Changes to Neurology Residency, Early Life Medical Schooling

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The group of experts provided perspectives on the shift in how residency programs are developed and laid out, as well as efforts to increase the number of young neurologists in the field.

The Association of University Professors of Neurology (AUPN) began back in 1968 as an organization of neurology department chairs to inform and curate neurological education, clinical practice and research, and to be a combined voice for neurology leaders to influence policy. That year, the organization had its first formal meeting, where Maynard Cohen was selected as president. Since its formalization, the AUPN has supported department chairs through its educational offerings that are geared toward the leaders in neurology departments including program directors and clerkship directors.

Over time, there have been dramatic changes in all aspects of neurologic care, and along with this, neurology education has transformed. These changes have affected all aspects of education across the educational continuum, including learners, teachers, educators, content, delivery methods, assessments, and outcomes. Several in the field believe that unification of educations across professions and specialties will allow for increased leverage of resources, meta-data, skillsets, and perspectives to develop a core foundation for all health professions so that students in different professions learn with and from each other.

To gain a greater understanding about the changes in neurology, how its taught, and the impact the AUPN has had in neurology departments, NeurologyLive® hosted a Roundtable Discussion featuring former AUPN presidents Robert Griggs, MD; Clifton Gooch, MD; and Henry Kaminski, MD. In this episode, In this episode, the panel provided insights on the changes seen in neurology residency over the years, including the removal of certain traditional practices and the ways educators have molded programs to promote hands-on experience. 

Marco Meglio: How has the administrative aspect of residency changed over the years?

Clifton Gooch, MD: I can jump in here. In the 90s, I was the residency director at Baylor for six years before becoming chair here for the past 15 years. I also oversaw a neuromuscular disease fellowship program at Columbia. So, I've witnessed the evolution. Back in 1993, when I began as the residency director, there was more autonomy within departments to design and execute the residency training. Oversight from the ACGME was limited, and we didn't have to complete a Program Information Form (PIF). We could shape the program based on our expertise. We designed the curriculum, rotations, and had a smoother relationship with hospitals for funding residency slots. It was more straightforward to acquire funding for additional slots if needed. However, there were still challenges like managing faculty and addressing resident issues. As time passed, the ACGME started asserting itself more, introducing detailed requirements and the PIF. This centralized control aimed to ensure consistent training quality across programs. The ACGME's influence has grown, leading to more regulations and paperwork. The bureaucratic burden has increased, along with the need to follow their guidelines for training. Additionally, funding residency programs has become tougher due to changes in clinical revenues. This centralization has its drawbacks, including disagreements about sub-specialty training division and the professional values we aim to instill in residents. We must prioritize patient care and maintain professionalism despite these challenges.

Robert Griggs, MD: I focused on bridging the gap between sub-specialty and general neurology. Many students don't enter neurology with a sub-specialty focus, so it's vital to attract more students to the field. I was concerned about medical schools not requiring neurology exposure. When I was president of the AUPN, we highlighted schools lacking a neurology clerkship or placing it late in the curriculum. For example, psychiatry had a third-year clerkship while neurology didn't. We published this disparity and pressured schools to change. We succeeded in shifting neurology clerkships to the third year, boosting the number of students entering neurology. Around 15% of our students now choose neurology, surpassing the average of 2-3%. This shift is crucial, especially as treatments for conditions like Alzheimer's demand neurologists' expertise. The shortage of neurologists underscores the need to attract and train more specialists.

Henry Kaminski, MD: Expanding on these points, during the transition period, we focused on enhancing education through various means. We established divisions for medical student and residency directors, and we aimed to involve VA Chiefs and Vice Chairs, creating a more inclusive environment. This allowed for idea-sharing and educational program development. We introduced an award for the medical school with the highest number of students entering neurology. Despite challenges, teaching remains energizing, whether it's guiding medical students who are just learning about cranial nerves or working with advanced fellows. It's exciting to witness their growth over the years. Transitioning from my specialty, myasthenia gravis, to general neurology helps me connect with residents and watch their progress. Despite frustrations, the satisfaction of nurturing the next generation of neurologists remains strong.

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