Szirmai Imre
Semmelweis Egyetem, Neurológiai Klinika, Budapest.
Ideggyogy Sz. 2010 May 30;63(5-6):156-63.
The education of neurologists is debilitated worldwide. University professors are engaged in teaching, research and patient-care. This triple challenge is very demanding, and results in permanent insecurity of University employees. To compensate for the insufficient clinical training, some institutes in the USA employ academic staff members exclusively for teaching. The formation of new subspecialties hinders the education and training of general neurologists. At present, four generations of medical doctors are working together in hospitals. The two older generations educate the younger neurologists who have been brought up in the world of limitless network of sterile information. Therefore their manual skills at the bedside and their knowledge of emergency treatment are deficient. Demographics of medical doctors changed drastically. Twice as many women are working in neurology and psychiatry than men. Integrity of neurology is threatened by: (1) Separation of the cerebrovascular diseases from general neurology. Development of "stroke units" was facilitated by the better reimbursement for treatment and by the interest of the pharmaceutical companies. Healthcare politics promoted the split of neurology into two parts. The independent status of "stroke departments" will reduce the rest of clinical neurology to outpatient service. (2) The main argumentation to segregate the rare neurological diseases was that their research will provide benefit for the diseases with high prevalence. This argumentation serves territorial ambitions. The separation of rare diseases interferes with the teaching of differential diagnostics in neurological training. The traditional pragmatic neurology can not be retrieved. The faculty of neurology could retain its integrity by the improvement of diagnostic methods and the ever more effective drugs. Nevertheless, even the progression of neurological sciences induces dissociation of clinical neurology. Neurology shall suffer fragmentation if the professional authorities fail to control the separation of subspecialties, if teaching of future neurologists, including practical knowledge and skills of diagnostic decision making, is not supported.
全球范围内，神经科医生的培养受到削弱。大学教授要兼顾教学、科研和患者护理。这三项任务要求极高，导致大学员工始终面临工作不稳定的状况。为弥补临床培训不足，美国一些机构专门聘请学术人员从事教学工作。新亚专业的形成阻碍了普通神经科医生的教育和培训。目前，四代医生在医院共同工作。老一辈医生教导在充斥着大量无菌信息的无限网络世界中成长起来的年轻神经科医生。因此，他们在床边的操作技能以及急诊治疗知识有所欠缺。医生的人口结构发生了巨大变化。从事神经科和精神科工作的女性人数是男性的两倍。神经科的完整性受到以下因素威胁：（1）脑血管疾病与普通神经科分离。治疗费用报销增加以及制药公司的利益推动了“卒中单元”的发展。医疗政策促使神经科分裂为两部分。“卒中科室”的独立地位将使临床神经科的其余部分沦为门诊服务。（2）将罕见神经疾病分离出去的主要理由是，对其研究将造福于高发性疾病。这种理由服务于地域野心。罕见疾病的分离干扰了神经科培训中的鉴别诊断教学。传统的实用神经科已无法恢复。神经科可通过改进诊断方法和使用更有效的药物来保持其完整性。然而，即便神经科学不断进步，临床神经科仍出现了分化。如果专业权威机构无法控制亚专业的分离，如果未来神经科医生的教学（包括诊断决策的实践知识和技能）得不到支持，神经科将面临分裂。
