the disease was initially described (4,5).Keynes was the first to describe that MG patients with thymomas do not respond as well to thymectomy as those with just hyperplasia (3). Thereafter, Masaoka demonstrated improved outcomes of thymectomy in younger patients with MG (6). As a result, there is a consensus to treat MG patients with thymectomy, especially in younger patients, with no evidence of a thymoma. In patients with an elevated pre-operative AchR antibody titer, a decrease in AchR antibody titer post-operatively was a measurement of success. This was especially true in patients with noninvoluted hyperplastic thymus glands.

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Background and ObjectivesOutpatient clinical experience is a key component of neurology residency. Understanding the educational environment for residents in the outpatient setting can inform educators to maximize teaching and learning opportunities, enhance resident exposure to subspecialty diagnoses and management, and deliver quality care. We studied the continuity clinic experience of 5 neurology residents over the course of their residency to determine the breadth of their ambulatory experience.MethodsWe used administrative health data from new and return patient visits scheduled with 5 neurology residents of the same class over 3 years of continuity clinic. International classification of disease codes pertaining to neurologic diagnoses and symptoms associated with these visits were analyzed. Frequency and proportions of the most commonly evaluated diagnoses and symptoms were tabulated. These were compared with previously published data about resident experience during training. We also analyzed resident experience over time.ResultsFive neurology residents evaluated 948 patients (mean 189.6; range 180–202; 59.2% female) during 2,699 clinic visits (mean 539.8; range 510–576) over 3 years in their continuity clinics. There were 6,555 international classification of disease codes associated with these visits (2,948 [44.9%] neurologic diagnoses, 2,249 [34.3%] neurologic symptoms, and 1,358 [20.8%] comorbidities). The most common neurologic diagnoses were as follows: headache disorders (24.5%), neuromuscular disorders (17.3%), movement disorders (12.1%), cerebrovascular disorders (11.5%), and epilepsy (7.5%). The most common neurologic symptoms evaluated by residents were as follows: seizure-like events (16.5%), sensory symptoms (12.4%), pain (10.3%), headache (9.7%), and motor symptoms (8.1%).DiscussionThe clinical experience of residents in the continuity clinic was diverse, but it was skewed toward headache, neuromuscular, and movement disorders, which constituted 54% of the workload. When compared with previous studies, the range of resident's outpatient clinical experience differed from that of inpatient experience. Based on the results of this study, we made changes to our outpatient curriculum by adding 2-month–long rotations in subspecialty clinics from postgraduate year 2 to 4 with the aim of boosting resident exposure to neurologic disorders in the outpatient setting.