ACGME Accreditation Council for Graduate Medical Education

Flexible Training in Neurology

July 27, 2006

Flexible Training in Neurology

The Neurology Residency Review Committee (RRC) has reviewed the American Neurological Association leadership proposal for flexible neurology residency (see www.aneuroa.org), and we wish to inform neurology department chairs and residency program directors that we support flexibility in residency education. In particular, the RRC supports education designed to incorporate research to maximize efficient development of neurologist investigators. This objective may be accomplished by using elective time to plan education that introduces more didactic components oriented towards research early in residency education, limiting the time commitment for some clinical rotations less relevant to a research career, and ensuring that residents continue to acquire the crucial clinical skills needed to assess clinical competency by paying special attention to the ACGME General Competencies and assessment of resident clinical performance. This can be accomplished without compromising the program requirements for residency education in neurology.

Rationale Derived from Feedback from Residency Program Directors, Department Chairs, and Other Educators

There is nearly universal support for the concept of introducing more flexibility into neurology residency education, particularly as it pertains to early research experiences. There are a variety of rationales to be considered while creating more structured, early research experiences:

1) Scholarship and research are an expected part of neurology residency program requirements, but it is difficult to provide time blocks for research within existing resident work hours limits and clinical service obligations.

2) Some residents have already developed a research interest and are training in an environment willing to help them explore these interests during residency.

3) Early research experience and mentoring may increase the probability of more successful transitions from residency to long term academic careers.

4) The trend towards increasing the length of medical training places an undue financial and psychological burden on trainees, and often contributes to delaying other lifestyle decisions (e.g., beginning a family).

5) Early research experiences will place residents in a position to apply for funding at an earlier stage of their careers, increasing the efficiency of training.

Neurology RRC Guidelines for Flexible Neurology Residency

1) As a reference, we encourage individual neurology departments and residency programs to review to the ANA leadership proposal as an example of how such flexible residency programs might be organized to provide both research experiences during residency and meet ACGME requirements for clinical neurology education and ABPN certification.

2) There is no application or program description required from programs to the RRC to implement flexible neurology residency education. However, the responsibility for satisfying the clinical neurology educational requirements of the ACGME (e.g., each resident is qualified to practice independently and competently) continues to be the responsibility of individual neurology departments, with particular emphasis on the roles of the department chair and the residency program director. Residency programs will be asked to describe the impact of flexible training on the residency program at the time of the usual site surveyor visit and program review for accreditation.

3) Each residency program considering the inclusion of a flexible residency option should consider the following:

a) The individual residency program must identify funding for this program. Medicare funding for residents will not pay for resident time to pursue research.

b) The program must be certain that all ACGME requirements for educating individual residents and for program accreditation will continue to be satisfied.

c) If elective rotation time is reduced to create research blocks, then specific plans for how residents will acquire the knowledge and skills needed to become clinically competent (and pass the ABPN examination) need to be created and assessed for learning effectiveness.

4) Each residency program should consider the impact of creating flexible education on residents in the program who will not choose to pursue a research option. The program must be dedicated to the development of clinical excellence for all residents. Creation of a “clinical masters” area of concentration (up to 4-6 months) for residents who choose to pursue clinical careers has been suggested as one approach to address this issue. Specific clinical or teaching expertise (e.g.-teaching skills, education research) may be developed during such a time block.