The more things change the more they stay the same: a case report of neurology residency experiences

Abstract

This study compared the neurology residency training experience for a single neurology resident at the University of Pennsylvania from the years 2002-2005. The prevalence of encounters seen during this residency was compared to the prevalence of neurological disorders typically observed by ambulatory neurologists in the United States (US). A total of 1,333 patients were evaluated during this residency. Ischemic stroke/transient ischemic accident, epilepsy, metabolic encephalopathy, peripheral neuropathy, and multiple sclerosis were the most common neurological disorders observed. The four most common reasons for an outpatient visit to a neurologist (i.e., headache/migraine, epilepsy, cerebrovascular disease, and peripheral neuropathy) typically account for approximately 49-55% of all appointments, but only contributed to approximately 40% of patient encounters during this neurology residency. While these results reflect the encounters of a single neurology resident, both the total number and distribution of neurological diagnoses were similar to previous experiences over two decades ago at US academic medical centers despite significant changes in health care delivery and policy. This case report demonstrates that neurology residency programs continue to overemphasize acute management of inpatient neurological disorders compared to outpatient care of more prevalent neurological complaints. Additional measures could be instituted to ensure a broader range of experiences during residency (i.e., online resident log). These methods could allow residency coordinators to identify certain areas of deficiency with regards to exposure to patients for a resident and ensure greater competency during residency.