Adult Residency Program Schedule

The adult neurology residency training schedule at UT Southwestern Medical Center represents the culmination of many years of refinement and incorporation of input from trainees. The schedule provides a balance of clinical work in a variety of practice settings, didactic instruction, and flexibility.

Steven Vernino, M.D., Ph.D., meets with PGY-1 residents.

Training begins with a gradual introduction to the practice of neurology and culminates in increasing autonomy and responsibility. Our graduates are incredibly competent and confident. The schedule below represents an approximate schedule for residents starting the categorical program in 2012.

Postgraduate Year 1 – Medicine Internship

Residents spend their first year as an integrated member of the UT Southwestern Internal Medicine Residency Program. The PGY-1 year includes nine months of internal medicine services (general medicine, cardiology, medical ICU, geriatrics, diabetes consult service), one month of elective, and one month of emergency medicine. Throughout the PGY-1 year, neurology residents attend continuity clinic in the Department of Neurology. Residents quickly gain a firm foundation in general internal medicine and acute care.

June is the final month of the PGY-1 year and is a dedicated "Introduction to Neurology." This unique experience is devoted to education without major clinical responsibilities. Residents attend small group review sessions of neuroanatomy, neuropharmacology, and neuroradiology. They also get focused instruction in performing general and subspecialty neurological history and examinations, basic training in common neurology procedures, basic clinical neurophysiology, and physicianship. The remainder of the month is a clinical overview of subspecialty and general outpatient neurology with one-on-one interaction with faculty and senior neurology residents.

Postgraduate Year 2 – Introduction to Neurology

The focus of the PGY-2 year is direct care of hospitalized patients with neurologic disease. Residents spend approximately eight months on the neurology inpatient and consult services at the teaching hospitals. During these rotations, residents develop diagnostic skills and become familiar with management of acute neurologic issues under the supervision of senior residents and attending faculty. The year is rounded out with rotations in the neurocritical care service, epilepsy monitoring unit, and neuropathology. Outpatient training continues with weekly neurology continuity clinics where residents follow patients with a wide variety of disorders throughout the entire four years of training. This longitudinal perspective on disease patterns and management benefits both the house staff and patients.

A typical PGY-2 rotation schedule is listed below. Overnight call on the Parkland Memorial Hospital service is every five nights (during about 6 months of the year). Call responsibilities are taken as a team. A senior resident (night float) always takes in-house call with the junior resident to provide supervision and teaching. During most months, rotating interns and medical students work closely with the neurology resident. At Zale Lipshy University Hospital's Neuroscience Center, residents provide specialized care to patients with neurological illness. Overnight coverage at Zale Lipshy University Hospital is provided by night float and overnight call every seventh night. Residents take home call while on Dallas Veterans Affairs Medical Center consult service. There are no other call responsibilities.

Postgraduate Year 3 – Mastering your Skills

PGY-3 residents have a more diverse experience including three months with child neurology at Children’s Medical Center and Texas Scottish Rite Hospital for Children. Subspecialty rotations with neuromuscular, movement disorders, and electroencephalography are scheduled, and elective rotations are available in a host of other areas. PGY-3 residents also participate in consultation services for psychiatry and inpatient neurology.

Residents may choose from a wide variety of clinical and research electives. Some electives are essential to the training of a well-rounded neurologist such as multiple sclerosis, sleep medicine, and neuroradiology. Other electives may be coordinated exclusively to meet the career goals or interests of one resident. Popular and unique electives at UT Southwestern include neurosonology, neuro-oncology, neuro-ophthalmology, and neuro-otology. Residents with academic interests may devote elective time to a clinical or basic science research project under the supervision of a faculty member. Residents on the research clinical scientist track will spend six months in the research laboratory.

There are no on-call responsibilities during outpatient rotations.

Postgraduate Year 4 – Becoming a Neurologist

The senior resident fills a major teaching and supervisory role and is essential to the education of medical students, interns, rotating residents from other programs, and junior neurology residents. The senior residents also learn to make appropriate triage and treatment decisions on acute patients. By the end of the PGY-4 year, the resident has become a fully competent neurologist.

The residents and faculty elect two PGY-4 residents to serve as Chief Resident. The Chief Resident assists with rotation and conference scheduling as well as representing the program on campus.

Flexible Training in Neurology

The ACGME allows and supports flexibility in neurology residency training programs. Our Residency Program allows residents to create an individualized program to achieve their career goals. The PGY-3 and PGY-4 year contain ten blocks (nine months) of flexible rotations including elective time and optional clinical rotations. Before the end of the PGY-2 year, residents can request a specific training "track" for the final two years of residency training.

For residents with basic science research interests, a research track schedule allows nine months of basic research during residency. This research track is available to residents with appropriate background and career goals. Residents with a goal of community-based private practice can follow a training track that includes an emphasis on a varied outpatient experience (including rotations with volunteer neurology faculty in community practices in Dallas and Austin). A vascular/hospitalist track, for residents interested in inpatient acute care neurology practice, includes additional rotations in inpatient consultation, several unique neurocritical care settings, training in neurosonology, as well as additional neuroradiology, neurosurgery, and neurointerventional experiences. Flexibility and abundant elective time allow all residents to develop their own training focus or acquire a diverse exposure to all neurological subspecialties.

Research Opportunities

UT Southwestern is a center of research excellence. Many of the Neurology and Neurotherapeutics faculty are not only outstanding teachers and clinicians, but also direct successful clinical or basic science research programs. Residents are required to participate in research at some level. Most perform short-term projects which do not require time away from the residency curriculum. Longer-term projects lasting several months can be accommodated during the residency by using elective time or a specified research track for clinician-scientists. Post-residency research fellowships are available at UT Southwestern in one of the clinical or basic neuroscience research laboratories.

Teaching Conferences

Daily neurology attending rounds are conducted on the inpatient and consult services. Grand Rounds are held every Wednesday at noon. In addition to the noon neurology residency didactic curriculum, teaching conferences include weekly neurophysiology case conferences, neuroradiology review conferences, case-vignette conference series, clinical neuroscience, and board review conference. One of the high points of the week is live patient-professor rounds conducted by Roger Rosenberg, M.D. An inpatient selected by the chief resident is examined by Dr. Rosenberg to highlight the historical and examination findings of interest, followed by a discussion of the diagnosis.

Subspecialty conferences include a weekly neuro-oncology tumor conference and brain cutting, and a series of weekly seminars including journal clubs, muscle and nerve biopsy conference, and EMG review.

Electives

An impressive array of established clinical electives are available. Residents work with experts using state-of-the-art tools in subspecialties of neurology or related fields including neuro-oncology, neuroimmunology (MS), neuro-ophthalmology, neuro-otology, sleep medicine, headache, autonomic disorders, behavioral neurology, spinal cord injury, neurorehabilitation, neuroradiology, interventional neuroradiology, neurosonology (carotid and transcranial doppler), or neurosurgery. Residents may also select additional experience in neuromuscular, movement disorders, epilepsy, or neurocritical care. Elective time can also be devoted to a research project under the supervision of research faculty.

Resident Evaluations

All residents receive formal constructive evaluations with escalating standards each year of their training. Live patient practical examinations are administered at least once each year with volunteer patients. During these "oral" examinations, two attendings observe the resident take a history, perform a neurologic examination, and discuss a differential diagnosis and work-up. These examinations help residents hone their clinical skills as well as fulfill the requirements for neurology board certification. In addition, all residents participate in the annual Residency In-Service Examination administered by the American Academy of Neurology. Outstanding performance is recognized each year at the annual Neurology Residency awards banquet.