Uchôa Cavalcanti Eduardo Boiteux
From the Neurology Outpatient Clinic, Rede SARAH de Hospitais de Reabilitação, Brasília, Brazil.
Neurol Educ. 2025 Sep 10;4(3):e200245. doi: 10.1212/NE9.0000000000200245. eCollection 2025 Sep.
Neurologists increasingly face clinical situations marked by diagnostic ambiguity, ethical complexity, and disorders that challenge traditional concepts of consciousness, personhood, and agency. Yet most neurology training programs remain focused on biomedical knowledge and procedural skills, offering limited preparation for these profound and often morally charged aspects of care. This educational gap may undermine clinical reasoning, ethical sensitivity, and the formation of a reflective professional identity. This review proposes the integration of 3 underrepresented but essential domains-epistemology, ethics, and philosophy of mind-into neurology education. Guided by Kern's 6-step curriculum development model, the article outlines theory-informed, evidence-based strategies to embed philosophical competencies within postgraduate training. Epistemology supports diagnostic reasoning through metacognitive insight, recognition of bias, and tolerance for ambiguity. Ethics education strengthens moral judgment and communication in scenarios involving capacity assessment, end-of-life care, and neurotechnological interventions. Philosophy of mind offers conceptual clarity for understanding disorders of consciousness, neurodegeneration, and altered personhood. Curricular strategies include narrative debriefings, ethics Objective Structured Clinical Examinations (OSCEs), interdisciplinary seminars, and reflective bedside teaching, all of which can be embedded into core clinical rotations such as neuro-intensive care unit (ICU) and cognitive neurology. Learning objectives are aligned with Accreditation Council for Graduate Medical Education milestones and supported by validated assessment tools, including reflective writing rubrics, structured ethical evaluations, and measures of ambiguity tolerance. Implementation barriers-including faculty readiness and curricular constraints-are addressed through faculty development, co-teaching models, and modular integration. By reframing philosophy as a clinical competency rather than a theoretical enrichment, this review offers a pragmatic and forward-looking approach to neurology education. Embedding philosophical reasoning into training enhances diagnostic precision, ethical engagement, and patient-centered care. The integration of philosophy into neurology education is not a veneration of the past, but a forward-looking complement, offering a humanistic framework to guide clinical reasoning and professional identity in an era shaped by artificial intelligence and neurotechnology.
神经科医生越来越多地面临着诊断模糊、伦理复杂以及挑战传统意识、人格和行为概念的疾病等临床情况。然而，大多数神经科培训项目仍侧重于生物医学知识和操作技能，在为这些护理中深刻且往往涉及道德的方面做准备方面有限。这种教育差距可能会削弱临床推理、伦理敏感性以及反思性专业身份的形成。本综述建议将三个未得到充分体现但至关重要的领域——认识论、伦理学和心灵哲学——融入神经科教育。以克恩的六步课程开发模型为指导，本文概述了将哲学能力融入研究生培训的理论导向、基于证据的策略。认识论通过元认知洞察、偏差识别和对模糊性的容忍来支持诊断推理。伦理教育在涉及能力评估、临终护理和神经技术干预的场景中加强道德判断和沟通。心灵哲学为理解意识障碍、神经退行性变和人格改变提供概念上的清晰性。课程策略包括叙事汇报、伦理客观结构化临床考试（OSCE）、跨学科研讨会和反思性床边教学，所有这些都可以融入神经重症监护病房（ICU）和认知神经科等核心临床轮转中。学习目标与研究生医学教育认证委员会的里程碑相一致，并由经过验证的评估工具支持，包括反思性写作评分标准、结构化伦理评估和模糊性容忍度测量。通过教师发展、联合教学模式和模块化整合来解决实施障碍，包括教师的准备情况和课程限制。通过将哲学重新定义为一种临床能力而非理论拓展，本综述为神经科教育提供了一种务实且前瞻性的方法。将哲学推理融入培训可提高诊断准确性、伦理参与度和以患者为中心的护理。将哲学融入神经科教育并非对过去的尊崇，而是一种前瞻性的补充，在由人工智能和神经技术塑造的时代提供一个人文框架来指导临床推理和专业身份。
