Neurology residency training at the millennium.

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Neurology training is changing because of the explosion of information and new treatment modalities that became available during the 1990s, the Decade of the Brain. The Residency Review Committee (RRC) mandated curriculum changes in 1998. During the same decade, the number of American medical graduates (AMG) who entered neurology declined. This occurred as the total number of positions was at an all-time high. An increasing number of positions in the mid-1990s were either filled by international medical graduates (IMG) or remained unfilled (Doug Perry, personal communication, 2001). Funding for residency positions has been threatened and lost because of changes in Medicare funding and reallocation of specialty residency slots to generalist slots within the Veterans Affairs (VA) system.1 In addition, the clinical income used by many academic departments to support teaching and administrative activities has been substantially reduced by managed care. Academic physicians now have less time to teach.2 Similar stresses in other specialties have led to high turnover rates among residency directors.3 In 1999, the Graduate Education Subcommittee (GES) of the American Academy of Neurology (AAN) conducted a survey of adult neurology program directors (ANPD) to ascertain the state of neurology training programs. The goal was to characterize current program content and performance, applicants and the neurology residency matching program (NEMP, “the match”), characteristics of training program directors, and type and amount of administrative support for residents. We wished to identify current trends in neurology resident education and how programs are dealing with major challenges. The GES designed a 45-question survey to assess the issues described above. Survey questions were determined over the course of several meetings by members of the GES, the majority of whom were ANPD or had been in the past. The responses were anonymous, although members of the AAN GES staff were able …