# A Vignette-Based Educational Intervention to Reduce Neurophobia and Improve Knowledge for the UK Medical Licensing Assessment: A Prospective Pilot Study

## TL;DR

A short educational session improved medical students' confidence and knowledge in neurology, which could help reduce fear of the subject and improve patient care.

## Contribution

A new MLA-aligned educational intervention was developed and tested to reduce neurophobia and improve neurology knowledge among medical students.

## Key findings

- Confidence scores increased significantly after the intervention in both study cycles.
- Knowledge, measured by SBA test scores, improved dramatically from 25% to 97.9% post-session.
- Five out of six SBA items achieved 100% correct responses after the session.

## Abstract

Introduction: Neurophobia, an aversion to clinical neurology, undermines medical education and may affect patient safety. The UK Medical Licensing Assessment (MLA) emphasizes vignette-based Single Best Answer (SBA) items, requiring practice in applied clinical reasoning. We developed a compact, MLA-aligned educational intervention to reduce neurophobia by improving confidence and knowledge.

Methods: Using the Model for Improvement, we produced a 34-page booklet and delivered a 90-min, resident-led, interactive session across two plan-do-study-act cycles at a district general hospital (QIP: 25-586). Sixteen students participated (two cohorts, n=8 each), completing paired pre- and post-session assessments. While limited by a small sample size, this pilot supports proof of concept and warrants multicenter evaluation to strengthen generalizability. The primary outcome was self-rated confidence (five-point Likert). The secondary outcome, assessed in cycle 2, was knowledge measured by a six-item SBA test. Wilcoxon signed-rank tests compared paired scores; effect sizes were reported as \begin{document}\left| r \right| = \frac{\left| Z \right|}{\sqrt{N}}\end{document}. Cronbach’s alpha assessed reliability.

Results: Both cycles produced significant confidence gains. In cycle 1, median confidence rose from 2.5 (IQR: 2.0-3.0) to 4.0 (IQR: 4.0-4.25) (p<0.05; |r|=0.90). In cycle 2, confidence rose from 3.0 (IQR: 2.0-3.0) to 5.0 (IQR: 4.75-5.0) (p<0.01; |r|=0.89). In cycle 2, mean SBA scores improved from 25.0% (SD: 8.33) to 97.9% (SD: 5.5) (p<0.01; |r|=0.90). The SBA tool showed acceptable reliability (Cronbach’s α=0.76). Five of six items reached 100% correct post-session; the sixth reached 87.5%.

Conclusion: A single, low-resource, MLA-aligned session significantly improved medical students’ confidence and objective knowledge in neurology. Conducted as a prospective pilot study using QI methodology, it demonstrates proof of concept and supports wider evaluation including multicenter trials and delayed retention testing to mitigate neurophobia and strengthen workforce readiness.