Adult Residency Program Schedule

2019 program directors and residents

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.

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 in the categorical program.

Postgraduate Year 1 – Integrated Internship

Interns are neurology residents from day one, and they spend their first year as an integrated member of the UT Southwestern Internal Medicine Residency Program. The internal medicine program bases their schedule on a firm system using a “4+1” block schedule. Each of the five firms comprises interns and residents who rotate through each training site together. Residents have a 4-week block of inpatient service followed by a week of outpatient clinics, which for neurology interns includes their Neurology Continuity Clinic. Residents train at Parkland Memorial Hospital, William P. Clements Jr. University Hospital, and the Dallas Veterans Affairs Medical Center.

  • Residents have 8 blocks of Internal Medicine training divided among the General Medicine wards, medical intensive care unit, cardiac intensive care unit, and hybrid rotations such as Infectious Disease, Gastrointestinal, or Nephrology.
  • Residents will do 1 block of Headache Medicine.
  • Residents will have 1 block divided between Emergency Medicine and the Neurocritical Care Unit at Zale Lipshy Pavilion—William P. Clements Jr. University Hospital.
  • Residents “+1 clinic week” will include their own Neurology Continuity Clinic at Parkland Hospital, General Neurology Clinic at Dallas Veterans Affairs Medical Center, and additional outpatient specialty clinics (such as Hypertension, Neuro-Ophthalmology, Rheumatology, and VA Movement Disorders).

June is the final month of PGY-1 and is a dedicated introduction to neurology that is affectionately referred to as Boot Camp. This unique experience is devoted to education without clinical responsibility. The first two weeks include small group review sessions of high yield neuroanatomy, the neurologic exam, diagnosis, neuropharmacology, and neuroradiology. There are also sessions led by upper-level residents, such as "How to survive a call" and other highly-anticipated topics. The second two weeks of Boot Camp features inpatient shadowing at all sites and in every rotation to serve as a gentle entry into the neurology services. At the end of the month, we have our annual Welcome Party for our newly matched interns, as well as incoming PGY-2s and fellows!

Postgraduate Year 2 – Introduction to Neurology

The focus of PGY-2 is direct care of patients hospitalized with neurologic disease. However, outpatient neurology experiences (General Neurology Continuity Clinic and Neuro-Oncology) as well as elective blocks are interspersed. Residents spend approximately 8 months on neurology inpatient and consult services at the 4 adult-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.

Rotations are scheduled in 2-week blocks. During most inpatient blocks, rotating interns and medical students work closely with neurology residents.

An example of a typical PGY-2 rotation schedule:

  • Parkland Stroke Service, 8 weeks
  • Parkland General Neurology Service, 8 weeks
  • Parkland Neurocritical Care Unit, 4 weeks
  • Parkland or Zale Lipshy Pavillion Epilepsy Monitoring Unit, 4 weeks
  • Zale Lipshy Pavilion General Neurology Service, 4 weeks
  • William P. Clements Jr. University Hospital Neurology Consult Service, 4 weeks
  • VA Medical Center Neurology Consult Service, 4 weeks
  • Behavioral Neurology, 2–4 weeks
  • Neuro-Oncology, 2-4 weeks
  • Elective, 4-6 weeks
  • Vacation, 3 weeks

For PGY-2 residents, overnight in-house calls at Parkland Hospital services averages to 1 in 5 nights out of approximately 4-5 months of the year. An in-house senior resident (night float) will handle cross-cover, supervise and teach the junior resident during the hours of 7 p.m.–7 a.m. during the week. This allows the PGY-2 resident to focus on emergency room consults without interruptions and with senior back-up. The PGY-2 resident triages consults, runs stroke codes, is the first to see the neurology consults in the emergency room, and makes decisions about patient disposition including admission to neurology services. This has been a valuable mentoring opportunity for both juniors and seniors, and it exemplifies one of our main program objectives: "supervised autonomy."

PGY-2 residents assigned to rotations at Zale Lipshy Pavilion and Clements University Hospitals have no overnight call responsibilities, as there is a dedicated night float system for these hospitals.

While on inpatient services, the residents do not have outpatient clinic responsibilities, and while on outpatient rotations, residents do not have any inpatient call responsibilities. There are no overnight (24 hour in-house) calls after PGY-2 year.

Postgraduate Year 3 – Mastering your Skills

PGY-3 residents have a more diverse experience with 3 months of Child Neurology at Children’s Medical Center and Texas Scottish Rite Hospital for Children. There are scheduled subspecialty rotations with Neuromuscular Disorders, Movement Disorders, and Electroencephalography; numerous elective rotations are also available in other areas.

PGY-3 residents fulfill their required ACGME psychiatry block on the inpatient psychiatry consult team at Parkland. PGY-3 residents also rotate among our neurology services at Zale Lipshy Pavilion, Clements University Hospital, and VA Medical Center.

A typical PGY-3 rotation schedule includes:

  • Child neurology consult service (8 weeks)
  • Outpatient child neurology clinics (4 weeks)
  • Outpatient subspecialty core rotations/electives (14-16 weeks)*
  • Psychiatry consult service (4 weeks)
  • University hospital night float (4 weeks)
  • Parkland emergency room neurology (2 weeks)
  • Parkland night float (2 weeks)
  • Zale Lipshy Pavilion general neurology service (4 weeks)
  • Clements hospital neurology consult service (4 weeks)
  • Vacation & conferences (4 weeks)

*Residents may choose from a wide variety of clinical and research rotations and electives. Some core rotations – such as Neuromuscular/EMG clinic, EEG, and Movement Disorders – are essential to the training of a well-rounded neurologist. Other electives may be tailored to a resident’s career goals or interests. Popular electives at UT Southwestern include Behavioral Neurology, Multiple Sclerosis, Sleep Medicine, a procedure rotation, Neuro-Ophthalmology, and Neuro-Otology. More information about our numerous elective possibilities is listed below. Residents with academic interests may devote elective time to a clinical or basic science research project under the supervision of a faculty member.

There are no on-call responsibilities during outpatient rotations. Resident continuity clinics are minimized during elective 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 learn to make appropriate triage and treatment decisions for acute patients. By the end of the year, the resident has become a fully competent neurologist well versed in a variety of disciplines.

An example of a typical PGY-4 rotation schedule:

  • Parkland Stroke Service, 6 weeks
  • Parkland General Neurology Service, 6 weeks
  • Zale Lipshy Pavilion General Neurology Service, 2–4 weeks
  • Clements University Hospital Neurology Consult Service, 2–4 weeks
  • VA Medical Center Neurology Consult Service, 2–4 weeks
  • Parkland night float, 2–4 weeks
  • University Hospital night float, 2–4 weeks
  • Parkland Emergency Room Neurology, 4 weeks
  • General Neurology Access Clinic (GNAC), 4 weeks
  • Elective and research time, 10 weeks
  • Vacation, 3 weeks

During the University Hospital night float or Parkland emergency room rotations, the senior resident has primary responsibility for making triage and admission decisions for acute neurology cases with oversight from the attending neurology faculty. During Parkland night float rotations, they handle cross-cover for the primary neurology services and neurocritical care unit, as well as supervise and teach the on-call PGY-2 resident. Senior residents mentor and supervise juniors while in-house during Parkland rotations. The GNAC provides the senior resident with an experience similar to outpatient neurology practice with a focus on consultation billing and documentation skills.

The residents and faculty elect three PGY-4 residents to serve as Chief Resident. There are two scheduling Chief Residents and one academic Chief Resident.

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. All residents are expected to participate in a scholarly project during residency, and PGY-4 residents give an oral presentation of their research at the annual Neurology Research Days in May of their senior year. 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. Many of the neurology subspecialty fellowships available at UT Southwestern are in one of the clinical or basic neuroscience research laboratories. For selected residents with a strong potential toward careers as clinician-scientists, we offer a structured research track.

Research Track

The UT Southwestern neurology residency program has been awarded an R25 research education grant from NINDS to support training for clinician scientists. The R25 research track is led by Dr. Marc Diamond, Director, Center for Alzheimer's and Neurodegenerative Diseases. Applicants interested in the research track should apply through ERAS for BOTH the research track and the regular categorical neurology program at UT Southwestern. During recruitment, candidates for the research track will interview for the regular neurology program and also receive additional information and interviews with research faculty. One resident per year can be matched to the R25-funded residency research track in the NRMP match. Additionally, qualified residents in the categorical neurology program can apply during their PGY-2 year to enter the research track.

The research track schedule includes 6 months of dedicated research time during the PGY-4 year of residency as well as the expectation to complete a year of post-residency research either in addition to or in combination with a subspecialty clinical fellowship. The goal of the research track is to prepare the neurology resident for a career in academic neurology as a clinician-scientist. In addition to research time, the program provides mentorship, workshops on manuscript and grant-writing, and training in research methodology. Research track residents are expected to produce and submit an initial K grant application.

Teaching Conferences

Daily neurology attending rounds are conducted on the inpatient and consult services. Grand Rounds are held every Wednesday at noon. Neurology residency didactics are held every Thursday afternoon and residents are excused from other duties to attend. Additional teaching conferences include afternoon report, RITE review, neuroradiology review conferences, M&M/Quality & Safety conference, research forum, and journal clubs. One of the high points of the week is live patient-professor rounds conducted by Roger Rosenberg, M.D. An inpatient selected by a wards senior 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

Residents have up to 38 weeks of flexible elective/selective time during residency. Neuro-oncology, headache, neuromuscular, movement disorders and EEG rotations are recommended and scheduled for all residents. An impressive array of established clinical electives are available to fill the remaining elective time. Residents work with experts using state-of-the-art tools in subspecialties of neurology or related fields including neuroimmunology (MS and autoimmune neurology), neuro-ophthalmology, neuro-otology, sleep medicine, autonomic disorders, palliative care, spinal cord injury, sports neurology, neurorehabilitation, neuroradiology, interventional neuroradiology, neurosonology (carotid and transcranial doppler), or neurosurgery. Residents may also select additional experience in core subspecialties like neuromuscular, movement disorders, epilepsy, or neurocritical care. Some elective time is usually 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" NEX 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