BS-VestMed-Curriculum

BS-VestMed Curriculum: The Bárány Society’s Education Initiative to Improve the Care of Patients with Vestibular Disorders

Vestibular symptoms such as vertigo, dizziness, and unsteadiness are commonly encountered in doctors’ offices and emergency rooms, but it is estimated that up to 80% of patients are not correctly diagnosed or treated. The symptoms are associated with a broad spectrum of illnesses and may be encountered by physicians in multiple specialties as well as non-physician allied healthcare professionals.

The Bárány Society has developed the Bárány Society Vestibular Medicine Curriculum (BS-VestMed-Cur), an interdisciplinary curriculum to standardize and advance treatment of a wide range of vestibular disorders and promote high quality vestibular training for all professionals involved with patients with vestibular disorders.

The curriculum is presented in the open access article “Curriculum for Vestibular Medicine (VestMed) proposed by the Bárány Society: The concept of Vestibular Medicine and the framework defining the knowledge, skills and attitudes needed for proficiency in Vestibular Medicine,” published in the society’s official journal, the Journal of Vestibular Research.

BS-VestMed-Cur provides a basis for current and future teaching and training programs for physicians and non-physicians, as well as serving as a resource for inspiration for teaching to students, postgraduate generalists such as primary care physicians and undergraduate health professionals, or anybody wishing to enter the field.

“The Bárány Society’s position is that no vestibular disease or disorder belongs to a particular physician specialty or healthcare profession,” explained Göran Laurell, MD, PhD, Uppsala University, former President of the Bárány Society. “Vestibular Medicine (VestMed) should be considered as an intrinsic or additional added competence to established specialties and professions. All health professions dealing with patients with vestibular disorders should share a common core of knowledge, skills, and attitudes, since patients might present with the same disorder to VestMed professionals with different clinical backgrounds.”

BS-VestMed-Cur was developed by a team of experts led by Raymond van de Berg, MD, PhD, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands, and Alexandre Bisdorff, MD, PhD, Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg. The curriculum sets out a comprehensive framework of suggested topics and skills. Subject areas include: anatomy, physiology, and physics; vestibular symptoms; history taking; bedside examination; ancillary testing; disorders; treatment; and professional attitudes.

The vestibular medicine (VestMed) concept embraces a wide approach to the potential causes of vestibular symptoms, acknowledging that vertigo, dizziness, and unsteadiness are non-specific symptoms that may arise from a broad spectrum of disorders, spanning from the inner ear to the brainstem, cerebellum, and supratentorial cerebral networks, to many disorders beyond these structures. For future implementation of the curriculum, multiple aspects could be considered. First, the curriculum should be a guide for institutions and individuals involved in teaching Vestibular Medicine, to make sure that their programs cover all the relevant topics. The hope is that the framework provided in this curriculum will assist those seeking to raise standards of content and delivery for current and future teaching and training programs, resulting in well-organized teaching materials and training centers.

Topics within each subject area are scored for levels of knowledge and skills. Levels of knowledge range from 1 (general awareness of a subject) to 4 (specific and broad knowledge). Levels of skill for each topic within each subject are scored from 1 (has observed or knows of) to 4 (competent to manage without assistance).

Basic and Expert knowledge and skill levels were determined by experts representing the various medical specialties and professions commonly treating patients with vestibular disorders. Both levels are clearly delineated in two supplementary tables.

The Basic Level Curriculum is the basis for all VestMed professionals. It allows low-threshold access to the fundamentals of VestMed and may encourage professionals to become members of the VestMed community at large. The Expert Level Curriculum differs from the Basic Level Curriculum in that it includes a higher level of detail and requires a higher level of understanding. Professionals who wish to practice VestMed as the main activity within their practice or profession should master the relevant areas of the Expert Level Curriculum.

Attainment targets are specified for each physician specialty and non-physician health profession to reflect their scope of practice. Dr. van de Berg and Dr. Bisdorff explained, “For example, a VestMed professional with a background in neurology or physiotherapy would not be expected to perform surgery but should have a basic understanding of the available procedures and when to refer for consideration of these.”

The BS-VestMed-Cur does not go into textbook levels of detail, nor does it define the design of a VestMed training program or criteria for training. Rather, it is intended as a guide for institutions and individuals involved in teaching vestibular medicine to ensure that their programs cover all the relevant topics.

“The hope is that the framework provided in this curriculum will assist those seeking to raise standards of content and delivery for current and future teaching and training programs,” commented Dr. van de Berg and Dr. Bisdorff.

These efforts will result in an online hub of evidence-based teaching materials customized to the level of knowledge, skills, and attitudes of each clinical specialty and profession. The developers of the BS-VestMed-Cur hope this curriculum will cross-fertilize clinical practice and stimulate transitional research in the vestibular field.

The program is designed to facilitate the establishment of accredited VestMed masterclasses and VestMed training programs for different clinical backgrounds. The first of these is the Diploma of Advanced Studies in Vestibular Medicine offered by the Universidad Nacional de Rosario, in Rosario Argentina. Read more about this innovative program here.

BS-VestMed-Cur is designed for:

Physician Specialists
Neurologists
Otorhinolaryngologists
Audiovestibular Physicians
Ophthalmologists
Psychiatrists
Emergency Medicine specialists
Rehabilitation Medicine specialists
Geriatricians
Pediatricians
General Internal Medicine specialists
General practitioners
Cardiologists 

Non-Physician Health Professionals
Physical Therapists
Audiologists
Physician Assistants
Nurses and Nurse Practitioners
Laboratory Technicians
Psychologists
Orthopticians
Behavioral Therapists
Medical/Clinical/Technical physicists

For more information about BS-VestMed-Cur or to inquire about setting up a program at your institution contact:

Raymond van de Berg, MD, PhD
raymond.vande.berg@mumc.nl

Alexandre Bisdorff, MD, PhD
alexbis@pt.lu