University of Texas Southwestern--Austin Neurology Program Curriculum

The ACGME requires that each residency program provides a comprehensive learning environment by which the residents are able to learn, practice, and achieve competency throughout the training program. These requirements include adequate patient care exposure, regularly scheduled didactic learning, and research experiences.

At a minimum, the resident is expected to complete the following patient care experiences:

• 18 months - clinical adult neurology
  • 6 months - adult neurology, inpatient
  • 6 months - adult neurology, outpatient
  • 3 months - elective
• 3 months - child neurology
• 1 month - psychiatry
• ½ day per week - continuity clinic
• Neuroimaging experience
• Critical care unit/emergency department experience including acute neurosurgical management

Neurology-Level 1 (PGY-2)

First-year neurology residents will be introduced to the basic clinical and scholarly experiences upon which the rest of their training will be based. Residents at this level will build upon their undergraduate medical education and intern knowledge base and competencies to learn how to obtain an accurate neurological history and to perform and interpret a neurological examination. PGY-2 residents will develop thoughtful patient assessments and management plans. While maintaining a high sense of responsibility for their patients, PGY-2 residents will learn to prescribe patient-appropriate care plans and to perform cost-effective diagnostic and therapeutic procedures as indicated, to include EEGs, EMGs, nerve conduction studies, evoked potentials, lumbar punctures, and CT and MRI imaging of the brain and spinal cord. They will learn how to evaluate and treat both common outpatient problems (headache, dizziness, neck and back pain, peripheral neuropathies) and neurological emergencies (coma and mental status changes, stroke, seizures). They will also learn to identify the level of illness severity in a timely manner, and when and how to seek help from upper-level residents or faculty. Throughout their first neurology year, PGY-2 residents will continue to develop and improve their written and oral communication skills. They will also establish a framework of understanding of neurology practice that will incorporate issues of patient advocacy, preventive healthcare, clinical ethics and effective cost-containment into each aspect of their future experiences.

As they progress through their first neurology year, PGY-2 residents will promote their scientific inquisitiveness by asking insightful questions, independently seeking knowledge, and reading and critiquing the medical literature. They will expand their neurology knowledge base and will acquire initial skills as teachers for medical students as well as for patients and their families. They will also develop the level of clinical efficiency that will allow them in subsequent years to function properly as supervisors of lower-level residents.

Neurology-Level 2 (PGY-3)

The second year of neurology training builds upon the skill and knowledge base established in the first year and will use evidence-based medicine to enhance patient care and self-improvement. Over the year, PGY-3 residents will refine their clinical assessment skills, as well as, perfect their history taking and neurological examination skills in infants and children. They will also broaden the scope and complexity of the healthcare problems they address to include multiple sclerosis, Parkinson’s disease and other movement disorders, neuromuscular diseases, dementia, central nervous system infections, and tumors of the nervous system. They will learn the interrelationship of abnormalities of the nervous system with normal growth and development of the nervous system. PGY-3 residents will be exposed to in-depth experiences in a variety of subspecialty areas, including EEG, EMG, neuroradiology, and neuropathology. In the primary care setting, they will expand their practice experience and will demonstrate greater clinical competency and efficiency, will show an increasing ability to practice medicine independently, and to begin functioning in an effective supervisory role towards lower-level residents.

PGY-3 residents will enhance their teaching role at the bedside and will expand their teaching efforts in the conference room. They will learn to develop effective group teaching sessions and to efficiently utilize available teaching materials and literary resources. Via exposure to a large number of neurologic experiences, the second-year neurology resident will begin to focus their career planning deliberations through discussions with faculty and mentors, and will successfully develop or confirm their future practice interests. As mid-level trainees, PGY-3 residents will affirm their role as trusted patient advocates, preventive healthcare providers, and ethical and cost-effective practitioners.

Neurology-Level 3 (PGY-4)

As a third-year neurology resident, they will continue to expand their knowledge base through additional core and subspecialty rotations, including psychiatry and critical care. As they prepare for the American Board of Psychiatry & Neurology’s certification examination, PGY-4 residents will further refine their competence in clinical diagnostic evaluations and technical procedural skills (EMGs, nerve conduction studies, EEGs and evoked potential testing), as well as their patient stabilization and office preparedness abilities. They will practice efficiently and effectively with a significant degree of independence in the evaluation and management of patients presenting with a wide variety of inpatient and outpatient neurological disorders. They also need to be able to demonstrate level-appropriate leadership, confidence, and supervisory capabilities. They will also develop focused sign-out skills to facilitate continuity of care and will learn how to expand these skills to apply to their future practice setting.

As they continue to move closer to their residency commencement, PGY-4 residents will assert their preceptorial and group teaching skills as they expand their capacity to critically evaluate the medical literature and to teach other healthcare professionals and multiple-level learners in a “round” format. They will complete plans for their future careers in general neurology or in additional fellowship training, as well as establish successful life-long learning habits.

Didactics

Neurology Boot Camp
This lecture series provides the PGY-2 residents with an intensive overview of neurology. These lectures are held in the SBSI (Seton Brain & Spine Institute) Conference room in Suite 300 of the CEC (Clinical Education Center) every Monday, Wednesday, and Friday for the first 8 weeks of the academic year.

Attendance is mandatory for all PGY-2 residents and optional for all others. Attendance is monitored via an honors-based sign-in sheet and is logged into New Innovations© by the Program Coordinator. Attendance rates will be reviewed and discussed at the resident Quarterly Review meetings with the Program Director.

Neurology Core Curriculum
These lectures are held at 7:30 am every Monday, Wednesday, and Friday in the SBSI Conference room, after completion of the Boot Camp series. These lectures are designed to provide the residents with the knowledge required to diagnose and treat neurology patients. Lecture topics follow those required for the AAN Resident In-training Exam (RITE) and ABPN board exam.

Attendance of at least 70% of all lectures is mandatory for all residents. Attendance is monitored via an honors-based sign-in sheet and is logged into New Innovations© by the Program Coordinator. Attendance rates will be reviewed and discussed at the resident Quarterly Review meetings with the Program Director.

Credit and a grade are given for each month of lectures based on attendance and examination. These grades become part of the cumulative transcript of residency training. An award and cash prize will be awarded to the resident(s) with the best performance in the didactic program at each year’s graduation banquet.

Grand Rounds
Grand Rounds are held the third Tuesday of every month, and is a mandatory, educationally rich conference for neurology faculty and residents. These are didactic-style presentations on clinical and basic science topics from both internal and external speakers. CME credit is provided.

Journal Club
A monthly conference designed to help residents develop skills in critically assessing the medical literature and verbally presenting their findings. Journal Clubs are usually held the second Thursday of each month, at the Clinical Education Center (CEC) at Brackenridge, starting at 5:30 PM. Attendance is mandatory for all residents. Typically 2-3 articles will be assigned for discussion and reviewed by the residents with a faculty moderator present. Residents will be provided with articles by the first of the month. Residents must complete a worksheet prior to attending Journal Club. The worksheet will question the type of study, basic methodology used, conclusions, and discussion including whether or not it will change ones practice. The reviewing resident will not paraphrase the article as all attendees, including the faculty, are expected to have already read the articles.

Stroke Conference
A quarterly conference on stroke is given by Dr. Neal Rutledge of Neuroradiology and Dr. Kent Ellington. Residents will present cases for discussion from 7:00 to 7:30. There will be presentations and discussion lead by the attendings from 7:30 to 8:30. Breakfast is provided.

Brain & Spine Rounds
Brain and Spine rounds are usually held the third Friday of each month at 7:00 AM. A resident will be assigned to present an interesting case from the wards, consult service, or clinics. The resident assignment will be determined by the UMCB or SMC ward attending, or the Program Director.

UTSW Lecture Series
These lectures were developed by the GME Office and are provided once a month. Topics will include ethical issues, professionalism, resident fatigue, and other critical subjects. Attendance is mandatory and is tracked by the GME Office.

Tumor Board
Tumor Board is held monthly. It is a multidisciplinary conference involving neurosurgery, pathology, radiation, radiation oncology, oncology, and neurology. Interesting tumor cases are presented and discussed.

Epilepsy Conference
Epilepsy Conference is led by one of our epileptologists, Dr. Briggs or Dr. Shen. Difficult epilepsy patients are presented. Management and epilepsy surgery plans are discussed.

Board Review
Board Review is generally held at the VA and led by Dr. James Little. It is generally a question and answer format.