociencias entre los estudiantes de medicina de la
Universidad Nacional Autónoma de Honduras
Fernando Cáceres
, Melba Zúniga Gutiérrez
, Alejandro David Barrientos Melara
, Jhiamluka Solano
Iniciativa Multidisciplinaria de Investigación y Servicio, Facultad de Ciencias Médicas, Universidad Nacional Autónoma
de Honduras, Tegucigalpa, Honduras
Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
Asociación de Educación Médica Hondureña, AEMH, Tegucigalpa, Honduras
Departamento de Medicina Interna, Oldham Royal Hospital, Manchester, Reino Unido
Article history:
Received: 29 July 2022
Revised: 2 August 2022
Accepted: 11 August 2022
Published: 31 August 2022
Medical education
Palabras clave
Educación médica
ABSTRACT. Introduction. There is an increase in the prevalence of neurological disorders. An adequate training of
medical neurology personnel is an imperative task. The phenomenon of neurophobia can affect proper learning and
even aspirations to be a neurology specialist. Methods. A cross-sectional study was carried out through a questionnaire
to evaluate the perception of students about medical specialties and factors that contribute to the difficulty of neurology.
The questionnaire was distributed through social media groups of medical students. Excel was used for the management
and tabulation of the answers obtained and SPSS for data analysis. Results. In relation to an interest in specialties (high
interest), the most frequent specialties were cardiology 37.3% (22) and neurology 20.3% (15). The complexity of
neuroanatomy 42.4% (25) and little contact with neurological patients 40.7% (24) were the factors that contributed to
the difficulty of neurology. Conclusion. The traditional teacher-centered teaching model is prone to neglect essential
tools such as neurology laboratories, standardized patient simulation, and essential contact with neurological patients.
There is an important need to implement new teaching methodologies in neurology and greater contact with
neurological patients.
RESUMEN. Introducción. Existe un aumento en la prevalencia de los trastornos neurológicos. La formación
adecuada del personal médico de neurología es una tarea imperativa. El fenómeno de la neurofobia puede afectar el
aprendizaje adecuado e inclusive las aspiraciones a ser un especialista en neurología. todos. Se llevó a cabo un
estudio transversal a través de un cuestionario para evaluar la percepción de estudiantes sobre especialidades médicas
y factores que contribuyen a la dificultad de la neurología. El cuestionario fue distribuido a través de grupos en redes
sociales de estudiantes de medicina. Se utilizó Excel para el manejo y tabulación de las respuestas obtenidas y SPSS
para el análisis de datos. Resultados. Con relación al interés en las especialidades (mucho interés), las especialidades
con más frecuencia fueron cardiología 37.3% (22) y neurología 20.3% (15). La complejidad de la neuroanatomía 42.4%
(25) y el poco contacto con pacientes neurológicos 40.7% (24) fueron los factores que contribuyeron a la dificultad de
la neurología. Conclusión. El modelo de enseñanza tradicional centrado en el docente es propenso a dejar de lado
herramientas esenciales como laboratorios de neurología, simulación de pacientes estandarizados y el contacto esencial
con pacientes neurológicos. Existe una necesidad importante para implementar nuevas metodologías de enseñanza en
neurología y mayor contacto con pacientes neurológicos.
1. Introduction
The formation of medical staff in neurosciences and
neurology areas is an imperative task due to the increased
prevalence of neurological disorders in the population. A
neurologist from Rochester University, New York
(Jozefowicz, 1994) defined for the first time the term
neurophobia. Jozefowicz described the term as: “Fear
towards neural sciences and clinical neurology due to
inability of students to apply their knowledge of basic
sciences in clinical situations” (Jozefowicz, 1994, p. 328).
Since this term was first defined, until now, a significant
number of studies have been done to evaluate neurophobia
F. Cáceres, et al.
INNOVARE Revista de Ciencia y Tecnología Vol. 11, No. 2, 2022
in faculties of medicine worldwide. Moreover,
neuroscience and neurology teaching in medicine faculty
curriculums has been broadly studied (Kam et al., 2013;
Matthias et al., 2013; Abulaban et al., 2015; Shiels et al.,
2017; McGovern et al., 2021). The main contributing
factors mentioned in literature usually are the lack of
integration between basic sciences and clinical rotations,
besides the complexity of neuroanatomy perceived by
students. Likewise, it is important to recognize that
modifiable and non-modifiable risk factors can contribute
to the development of neurophobia.
Non-modifiable risk factors are previous clinical
exposure to neurology, personal aspects, and education
degree. Multiple modifiable risk factors have been
identified, including teaching quality, use of complex
terminology, lack of standardized patient simulators and
separation of clinical and basic sciences. These factors
must be approached appropriately to enrich teaching-
learning processes (Abushouk & Duc, 2016).
Identifying the presence of neurophobia in students
that will soon face a clinical setting with a continuous
increase of patients with neurological disorders should be
a stimulating factor to boost even more teaching reforms
in this area in universities (Jozefowicz, 1994). The aim of
this study was to know the perception among medical
students from Universidad Nacional Autónoma de
Honduras (UNAH) regarding neuroscience learning. The
study findings can contribute to developing strategies that
help overcome modifiable risk factors and provide
decision makers with elements needed to create new
neuroscience curricula.
2. Methods
A cross-sectional study was carried out using a
questionnaire in medical students from UNAH, one of the
three universities that offer medicine in Honduras. Non-
probabilistic convenience sampling was used. At the time
of data gathering, the medical students included in this
study were receiving classes online. Therefore, data
collection was conducted virtually.
The questionnaire was distributed through social
networks, including the communication channels
established for each academic year. Students who
answered the questionnaire online (Google Forms) were
included, obtaining 59 responses.
2.1. Interviewed population
Medical students of the Faculty of Medical Sciences of
UNAH, Ciudad Universitaria campus, who were enrolled
in the second year (morphological sciences) and fourth
year, both considered pre-clinical years, and seventh year
(internship) considered clinical year, during the second
academic period of 2021.
2.2. Questionnaire
The questionnaire was designed and adapted from two
questionnaires described by other authors; the first is the
most widely used in published studies on the subject and
has been adapted to multiple contexts and languages. The
questionnaire is structured in two sections. The first
assesses students' perception of seven medical specialties
(cardiology, endocrinology, gastroenterology, geriatrics,
neurology, respiratory medicine, and rheumatology), and
the second section analyses the potential factors
contributing to the difficulty of neurosciences (Schon,
The second questionnaire used was modified from the
one proposed by Schon (2002), adding questions on
learning methods (Zinchuk et al., 2010). Before
distributing the questionnaire, a test was conducted with
10 students, not included in the study to ensure
understanding and clarity of the questions. The responses
to the first questionnaire were based on a Likert scale from
1 (Very limited) to 5 (Very good), regarding the variables
on interest, knowledge, difficulty, and ability of the seven
medical specialties. The responses of the second
questionnaire about student perception on neurology and
neurosciences were based on a scale from 1 to 4, being 1
= unimportant and 4 = very important.
2.3. Data analysis
Excel 2019 was used for the management and
tabulation of the responses obtained, and the statistical
program for social sciences SPSS was used for data
2.4. Ethical aspects
Prior to completing the online survey, students were
notified that their participation was voluntary and
anonymous and that completing and returning the survey
implied consent. The study protocol was evaluated by the
Biomedical Research Ethics Committee (CEIB) of the
Faculty of Medical Sciences, UNAH, with registration
number IRB 00003070.
3. Results
A total of 59 students filled out the online
questionnaire, 44.1% (26) corresponded to fourth-year
students, 30.5% (18) to seventh-year students (rotating
internship), and 25.4% (15) to second-year students
(morphological sciences). Of the students who
participated in the study, 100% (59) belonged to the
UNAH. Of the students, 52.5% (31) were female and
47.5% (28) were male. Of the seven specialties evaluated
(Figure 1) concerning current interest in the specialty, the
F. Cáceres, et al.
INNOVARE Revista de Ciencia y Tecnología Vol. 11, No. 2, 2022
Figure 1. Comparison of average score obtained, on a Likert-type scale from 1 to 5, in Interest, Knowledge, Difficulty and Skills, of the
seven medical specialties. Car, cardiology; End, endocrinology; Gas, gastroenterology; Res, respiratory medicine; Nef, nephrology; Neu,
neurology; Psi, psychiatry.
two with the highest frequency of "very interested" were
cardiology 37.3% (22) and neurology 25.4% (15). The
specialty with the lowest frequency of interest was
psychiatry 25.4% (15). Of the students in their fourth year,
46.2% (12) stated that they were quite or very interested
in neurology, while only 33.3% (6) of the students in their
seventh year stated the same.
When asked about their current level of knowledge in
neurology, 39% (23) considered they had some
knowledge, and 37.3% (22) had moderate knowledge.
When evaluating the difficulty perceived by the student,
the two specialties with the greatest perceived difficulty
were neurology 67.8% (40) and cardiology 47.5% (28).
Concerning the confidence students had when evaluating
patients with neurological pathologies, 39% (23) of them
stated feeling anxious or uneasy, and 37.3% (22) felt
competent when evaluating them.
According to the students, the aspects that most
contributed to the difficulty of neurology were the
complexity of neuroanatomy 42.4% (25) and little contact
with neurological patients 40.7% (24). The learning
methods most highly rated by students were evaluation of
real patients 88.1% (52), classroom/lectures 67.8% (40)
and textbooks 61.0% (36). Students were asked about
other methods they considered useful for learning such as
"simulator techniques and clinical case approach in class,"
"interaction with patients and face-to-face classes," and
"workshops and simulations." The neuroscience teaching
methods that students considered most useful were more
patient bedside teaching 64.4% (38), more exposure to
patients (shifts, inpatient wards) 61% (36), and 54.2%
(32) felt that neuroanatomy teaching should be improved.
The majority of students 71.2% (42), considered
neurosciences to be important for the practice of general
medicine, and only 33.9% (20) of the students stated that
they were satisfied with the amount of education received
in neuroscience.
Forty-four responders (74.6%) reported that they did
not have sufficient knowledge of neurosciences, 42.4%
(25) stated that neurology is one of the most difficult
disciplines in medicine, and 67.8% (40) felt that they had
had limited exposure to neurological patients. When
evaluating these parameters in students in their seventh
year, 88.8% (52) agreed with the statement "I would like
to have more exposure to neurological patients", and only
33.3% (20) were satisfied with their training in neurology
(Table 1).
F. Cáceres, et al.
INNOVARE Revista de Ciencia y Tecnología Vol. 11, No. 2, 2022
Table 1
Perception of neurology and neurosciences by students.
Do not Know/Does
not apply
N (%)
Disagree a lot
N (%)
Disagree N
N (%)
Agree a lot
N (%)
I believe that neuroscience is important to
general medicine practice.
1 (1.7)
2 (3.4)
14 (23.7)
42 (71.2)
I am satisfied with the amount of
education I have received in
2 (3.4)
10 (16.9)
26 (44.1)
15 (25.4)
6 (10.2)
I am satisfied with my neurology
2 (3.4)
11 (18.6)
26 (44.1)
16 (27.1)
4 (6.8)
I feel comfortable with neuroscience
3 (5.1)
9 (15.3)
24 (40.7)
18 (30.5)
5 (8.5)
I have adequate knowledge of neurology.
5 (8.5)
7 (11.9)
30 (50.8)
14 (23.7)
3 (5.1)
I think neuroanatomy is difficult.
1 (1.7)
4 (6.8)
18 (30.5)
22 (37.3)
14 (23.7)
I think neurology is difficult.
2 (3.4)
3 (5.1)
11 (18.6)
25 (42.4)
18 (30.5)
I think neurology is one of the most
difficult disciplines in medicine.
2 (3.4)
12 (20.3)
20 (33.9)
25 (42.4)
I have had limited exposure to
neurological patients.
8 (13.6)
1 (1.7)
10 (16.9)
13 (22.0)
27 (45.8)
I would like to have more exposure to
neurological patients.
3 (5.1)
1 (1.7)
4 (6.8)
13 (22.0)
38 (64.4)
I'm afraid of neurology/neurosciences.
11 (18.6)
15 (25.4)
19 (32.2)
8 (13.6)
6 (10.2)
*Adapted from Schon (2002).
4. Discussion
Neurology is perceived by medical students and non-
specialist physicians as the most difficult specialty almost
globally. This endemic fear of neurological diseases
appears mainly due to the perception of not having the
necessary skills to identify and manage them adequately.
The consequences of this perception are more evident
when medical students and young physicians cannot apply
their basic neurological concepts when approaching a
neurological patient. Such a phenomenon is described by
the term neurophobia (Chhetri, 2017).
In Honduras, a traditional teacher-centered teaching
model predominates, which has as its main axis the
teacher, who develops a curriculum, leaving aside, in
some cases, essential tools such as neurology laboratories,
standardized patient simulation and essential contact with
neurological patients. In addition, there has been a slow
process of evaluation and curricular redesign of healthcare
careers. Together, these problems have represented a
challenge in implementing new educational methods
which could help solve phenomena such as neurophobia
(Thiebaud et al., 2021).
Among the population studied, neurology was found
to be the second most interesting discipline, second only
to cardiology. However, despite this, neurology is by far
perceived as the most difficult medical field by students
and the second area in which they perceive they have the
least skills. This goes hand in hand with findings reported
in other studies also considering neurology as the most
difficult specialty, and they also found it to be the area in
which they enjoy the least knowledge (Youssef, 2009;
Kam et al., 2013; Matthias et al., 2013; Abulaban et al.,
2015; Shiels et al., 2017; McGovern et al., 2021).
In assessing factors contributing to the perceived
difficulty in neuroanatomy, almost half of the students
stated that it was due to the complexity of neuroanatomy.
Other studies have already described the perceived
difficulty of students with neuroanatomy; a national
survey conducted in the United Kingdom found that 70%
of students considered the complexity of neuroanatomy a
significant factor for perceived difficulty in neuroscience
(Pakpoor et al., 2014).
To further understand the perception of
neuroanatomy, a study involving 383 Irish students
described they found learning neuroanatomy more
difficult than any other anatomy subject. For these
students, the factors most influencing difficulty were
those specific to neuroanatomy, such as visualization of
structures in dissections of the central nervous system and
appreciation of the three-dimensional relationship of
structures (Javaid et al., 2017).
Interestingly, the perception of difficulty did not vary
according to the teaching modality in which the students
were, either being taught by systems or by regions. The
F. Cáceres, et al.
INNOVARE Revista de Ciencia y Tecnología Vol. 11, No. 2, 2022
medical school included in this study uses a regional
approach to neuroanatomy, where the subject of
neuroanatomy is mostly taught using lectures. Another
frequent factor in the student population was the lack of
contact with neurological patients. This is consistent with
a study conducted on Mexican students, which found that
12.5% considered little contact with neurological patients
to influence the perceived difficulty of neurology
(Sánchez-Jordán et al., 2017).
The ideal learning methods for neuroscience have
been investigated in different contexts and realities. The
students included in this study considered real patient
assessment, face-to-face classes/lectures and textbooks to
be the best learning techniques. This is consistent with
other studies, such as the one conducted in Costa Rica that
evaluated collaborative learning for neuroanatomy
learning and found that more than 80% of students
considered that the use of clinical cases improved their
learning (Chang-Segura, 2019); the perception of United
States students regarding learning methods is also
consistent with what was found in this study (Zinchuk et
al., 2010).
Clinical simulation is one of the most useful methods
in medical education in undergraduate level learning,
especially in the field of neurosciences (Abushouk & Duc,
2016). In a study conducted by Universidad Autónoma de
Yucatán, Mexico, 34 students underwent a simulation
course to develop neurological clinical competencies with
an expert in neurology. A statistically significant
improvement was seen from 0% to 26.47% among
students in pretest and posttest, respectively. Likewise, an
improvement was seen in the doctor-patient relationship,
although it was not statistically significant (Álvarez-
Sánchez et al., 2021).
It is important to recognize that neurophobia not only
limits and affects the teaching-learning processes of
neurology at different levels of medical training, but also
influences the perspective that students have towards the
specialty as a career choice (Gupta et al., 2013), which
should motivate medical schools to implement new
methodologies to improve students' experience when
exposed to neurology.
On the other hand, there are limitations in resources
that are often considered a challenge and an important
cause that affects the process of implementing new
methodologies that can mitigate the effects of
neurophobia. However, some studies have been directed
to be able to overcome these limitations (Kumar, 2018).
Among these proposed approaches are videos and post-
dissection slides that can help strengthen the
understanding of the anatomy that represents the basis for
understanding clinical neurology (Welch et al., 2020).
This study represents an exploration of the perception
of second and fourth-year students (preclinical area) and
rotating internship (clinical area) of UNAH about their
learning in neurosciences, but it has some limitations; of
the three medical schools, only one was included. In
addition, although the distribution of students by years of
study is equal, a relatively small sample was reached.
However, the results coincide with similar studies with
larger samples, which confirms our suspicion of
neurophobia in the medical student population in
Honduras. It is important to continue to conduct more
studies evaluating the quality of medical education
provided in the country to develop possible interventions
and strategies to improve medical education in Honduras.
5. Conclusion
Neurology was the specialty perceived as the most
difficult and one of the areas of knowledge in which
students expressed the least skills, indicating that
neurophobia is a reality not only in medical schools
worldwide but also in Honduras. This is of particular
importance due to the increasing prevalence of
neurological disorders globally, which should force the
implementation of new tools in medical education to
overcome this phenomenon.
The students also expressed the need to implement new
teaching methodologies in neurology and more contact
with neurological patients. As previously indicated, it is
necessary to facilitate these teaching methodologies, such
as clinical simulation and promote collaborative learning,
measures that would be easily implementable, low cost
and have a high impact on the training of future physicians
in our country. Additionally, consideration should be
given to the inclusion of neurology outpatient attendance
in the early stages of the career, facilitating access to
neurology professors to mentor medical students,
promoting a therapeutic approach over a conceptual one,
and procedure-based learning, which commonly attracts
6. Author Contributions
MZG and FCC conceptualized the study. MZG
coordinated data collection and analysis. JS supported the
thematic and methodological process during the study. All
authors conducted the literature review, wrote, read, and
approved the final version of the manuscript.
7. Conflicts of Interest
The authors declare no conflict of interest.
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