This is a great time to become a neurologist. The coronavirus pandemic does not change that. As more patients present with more neurologic diseases, those diseases require more work, more urgency, and more clinicians. Neurology is the only medical specialty with more jobs advertised than available physicians (Avitzur, Neurology Today, February 7, 2019). Our fully accredited residency program is poised to help you join this growing active field.
In meeting this challenge, the Department of Neurology is a rapidly growing clinical and academic part of the University of Missouri Healthcare System and School of Medicine. For the last two decades, our faculty has doubled. Four times. Our clinical subspecialty experts cover virtually all neurology topics, last year resulting in outpatient activity with 16,276 visits, 889 electromyography / nerve conduction studies, 180 limb ultrasounds, 531 adult and 492 pediatric electroencephalographies (EEGs), 183 neurocognitive tests, and 2,644 sleep studies. Our inpatient footprint last year saw us admit over 250 epilepsy monitoring patients and read 863 more EEGs as part of a level IV Epilepsy Center (highest available designation), hospitalize another 2,166 people, and run 1,355 acute stroke codes. Speaking of stroke, we are a certified Comprehensive Stroke Center, featuring multiple neurology stroke attendings (including two neurologists who do endovascular procedures), and utilizing a 14 bed neurosciences intensive care unit run by three fellowship-trained intensivist neurology attendings. Alongside this extensive clinical activity, our research work is robust, with 4 federally funded research grants and 24 sponsor funded clinical trials or registries. Over the last two years, our faculty have produced 154 peer reviewed publications, 139 meeting abstracts, and 58 other publications.
We have used this departmental activity to grow our neurology residency, while also expanding one fellowship program and adding four others. The residency program added new didactics, better work-flow patterns, and new assessment and feedback systems. We balanced residency training so that graduating residents can learn almost any area of clinical neurology. Residents may work one-on-one with specialists in fields such as stroke, epilepsy, movement disorders, neuromuscular, neurointensive care, multiple sclerosis, cognitive-behavioral neurology, sleep neurology, neuro-oncology, pediatric neurology, and headache. We regularly revisit our curriculum of rotations, didactic sessions, conferences, and research opportunities. And, we’ve changed and improved the program to respond to residents’ wants and needs. We designed and started a two-week course, NeuroSchool, for neurology residents going from PGY1 to PGY2, during which residents have no assigned clinical rotation, but instead complete an aggressive set of daily didactics (including lectures, group exercises, “patient-based learning” [PBL] activities, simulations), a syllabus of daily readings, daily written assessment activities, and a final exam. We changed from an on-call system to a night-float system. We adjusted weekday start and stop times and weekend coverage to protect continuously monitored work duty hours. We began a new continuity clinic rotation where, for a week, each day the resident had a ½ day clinic and ½ day elective, thus allowing even PGY2 residents to taste elective time to aid fellowship planning. We also increased elective time overall. Last year we launched a new affiliation with Children’s Mercy Hospital in Kansas City, allowing our residents to rotate there as well as at MU for a diversified and robust pediatric neurology educational experience. We developed and implemented a multifaceted wellness program. We started a committee on diversity and inclusion, with resident representation, to report directly to our Department Chair.
Our goal is to nurture residents to give them excellent clinical training to take into either private practice or an academic neurology career. Our graduates have embraced that challenge well. Every graduating resident for the past several years has had at least one peer-reviewed publication, some many more. Some graduates go straight into practice, and they do well. Most choose to go into fellowships, and when they do, they secure good positions in well rated programs in competitive disciplines.
As of this match season, we now match six residents into our program each year. Each resident has his or her own workstation and storage area in a dedicated residents office. In addition, a conference room, library and full departmental staff and resources are right down the hall. We have made extensive use of virtual and telehealth platforms to continue residency training in full compliance with ACGME oversight during the coronavirus pandemic. Residents have online access to an extensive array of products including UpToDate, our electronic medical record system, a clinical imaging system, and the University’s extensive library system. We provide our residents with an annual book fund, membership in the American Academy of Neurology, and a subscription to the Continuum journal series.
There is no getting around the large strange shadow the coronavirus pandemic has cast on 2020-2021. COVID-19 and the responses of our communities have affected medical practice, medical training, and society more generally. Here, we have had to roll with these punches, but, really, we’ve done so. Sometimes that has meant being creative with virtual platforms for education and patient care. We have done noon conferences and other activities on Zoom, and rather than my regular noontime monthly meetings with residents, we started having weekly or biweekly evening meetings and we shared dinner time. We’ve figured it out, and we keep doing so. We humans are a resilient species and so that’s what we will do. So far, we’ve stayed safe, continued with training, and everyone will get all the rotations they need and graduate on time. For the 2020-2021 residency interview season, the pandemic means no live in-person events, and I am really sad about that. To accommodate, we will find other ways for applicants to get to know us. We will put some information and links on this website, so explore it! Please also check out our social media posts. I will hold a few open house meetings online to go over the program and answer questions, and I will ask our residents to do so as well. We’ll have a few of these before applications are due and also a few times during the application season (please RSVP for any or all dates you’d like).
Finally, for me, personally, I want to share that I love being a residency program director. My first best destiny is as a teacher. What I love most, and do best, is teach, and help learners learn. My approach is to try to reach each learner so that person feels touched, personally. I want the learner to feel individually valued and understood, invested in the topic I hope to teach, so that the learning moment somehow can directly speak to the learner. As a residency program director, I commit to each resident, know and value each one of them as a person, invest myself in the person’s welfare, and try to facilitate the person’s learning and maturation.
From these core values, my approach to education, pedagogically, is straightforward. My principles are: (1) learners learn more than teachers teach; (2) help make things clear, focused, and understandable; (3) motivate the learner, and make it fun; and (4) advocate for learning, and for the learner. With these values and approaches, I have tried to teach and inspire interest in neurology.