The program’s goal is to train master clinicians in neurology. The residency differs from many neurology training programs in that the curriculum emphasizes outpatient neurology as much as hospital-based rotations. Residents learn by seeing patients, which means that residents run the ward teams and rounds as well as evaluate and care for outpatients.
Now is an exciting time to join the training program, as it is expanding to eventually have 24 residents and adding new learning opportunities for trainees.
In addition to clinical experience, training includes a robust educational curriculum.
The curriculum provides rigorous training in the diagnostic approach and management in all areas of neurology in both inpatient and outpatient settings, including important rotations in community-based clinics. All residents are encouraged to develop research and quality improvement projects early in their training. In all years, the program strives to foster an open, dynamic learning environment that encourages discussion and debate. Each rotation block lasts four weeks.
The program fulfills the Accreditation Council for Graduate Medical Education requirements of:
- 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
The Internal Medicine year is geared toward providing a solid foundation in clinical practice and management of general medical problems in both hospitalized and ambulatory adult patients. The intern year is setup in a 4+1 schedule, meaning residents spend four weeks on an inpatient schedule followed by one week of clinic. Neurology residents have a similar schedule to other preliminary year interns at Dell Medical School with the exception of a four-week neurology block replacing an ICU block. This allows residents to get early exposure to neurology on the wards. Clinic week at the Central Texas VA consists of urgent care, specialty care and primary care of an adult population.
First-year neurology residents are introduced to the basic clinical and scholarly experiences upon which the rest of their training is based. Residents build upon their undergraduate medical education and intern knowledge base and competencies to learn how to obtain an accurate neurological history and perform and interpret a neurological examination. PGY-2 residents develop thoughtful patient assessments and management plans to include EEGs, lumbar punctures and CT and MRI imaging of the brain and spinal cord. They 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). Throughout their first neurology year, PGY-2 residents continue to develop and improve their written and oral communication skills. They also develop focused sign-out skills to facilitate continuity of care. They establish a framework of understanding of neurology practice that incorporates issues of patient advocacy, preventive health care, clinical ethics and effective cost containment into each aspect of their future experiences.
As they progress, PGY-2 residents promote their scientific inquisitiveness by asking insightful questions, independently seeking knowledge and reading and critiquing medical literature. They expand their neurology knowledge base and acquire initial skills as teachers for medical students as well as patients and their families. They also develop clinical efficiency and begin to manage the ward team to prepare for their subsequent years as proper supervisors of lower-level residents.
The second year of neurology training builds upon the skill and knowledge base established in the first year and uses evidence-based medicine to enhance patient care and self-improvement. Over the year, PGY-3 residents refine their clinical assessment skills as well as perfect their history-taking and neurological-examination skills for infants and children. Adult neurology residents spend a total of three months over PGY-3 and PGY-4 working with the child neurology faculty members who oversee inpatient child neurology consultations and outpatient clinical assessments. They also broaden the scope and complexity of the health care problems they address to include multiple sclerosis, neuromuscular disease, dementia, central nervous system infections, tumors of the nervous system and Parkinson’s disease and other movement disorders. PGY-3 residents are exposed to in-depth experiences in a variety of subspecialty areas, including EEG, EMG, neuroradiology and neuropathology.
PGY-3 residents show an increasing ability to practice medicine independently and begin functioning in an effective supervisory role toward lower-level residents. They enhance their teaching role at the bedside and expand their teaching efforts in the conference room. They learn to develop effective group-teaching sessions and to efficiently use available teaching materials and literary resources. Via exposure to a large number of neurological experiences, PGY-3 residents begin to focus their career-planning deliberations through discussions with faculty members and mentors and successfully develop or confirm their future practice interests. As mid-level trainees, PGY-3 residents affirm their role as trusted patient advocates, preventive health care providers and ethical, cost-effective practitioners.
As seniors, PGY-4 neurology residents continue to expand their knowledge base through core and subspecialty rotations, including psychiatry. As they prepare for the American Board of Psychiatry and Neurology’s certification examination, PGY-4 residents further refine their competence in clinical diagnostic evaluations and technical procedural skills, as well as their patient stabilization and office preparedness abilities. They 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 in preparation for future practice. They also need to be able to demonstrate level-appropriate leadership, confidence and supervisory capabilities.
As they continue to move closer to their residency commencement, PGY-4 residents assert their preceptorial and group teaching skills as they expand their capacity to critically evaluate medical literature and teach other health care professionals and multiple-level learners in a “round” format. They complete plans for their future careers in general neurology or in additional fellowship training as well as establish successful lifelong learning habits.
Didactics & Conferences
In addition to the rich clinical experience, the program has a robust formal educational curriculum. Lectures are protected time for resident education with pager coverage provided by the attending physicians on the inpatient service.
This lecture series provides PGY-2 residents with an intensive overview of neurology as well as instruction in evaluation and management of neurological emergencies. Lectures are held at the Ascension Seton Brain and Spine Institute.
Day, Morning, Afternoon Monday,, Tuesday,Grand Rounds,Didactics & Journal Club* Wednesday,Neuromuscular Lecture** Thursday,,Epilepsy Conference Friday,Brain & Spine Rounds**,Stroke Conference
*Journal Club occurs biweekly
**Neuromuscular Lecture Series and Brain and Spine Rounds occur monthly
Neurology Core Curriculum
Core curriculum lectures are held on Tuesdays from 1 to 4 p.m. in the Dell Seton Medical Center team room. They are designed to provide residents with the knowledge required to diagnose and treat neurology patients. Lecture topics fully prepare the residents for the American Academy of Neurology Resident In-Training Exam and American Board of Psychiatry and Neurology board exam.
Grand Rounds are held every Tuesday of the month and are a mandatory, educationally rich conference for neurology faculty members and residents. There are didactic-style presentations on clinical and basic science topics from both internal and external speakers. Continuing Medical Education credit is provided.
Journal club is a biweekly conference designed to help residents develop skills in critically assessing medical literature and verbally presenting their findings. Attendance is mandatory for all residents. Typically, one to two articles are assigned for discussion and reviewed by residents with a faculty moderator present.
Steven Warach, M.D., delivers a weekly conference on stroke. Attendings lead case presentations, literature reviews and discussions from noon to 1 p.m.
Brain & Spine Rounds
Brain and spine rounds are usually held the third Friday of the month at 7 a.m. One resident is assigned to present an interesting case from the wards, consult service or clinics.
GME Lecture Series
The GME Office provides lectures once a month on topics such as ethical issues, professionalism, resident fatigue and other critical subjects. Attendance is mandatory and is tracked by the GME Office.
One of the program’s epileptologists presents difficult epilepsy cases during the epilepsy conference. Management and epilepsy surgery plans are discussed.
Training facilities include the Dell Seton Medical Center teaching hospital, UT Health Austin and multiple outpatient sites for adult neurology, pediatric neurology and psychiatry rotations.
Dell Seton is the program’s primary inpatient teaching facility. The modern, 211-bed hospital serves as the Austin-Area Comprehensive Stroke Center. In addition to stroke certification, it offers a Level 4 epilepsy monitoring unit. The hospital will soon have Austin’s first neurological intensive care unit. All adult inpatient neurology rotations are at Dell Seton, meaning residents spend approximately 50% of their time at this hospital. The preliminary medicine year inpatient rotations are also at Dell Seton.
The Health Transformation Building (HTB) is home to the residency continuity clinic, where residents follow their own panel of patients from PGY-2 through PGY-4. Residents also have the opportunity to rotate through the UT Health Austin neurology clinics within the Mulva Clinic for the Neurosciences. The Seton Infusion Center is also in the HTB, which allows for many neurology patients who require outpatient infusions to receive treatment there.
Residents provide care in the outpatient clinic that serves veterans in Austin and surrounding areas. Residents rotate during PGY-2 at the VA, where they learn the fundamentals of outpatient neurology. Here, residents build the knowledge base necessary to succeed in the general neurology clinic. In addition to learning the foundations of outpatient neurology, residents learn to administer botulinum toxin for migraine and perform electromyogram and nerve conduction studies (EMG/NCV).
Residents complete outpatient rotations as part of this comprehensive program with an array of neurologists with different subspecialities, including epileptologists, clinical neurophysiologists, cognitive behaviorists and post-traumatic head injury specialists. Here, residents have the opportunity to hone their EMG/NCV skills alongside fellowship-trained neurologists and additional common outpatient neurology procedures such as botulinum toxin injections.
Dell Children’s is the only dedicated freestanding pediatric hospital in the 46-county Central Texas region. It features a Level 1 Trauma Center, pediatric ICU, cardiac ICU, Level IV NICU and comprehensive epilepsy monitoring unit. The hospital and Dell Med created the Texas Center for Pediatric Neuroscience to be housed in a new building adjacent to the hospital and staffed entirely by Dell Med child neurology and pediatric neurosurgery faculty members. The center features multidisciplinary programs for individuals with epilepsy, headache, autism, stroke and other neurological disorders. Outpatient sessions are held in an outpatient building adjacent to the hospital or in nearby practice locations.
Residents rotate at Shoal Creek Hospital, providing inpatient services including intensive psychiatric stabilization for patients dealing with emotional crises, depression and drug or alcohol dependence.