Curriculum

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 of both programs are identical and 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 set up in a 4+1 schedule, meaning residents spend four weeks on an inpatient schedule at Dell Seton Medical Center with some rotations at Ascension Seton Medical Center Austin, 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 weeks at Central Texas Veterans Health Care System consist of urgent care, specialty care and primary care of an adult population.

At both the Dell Seton and Ascension Seton programs, 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 electroencephalographys, 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.

On the inpatient services, PGY-2 residents hold the pager and are the first to respond to non-urgent and emergent consults or patient-care issues. However, they are always provided robust supervision. There is an in-house night senior for the first four months of the year, during which every PGY-2 resident has the opportunity for direct observation and feedback. Subsequent to this, the senior resident and attending are available by phone and staff each consult. This graded approach with increasing independence is critical to balance both patient safety and foster growth of our residents. There is dedicated staff for the neurocritical care unit 24/7, so junior residents are not expected to manage these patients overnight.

At both the Dell Seton and Ascension Seton programs, 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, Parkinson’s disease and other movement disorders. PGY-3 residents are exposed to in-depth experiences in a variety of subspecialty areas, including EEG, electromyography, 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.

Both PGY-3 and PGY-4 residents serve as seniors on various inpatient teams: both vascular and non-vascular services at Dell Seton Medical Center and Ascension Seton Medical Center as well as the neurocritical care service at Dell Seton Medical Center. All of these teams act as traditional teaching services, although each service exposes residents to different patient populations and workflows. For example, Ascension Seton Medical Center gives residents exposure to pure consultative neurology whereas the Dell Seton Medical Center services are a hybrid of both primary neurology patients and consults. Both hospitals serve as referral centers to the community, but each has their own expertise. Residents might expect to encounter complex cardiac conditions and neurologic complications of obstetrical disease at Ascension Seton Medical Center, whereas at Dell Seton Medical Center they may be more likely to be challenged by patients with complex rheumatologic and infectious diseases.

At both the Dell Seton and Ascension Seton programs, 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.

New rotations for senior residents include supervisory roles in the neurocritical care unit, a “teaching senior” position where residents coordinate various educational conferences, and additional outpatient offerings such as epilepsy and movement disorder rotations.