Education Research: Neurology residency training in the new millennium

Abstract

Objective: To survey adult neurology program directors (ANPD) to identify their most pressing needs at a time of dramatic change in neurology resident education.Methods: All US ANPD were surveyed in 2007 using an instrument adjusted from a 1999 survey instrument. The goal was to characterize current program content, the institution and evaluation of the core competencies, program director characteristics, program director support, the institution of work duty hour requirements, resident support, and the curriculum needs of program directors and programs.Results: A response rate of 82.9% was obtained. There is a significant disconnect between administration time spent by ANPD and departmental/institutional support of this, with ANPD spending approximately 35% of a 50-hour week on administration with only 16.7% salary support. Rearrangement of rotations or services has been the most common mode for ANPD to deal with work duty hour requirements, with few programs employing mid level providers. Most ANPD do not feel work duty hour reform has improved resident education. More residents are entering fellowships following graduation than documented in the past. Curriculum deficiencies still exist for ANPD to meet all Neurology Program Requirements, especially for nontraditional neurology topics outside the conventional bounds of clinical neurology (e.g., practice management). Nearly one quarter of neurology residency programs do not have a meeting or book fund for every resident in the program. Conclusions:

Results of the American Academy of Neurology Resident Survey

“…It addressed general educational topics encountered during neurology training. The table summarizes a survey about ACGME duty hours 3 that disagrees with our survey. Overall, program directors reported a more negative impact of ACGME duty hours on patient care and education than the residents.…”

“…These may be due to a lack of defined instructors. 2,3 Based on this information, the AAN offers trainees a 6-part basic science course over a 3-year cycle at AAN annual meetings. The perceived deficiency in business aspects of medicine has been brought to the AAN leadership.…”

“…[1][2][3] Previously, residents had virtually unlimited hours, providing the backbone of care. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident work hours to 80 hours/week.…”

Emerging Subspecialties in Neurology: Palliative care

“…Fewer than 5% provide internal clinical rotations, and fewer than 3% provide external clinical rotations. 8 MD and DO adult and child neurology residency graduates are eligible to apply for ACGME-and American Osteopathic Association (AOA)-accredited palliative care fellowship training. According to the American Academy of Hospice and Palliative Medicine, as of May 2012, there are 78 ACGME-accredited and 7 AOA-accredited programs, with more than 234 positions available.…”

Emerging Subspecialties in Neurology: Neuropalliative care

“…According to a 2009 survey of adult neurology program directors, 52% of programs provide a didactic on end-of-life and palliative care principles. 7 Five percent of programs have an internal rotation, and 3% of programs offer an external rotation in palliative care. 7 In addition to hospital-based rotations and individual didactics, palliative care courses that are geared toward improving resident knowledge in end-oflife care, prognostication, opioid dosing, communicating with patients and their families, delivering bad news, and holding a family conference have been successfully implemented.…”