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, an international, interdisciplinary society that facilitates collaboration between scientists and clinicians involved in vestibular research, has developed a Curriculum to promote high quality vestibular training for all professionals involved with patients with vestibular disorders. The Curriculum is presented in the Journal of Vestibular Research, published by IOS Press.
The Bárány Society's position is that no vestibular disease or disorder belongs to a particular physician specialty or healthcare profession. 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."
Göran Laurell, MD, PhD, Uppsala University, President of the Bárány Society
The Bárány Society Vestibular Medicine Curriculum (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. It 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.
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 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.
In the future, the possibility of establishing accredited VestMed masterclasses and VestMed training programs for different clinical backgrounds will be explored, the authors noted. Joseph M. Furman, MD, PhD, University of Pittsburgh, and Editor-in-Chief of the Journal of Vestibular Research, envisions that these efforts might eventually 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," Dr. Furman added.
van de Berg, R., et al. (2021) Curriculum for Vestibular Medicine (VestMed) proposed by the Bárány Society. Journal of Vestibular Research. doi.org/10.3233/VES-210095.