Step Outside the Box
In 2020, under the direction of our new Department Chair, Elan D. Louis, M.D., we took the opportunity brought on by change of leadership to re-evaluate our adult neurology residency program. This opportunity allowed us to step back, think outside the box, and envision and develop a new path for our program. The committee was directed to not place limits on the vision, and after nine months of meetings and careful deliberation, developed a new architecture for residency training comprising six pillars:
- Self-Directed and Individualized
- Full-Spectrum Clinical Experience
Self-Directed and Individualized
Although we have a formal structure and framework to guide our residents through training, we recognize and respect that each person has her/his individual interests and career goals. Our residents can focus on areas of special interest and are given the latitude to explore, discover, and develop individual interests as they self-style their own experience. Our program directors work closely with residents to guide them to an appropriate mentor, taking advantage of all the opportunities UT Southwestern and the surrounding region have to offer.
A three-year training experience designed by the trainee with supportive advice from faculty mentors, advisers and program directors. Flexibility begins as early as the intern year, and while there are ACGME guidelines to follow and top-down directives to honor, there is an equal recognition of the needs, interests and focus of trainees.
The UT Southwestern neurology residency program is a hands-on experience. Our residents are participants, not witnesses who elsewhere might stand back and observe faculty taking care of patients. Residents who are engaged, conscientious, and passionate about neurology and patient advocacy thrive here. We firmly embrace the concept of “see one, do one, teach one.” You will leave this rigorous program knowing you are an excellent neurologist who can handle anything.
Full-Spectrum Clinical Experience
At UT Southwestern, we are not a “one hospital training program.” We provide a clinical experience in three distinctly different settings:
- William P. Clements Jr. University Hospital (on the UT Southwestern campus)
- Parkland Hospital (one of the busiest public hospitals in the U.S.)
- VA North Texas Health System (the Dallas Veterans Affairs hospital)
This provides expansive knowledge of the full spectrum of neurological disease, the resources afforded to broad patient populations, and various inpatient and outpatient practice models.
People make the difference, and our residents are the crown jewels who make our program what it is. We are a family that looks out for one another. Our focus on people is centered on good doctoring and sensitive, patient-centered care. In addition to covering a wide range of neurological topics, our didactic curriculum includes core training in “the art of neurology” and a thoughtful approach to building human connections. These are the intangibles that are traditionally learned with experience but are not explicitly taught. We help residents develop life skills during formal training – skills that are frequently minimized at other institutions. These are the intangible skills of good doctoring.
Residency programs at most institutions, including UT Southwestern, emphasize the inpatient training experience, but neurology is largely an outpatient specialty. Therefore, we expose our trainees to greater degrees of outpatient experiences. We balance the wealth of inpatient opportunities with the numerous clinical subspecialty clinics we have to offer. Our diverse and accomplished faculty have many subspecialties, allowing residents to have rotations and/or elective opportunities in a variety of disciplines.
The Department of Neurology at UT Southwestern is privileged to have the resources, facilities, and myriad clinical experts to provide each of our patients the care every human being deserves. The scope of innovative scientific work taking place at this institution is truly incredible and inspiring. We are a warm and supportive program.
Come join us!
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 four-week block of inpatient service followed by a week of outpatient clinics.
- Have eight 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 Clements University Hospital (CUH).
- Have a “+1” clinic week that includes the Neurology Continuity Clinic at Parkland Hospital, General Neurology Clinic at Dallas VA Medical Center, and additional outpatient specialty clinics such as headache medicine, neuro-oncology, and VA movement disorders.
June is the final month of PGY-1 and provides a dedicated introduction to neurology. This month is affectionately referred to as "Boot Camp." This unique experience is devoted to education without clinical responsibilities. 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 on "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 incoming PGY-2s, as well as our newly matched incoming interns and fellows.
PGY-2 focuses on direct care of inpatients with neurologic disease; however, outpatient neurology experiences and elective blocks are interspersed throughout the year. Residents spend approximately eight 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 two-week blocks. During most inpatient blocks, rotating interns and medical students work closely with neurology residents.
This is a typical PGY-2 rotation schedule:
|Parkland Stroke Service||8 weeks|
|Parkland General Neurology Service||8 weeks|
|Parkland Neurocritical Care Service||4 weeks|
|Parkland or CUH Epilepsy Monitoring Unit||4 weeks|
|CUH General Neurology Service||4 weeks|
|CUH Neurology Consult Service||4 weeks|
|VA Medical Center Neurology Consult Service||4 weeks|
At Parkland Hospital, PGY-2 residents take overnight in-house calls every fifth night. Overnight, the on-call PGY-2 resident triages ED consults, runs stroke codes, is the first to see the neurology patients in the emergency room, and makes decisions about patient disposition, including admission to neurology services. The in-house senior resident manages cross-cover issues for admitted patients and supports 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 CUH have no overnight call responsibilities, as there is a dedicated night float system for these hospitals.
Outpatient responsibilities are minimized while on inpatient services. There are no overnight (24-hour in-house) calls after the PGY-2 year.
PGY3 focuses on subspecialty and outpatient neurology experiences, with scheduled rotations in neuromuscular disorders, movement disorders, and electroencephalography. Residents may choose from a wide variety of additional clinical and research electives based on career goals or interests. See the core rotations and electives section for details.
ACGME-required pediatric neurology rotations are fulfilled at Children’s Health and Scottish Rite for Children, and the psychiatry rotation is fulfilled via Parkland’s inpatient psychiatry consult team. Residents also rotate among our neurology services at CUH and the VA Medical Center.
This is a typical PGY-3 rotation schedule:
|Child Neurology Consult Service||8 weeks|
|Outpatient Child Neurology Clinics||4 weeks|
|Outpatient subspecialty core rotations/electives||14 weeks|
|Parkland Psychiatry Consult Service||4 weeks|
|CUH Night Float||4 weeks|
|CUH Emergency Room Neurology||2 weeks|
|Parkland Emergency Room Neurology||2 weeks|
|Parkland Night Float||2 weeks|
|CUH General Neurology Service||4 weeks|
|CUH Neurology Consult Service||4 weeks|
|Vacation and Conferences||4 weeks|
Outpatient responsibilities are minimized while on inpatient services, and resident continuity clinics are minimized during elective rotations.
In the spring, residents and faculty elect two current PGY-3s to serve as administrative Chief Residents and one PGY-3 to serve as academic Chief Resident for the following academic year.
The senior resident fills a major teaching and supervisory role and is essential to the education of medical students, rotating interns, residents from other programs, and junior neurology residents. The senior residents triage and initiate treatment decisions for acutely ill patients. By the end of the year, the resident has become a fully competent neurologist who is well-versed in a variety of disciplines.
This is a typical PGY-4 rotation schedule:
|Parkland Stroke Service||6 weeks|
|Parkland General Neurology Service||6 weeks|
|CUH General Neurology Service||2–4 weeks|
|CUH Neurology Consult Service||2–4 weeks|
|VA Medical Center Neurology Consult Service||2–4 weeks|
|Parkland Night Float||2–4 weeks|
|CUH Night Float||2–4 weeks|
|Parkland Emergency Room Neurology||4 weeks|
|CUH Emergency Room Neurology||4 weeks|
|Elective and Research time||10 weeks|
Senior residents mentor and supervise juniors in-house during inpatient rotations. During Parkland night-float rotations, senior residents handle cross-cover for the primary neurology services while supervising and teaching the on-call PGY-2 resident.
The administrative Chief Residents build the inpatient, outpatient, and clinic rotation schedules. The academic Chief Resident oversees the core didactic schedule.
We offer several differentiated tracks that align with traditional career paths. These tracks are optional and are intended to streamline education in areas in which many residents express a desire for more formal training.
- Clinician-Educator Track (CET): The CET provides the foundations of inquiry, collaboration, and mentorship that are crucial to building a career in academic neurology and medical education.
- Clinician/Private Practice Track (CPPT): The CPPT prepares residents for a career as a neurologist in an independent clinical practice.
- Clinician-Scholar Track (CST): The CST provides structured, intensive instruction and mentorship to prepare for a career in academic neurology as a clinician-scientist by providing mentorship, workshops on manuscript and grant writing, and training in research methodology.
- Clinical Research (CR; Non-tenure Track): The CR track provides residents with instruction and experience in performing clinical research.
- Training Resident Doctors as Innovators in Science (TARDIS; Tenure-Track): UT Southwestern holds a Physician-Scientist Institutional Award from the Burroughs Wellcome Fund, which is aimed at increasing the number of single-degree physicians who pursue basic/translational research as a career path.
- R25 Track (RT; Tenure Track): Resident research is supported by an R25 research education grant from the National Institute of Neurological Disorders and Stroke (NINDS) and is designed to prepare eligible neurology residents for future NIH K award submissions.
UT Southwestern is a center of research excellence, and many members of the Neurology Department faculty direct research programs in clinical or basic science. All residents are expected to participate in scholarly activities 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. Many residents 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 teaching rounds are conducted on the inpatient and consult services at all rotation sites. PGY2s present cases at afternoon report on Mondays. PGY3s each present a clinical-pathological case conference on a Tuesday at noon over the course of the year. Departmental Grand Rounds are held every Wednesday at noon. Protected neurology residency didactics are held every Thursday afternoon from 2-5 pm; residents are excused from all other duties to attend. Didactics cover a broad range of neurology topics as well as RITE reviews, neuroradiology conference, research series, and journal club. Resident-led departmental Quality & Safety conference occurs on the last Friday of each month. In addition, each fellowship program and division has a variety of weekly conferences that residents attend during their subspecialty rotations.
Residents have up to 38 weeks of flexible core rotation and elective time during residency. Core outpatient rotations, such as headache medicine, neuro-oncology, neuromuscular medicine, movement disorders and EEG are built into every resident's rotation schedule. Additional clinical and research electives are available in subspecialties of neurology or related fields, including:
- Neuroimmunology (MS and autoimmune neurology)
- Behavioral neurology
- Sleep medicine
- Autonomic disorders
- Palliative care
- Spinal cord injury
- Sports neurology
- Procedure rotation
- Interventional neuroradiology
- Neurosonology (carotid and transcranial Doppler)
Residents may also select additional experience in core subspecialties.
Research electives: These typically consecutive weeks are devoted to a clinical or basic research project under the supervision of a faculty mentor. Future clinician-scientists may apply for the Department’s R-25 grant, which provides six months of protected research time during the PGY4 year and 12 months of post-residency research.
Over the last five years, 95% of UT Southwestern's graduating neurology residents pursued additional post-residency training. More than half of residents have chosen UT Southwestern neurology fellowships – a testament to the quality and breadth of our subspecialties, as well as the welcoming and supportive environment for trainees. Our graduates also feed other competitive institutions, such as the Mayo Clinic, Johns Hopkins, Massachusetts General, Brigham & Women’s, UCSF, UCLA, Northwestern, and Mount Sinai.