Department of Neurology

Selection Process

All residents are selected through the San Francisco Match (SFM). Applicants must be graduates of an LCME accredited medical school or hold a valid ECFMG certificate. Most residents have completed two preliminary years (pediatrics) in an ACGME accredited program prior to starting neurology. The following 3 options for training in Child Neurology are designated by the American Board of Psychiatry and Neurology:

1. 2 years of pediatric residency; or…
2. 1 year of medicine and 1 year of pediatrics; or…
3. 1 year of pediatrics plus 1 year of basic neuroscience training.

The selection committee consists of all faculty members. The Division Director reviews all files received from the Central Application Service. After reviewing the files, applicants are selected for an interview based on the following criteria: Grades and achievements in medical school and college are considered. Test scores on the USMLE examinations are considered. At least three letters of recommendation are evaluated. Applicants selected for interviews are interviewed by 3 faculty members. Communication, maturity, professionalism, motivation and social skills are evaluated at the interview. The committee has a final meeting and a rank list is generated and submitted to the SFM.

Training Program

During the 3 year program residents are provided with a broad foundation in general neurology and, specifically, pediatric neurology, thereby preparing them for independent practice or entry into a subspecialty fellowship. Extensive clinical experience with diverse populations and bedside teaching are emphasized and are supplemented with a variety of didactic sessions. Particular attention is given to the humanistic, social and ethical aspects of neurology practice, as well as to the acquisition of academic knowledge and appreciation of the intellectual challenges of the specialty.

Year 1:

The main goal of training in the first year is for each resident to achieve competence in the performance of the neurological evaluation and the development of management skills on both inpatients and outpatients. Specifically, the resident should show proficiency in collecting the relevant historical information, performing an accurate general and neurological examination, localizing the lesion to the appropriate areas of the nervous system, and beginning to develop differential diagnoses and management skills for the more common neurological entities. This is accomplished through supervised experience on the adult neurology ward and consultation services. An OPD rotation provides a month to concentrate on adult neurology outpatient care. Residents are also assigned to a half day per week in a general pediatric neurology continuity clinic. They attend this clinic all three years. Early in the academic year, there are introductory lecture series covering neurological emergencies, neuroradiology and clinical neurophysiology. In the last 6 months the resident spends one month on the pediatric neurology inpatient service.

Each resident is assigned a faculty advisor. During all three years of training advisors meet with their assigned residents at least twice a year to review the resident's performance and address any concerns. All residents are required to take the in-service exam each year. The advisors and program director review exam results and meet with residents to review their performance.

Year 2:

Pediatric neurology residents begin their 6 months of inpatient rotations on pediatric neurology in the second year. During these rotations the residents develop the skills required to lead a team of rotating residents and students and to responsibly monitor the management of inpatients under the supervision of the attending. They also provide consultations in the emergency rooms at UHB and KCH and on inpatients on other services. They learn to manage pediatric neurology emergencies and to communicate with residents and attendings on other services. During the first several months of the inpatient rotations, the second year resident is closely supervised by a third year resident. Residents also attend their continuity clinic plus the subspecialty clinics and additional other general pediatric neurology clinic each week.

The one month neuropathology rotation occurs in the 2nd year. Residents are also required to spend a full month on child psychiatry. Four months of electives allow the resident to obtain additional training in subspecialties, such as neuroradiology, neuro-ophthalmology, epilepsy/EEG, neuromuscular/EMG and research.

Year 3:

During their final 5 months of inpatient rotations on pediatric neurology the residents improve the skills required to lead a team of residents as a ward senior. This is monitored closely by the attending. They closely supervise the 2nd year residents during their initial 2-3 months on the pediatric neurology inpatient/consult service and are involved in supervising and teaching rotating residents and students. They also continue to attend the subspecialty clinics and their continuity clinic during this time. One month is spent as a senior resident on an adult neurology consult service.

Six months of elective time allows the resident to pursue research or other interests, such as clinical neurophysiology, epilepsy, neuromuscular disorders, neuroradiology. Outside electives are also available in movement disorders, sleep medicine, genetic metabolic disorders, and neuro-oncology.

Teaching responsibilities for both 2nd and 3rd year residents involve supervision and training of residents and medical students rotating on pediatric neurology. The residents are also responsible for preparation of 2-3 case presentations/ topic reviews, 1-2 epilepsy reviews, 1-2 journal clubs and a major presentation to the entire department each year. All these are under the direction of an attending.

Specifics

During the residents' 1st year on adult neurology they spend approximately 30% of their on-call time covering the ERs under the direct supervision of an adult neurology senior resident. The remainder of the time is spent covering inpatients, admissions and consults under the supervision of the senior adult neurology resident and the attending. During 2nd year, the resident spends 6 months on the pediatric neurology inpatient service. He/she also spends 2 required months on neuropathology and child psychiatry and has 4 months of electives. During 3rd year the resident spends 5 months on the pediatric neurology inpatient service, one month on the adult consult service and 6 months on electives.

The pediatric neurology inpatient team consists of the attending, 2nd and 3rd year pediatric neurology residents, one 2nd or 3rd year adult neurology and one or two pediatric 2nd or 3rd year residents plus an occasional child psychiatry resident. This team is responsible for admissions, and all consults (including the emergency rooms) at UHB and KCH. About 50-60 new admissions and consults are seen each month. Rotating residents are assigned patients and consults under the supervision of the senior resident. Work rounds under the supervision of the pediatric neurology residents are made by all the residents prior to morning report. All admissions and consultations are presented to the attending at morning report and all patients are examined by the attending. Teaching rounds are made 5 times per week. The senior neurology resident closely supervises the rotators and along with the attending is ultimately responsible for patient care. An attending is available to residents 24/7.