Adult Residency Program
The adult neurology residency training schedule at UT Southwestern Medical Center 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 increases in autonomy and responsibility. Our graduates are incredibly competent and confident.
PGY-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 uses a “4+1” block schedule based on “firms”—groups of interns and residents who rotate through each training site together. The 4+1 schedule provides residents with a 4-week block of inpatient service followed by a week of outpatient clinics.
- Have 8 blocks of internal medicine divided among general medicine, medical intensive care, cardiac intensive care, and hybrid rotations such as infectious disease, gastroenterology, or nephrology.
- Have one block of headache medicine.
- Have one block divided between emergency medicine and the Neurocritical Care Unit at Zale Lipshy Pavilion—William P. Clements Jr. University Hospital.
- Have a “+1” clinic week that includes: the 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 provides a dedicated introduction to neurology, 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.
PGY-2: Introduction to Neurology
PGY-2 focuses on direct care of inpatients with neurologic disease; however, this service is interspersed with outpatient neurology experiences (General Neurology Continuity Clinic and Neuro-Oncology) as well as elective blocks. Residents spend approximately 8 months on neurology inpatient and consult services at four 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.
A typical PGY-2 rotation schedule:
|Stroke Service, Parkland||8 weeks|
|General Neurology Service, Parkland||8 weeks|
|Neurocritical Care Unit, Parkland||4 weeks|
|Epilepsy Monitoring Unit, Parkland or Zale Lipshy Pavilion||4 weeks|
|General Neurology Service, Zale Lipshy Pavilion||4 weeks|
|Neurology Consult Service, William P. Clements Jr. University Hospital||4 weeks|
|Neurology Consult Service, VA Medical Center||4 weeks|
At Parkland Hospital, PGY-2 residents serve overnight in-house calls about 1 in 5 nights, focusing on emergency room consults with in-house 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. The senior residents manage cross-cover issues and support the on-call PGY-2. 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.
PGY-3: Mastering your Skills
PGY-3 residents have a more diverse experience with 3 months of pediatric 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 sub-specialties.
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:
|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. See the electives section for more information.
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.
PGY-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 triage and initiate 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.
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|
During Parkland night-float rotations, senior residents 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 in-house during inpatient 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 two scheduling Chief Residents and one academic Chief Resident.
UT Southwestern is a center of research excellence, and many members of the Neurology and Neurotherapeutics faculty direct research programs in clinical or basic science. 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 that 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.
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.
Residents have up to 38 weeks of flexible elective/selective time during residency. Headache medicine, neuromuscular, movement disorders and EEG rotations are recommended and scheduled for all residents. Clinical electives are available in subspecialties of neurology or related fields including neuroimmunology (MS and autoimmune neurology), neuro-oncology, 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 such as headache medicine, neuromuscular, movement disorders, epilepsy, or neurocritical care. Some elective time is usually devoted to a research project under the supervision of faculty mentors.