Residency Program Description

The educational purpose of our program is to provide neurology residents with an experience that serves a high-quality neurologic education. We work with other services to maximize the flexibility of choice and provide an opportunity to evaluate and learn about a wide range of neurologic problems to include inpatient and outpatient experiences. In addition, acute management of neurologic emergencies and non-emergent visits along with intensive care unit (ICU) patient evaluations are provided.

Educational materials include a core of recommended reading material (listed in the basic science series) along with current literature searches to include review articles and new current therapies in neurology. Specifics are included in the Neurology Resident Training Program Outline, which is distributed/discussed at Orientation and a copy is on file in the VA and UT Health San Antonio Neurology Offices.

The goal of training our residents to become excellent clinical neurologists includes the following standards of performance for promotion in the Neurology residency. This includes these three main areas.

Clinical (wards, consults, clinics, etc) – this will be assessed by written evaluations. Each resident must obtain at least an adequate performance evaluation of each service, clinic, etc. We have a comprehensive evaluation program (360-degree evaluation process) which includes assessments by patients, nurses, nurse practitioner, medical students, resident and intern rotators, and attending physicians.

This includes adequate performance in the core competencies.
Exams– this includes a personal goal of scoring high enough to be able to show preparation to pass the written board exam. Oral board vignette case studies and patient presentations are set to aid the resident with their learning and preparation for studies with their certification exams. Those who need assistance will work with faculty in reading programs to enhance their preparation for their exams.

Conferences (participation and attendance) –Residents must come to all conferences prepared to discuss the designated topics (reading and research of topics prior to conferences). The core competencies are being stressed in some lectures and new lectures are developed to address these areas. All residents will know the six core competencies and their importance to our educational process.

Residents who do not meet the standards of performance for promotion will be placed on remediation. An individualized program for remediation will be instituted after meeting with a committee of their faculty mentor, residency program director, and Chair of Neurology.

This may include repeating rotations, further testing, repeated evaluations by faculty at conferences, more on-call responsibilities. This process is conducted as per the policies of UT Health San Antonio (www.uthscsa.edu/gme) and our program-specific policies.

There is an opportunity of increasing responsibility and professional maturation of the residents. Residents at all levels take night call (in hospital) with faculty back up. For all aspects of the program, there is faculty supervision. This gives the faculty ample opportunity to have contact with residents during a variety of settings and provide support, evaluation, and feedback to the residents. To monitor resident progress and document performance, faculty members evaluate residents during every rotation, consistent with ACGME requirements.

This evaluation includes assessment of clinical judgment, knowledge, technical skills, professional attitudes, behavior, humanistic qualities, and overall ability to manage patient care. The faculty will go over the evaluation with the resident and both will sign the evaluation form. There is on-going verbal and written feedback given to the residents. Evaluations forwarded to the Program Director who reviews the evaluations and periodically meets with the residents.

The resident is counseled on their strengths and weaknesses, any concerns or disagreements are noted and the resident is encouraged to write a response to any evaluations, and future meetings are set. Each resident is an active participant in formulating plans for his or her development and plans to correct any deficiencies.

Evaluations are used to guide decisions about how to increase the resident’s level of responsibility. This is part of the programs evaluation system also allows faculty to assesses each resident’s educational progress (program’s learning and performance objectives) and clinical abilities.

The feedback is given to the resident on an ongoing basis to aid with progressive improvements in each residents’ competence and performance. Residents receive ongoing verbal feedback and record review from their faculty attending on each rotation.

All residents and their performance evaluations are discussed at each faculty meeting. This includes the previous months’ evaluations in the new 360-degree evaluation process: patients, nurses, grand rounds, rotators, medical students, and faculty attendings. The decision to advance residents to positions of higher responsibility is made on the basis of evidence of their satisfactory progressive scholarship and professional growth. This decision is made by the residency program director with input from the faculty and Chair. Records of these evaluations are kept in the resident’s permanent file in the Neurology Office which residents may review at any time. This file and all other pertinent documents are kept confidential. In addition, the Program Director and faculty are also continuously monitoring resident health status, stress, mental or emotional conditions inhibiting performance or learning and drug- or alcohol-related dysfunction. Faculty are sensitive to the need for providing confidential counseling and psychological support services to residents and training situations that consistently produce undesirable stress on residents are evaluated and modified.

During the final year of training, the faculty members meet for a final evaluation of each senior resident’s performance. The evaluation includes a discussion on whether the resident has demonstrated sufficient professional ability to practice competently and independently. This final evaluation is also kept in the resident’s permanent file.

This evaluation and promotion process is done in accordance with the institutional policies and procedures (http://www.uthscsa.edu/gme).