Mission

Dedicated to excellence, the NCC Neurology Residency Program is committed to shaping the future of neurology by providing unparalleled clinical training, academic and research excellence, and preparing our residents to be compassionate, highly skilled neurologists. Our mission extends beyond medical practice, aiming to contribute significantly to the well-being of service members and their families. We strive to maintain the highest standards in clinical care, education, and research, solidifying our position as a leader in neurology training within the Military Health System.

Vision

The aim of the Neurology Residency program is to prepare physicians to independently practice clinical neurology, successfully pass the ABPN Board examination, develop military officers proficient in military health readiness, and foster opportunities for residents to pursue their individual research interests during their training. Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social behavioral sciences, as well as the application of this knowledge to patient care.

Aims

• Demonstrate understanding of major developments in the clinical sciences related to neurology through
• Demonstrate understanding of the basic sciences through the application of this knowledge in patient care, passing clinical skills examinations focused on neurocritical care, pediatric neurology, ambulatory/episodic, neuromuscular, neurodegenerative, and palliative care.
• Demonstrate knowledge of bioethics, cost-effective care, systems-based care within the Military Healthcare System, palliative care, psychopathology, psychiatric care, and psychopharmacology.

The Didactics schedule is overseen by the Program Director and Assistant Program Director. A Senior and Junior are designated as the "Academic Chief Resident," who collaborates with the faculty to develop this year's curriculum, Tuesday morning resident sessions, and other monthly conferences. The Academic Chief will assist senior residents in assigning lectures, sending out schedules, and coordinating with the Program Director for specific academic needs or resident requests.

PGY-1 residents attend conferences required by their assigned service. PGY-2 and more senior residents are required to attend Wednesday morning conferences unless emergent patient care issues arise. Only the post-call PGY2 resident is excused (for inpatient ward work), and the program administrator may take attendance if accountability becomes an issue. The goal of these didactic sessions is to broaden residents' neurological knowledge, covering essential elements from basic to clinical neuroscience. The objective is to master key points from these sessions. As a reminder, this program cannot possibly teach all neurology knowledge during didactic sessions and time in the hospital. It is expected that every resident studies neurology topics at home.

To ensure all residents are relieved of clinical activities during didactics, the following mechanisms will be instituted on Wednesdays from 7:30 - 10:30 a.m.

• Ward/Consult resident pagers will be covered by a PGY-1 rotating on the neurology service.
• If there is no intern, pagers go to the sub-interns or 4th-year medical students on neurology service.
• The staff will be the direct backup for all of the above. In the event there are no rotators on service, pagers are to be held by staff from 7:30 - 10:30 a.m.

Standard Lecture Schedule (basic template, subject to change)

• 7:30 - 8:30 a.m.: Neuroradiology
• 8:40 - 9:35 a.m.: Basic Science/Clinical Lecture
• 9:35 - 10:30 a.m.: Basic Science/Clinical Lecture

Residents are also required to attend

• Chief Rounds or Grand Rounds: 8 - 9 a.m. Fridays
• Morning report: Monday and Thursday 8 -9 a.m., Mountain conference room, America Building, 6th floor– ward residents present cases.
• Tuesday morning series: 8 - 9 a.m., This educational morning is a resident-run academic session arranged by the chief residents and academic chief to focus on specific resident-focused academics, such as targeted lectures, board review, invited lectures, and journal club. This is protected time for academics and is mandatory.
• Residents rotating at Suburban, NIH, UMMC, NMCP, JCP, and WHC are excused from attending the above conferences. Unless there are urgent patient needs, all residents shall be present and on time for all conferences.

Additional Conferences

Residents are funded to attend one national conference over the course of their residency. In this program, PGY-4 residents are funded to attend the AAN meeting. If funds are available, we also try to send residents to the Cleveland Clinic Update conference, the Neuropathology Course, and the Epilepsy conference that are local.

Journal Club

Attendance is mandatory for all residents (except for patient emergencies and those on outside rotations) for this monthly segment of the didactic curriculum. Typically, Journal Club will meet one Tuesday or Friday of every month at 8 a.m. The assigned resident MUST work with a staff in deciding which articles are chosen. The resident should choose articles that may help answer questions that arose during patient evaluations (PBLI). Practice parameters from the AAN are suggestions.

Research

A research project in the form of a case report (or equivalent) is required of all residents unless the resident can show proof of proficiency in medical research before residency. Approval can be granted by the Program Director. This project is an excellent way to learn research techniques, issues of patient rights, and statistics. During the PGY-2 year, the groundwork for this project should be completed with a presentation in the spring of the PGY-4 year during Neuroscience Research Day. Plan on a 10–15-minute presentation followed by 5-10 minutes for questions. It is hoped that your interest in research does not end there, and that during the rest of your training you will pursue other research interests. If your work is accepted for publication as an abstract at a national meeting such as the annual AAN meeting, every effort will be made to ensure you can attend the meeting to present your work.

Grand Rounds

Grand Rounds are staff-level lectures for the Neurology Department, held typically on the first Friday of each month from 8 - 9 a.m. Attendance is required for all residents.

• Adult Neurology consult service
• Neuro-ophthalmology
• Epilepsy/EEG
• Clinical Neurophysiology (combined EMG and EEG)
• Neuroradiology
• Neuromuscular
• Movement Disorders
• Neurobehavioral
• Neuro-oncology
• Child Psychiatry
• Sleep disorders
• Neurocritical care
• Stroke neurology
• Consult
• Research elective
• Neuro-immunology

The in-house call schedule and the number of on-call days will be individually discussed with each resident at the beginning of each rotation. In general, residents should anticipate participating in on-call duties:

• 5 weekday duty periods (5 p.m. – 10 p.m.) per month
• 2 weekend duty periods (8 a.m. - 10 p.m.) per month
• Residents will not take more than 7 call days per month.

In addition to the rotation schedule, there are specific Military Unique requirements embedded in this curriculum, ensuring a comprehensive training experience:

Neuroscience Research Day Presentations

Residents are expected to actively participate in Neuroscience Research Day presentations, fostering engagement with ongoing research initiatives.

100% Compliance with Military Required Training

Residents are expected to maintain 100% compliance with all military-required training, including but not limited to ACFT/PRT/PFT, SHARP, CWT, etc. This ensures a commitment to military readiness and the holistic development of residents.

The utilization of simulation centers with live patients is a critical component of the military neurology training process, providing an immersive and dynamic environment for residents to enhance their clinical skills. 

Clinical Skill Enhancement

The primary objective of incorporating simulation centers is to enhance the clinical skills of military neurology residents. Simulation allows residents to practice and refine their diagnostic and procedural abilities in a controlled setting before applying them in real-world patient care scenarios.

Scenario Development

Simulation scenarios are meticulously developed to replicate realistic neurology cases. These scenarios are designed to challenge residents, encompassing a spectrum of neurological conditions, emergencies, and complex patient interactions that military neurologists may encounter in their service.

Incorporation of Live Patients

The uniqueness of the military neurology simulation process lies in the integration of live patients into the scenarios. This involves collaboration with willing participants who portray patients, adding an additional layer of realism to the simulations.

Simulation Center Utilization

Dedicated simulation centers equipped with advanced technology and realistic patient care settings serve as the backdrop for these sessions. These centers are designed to mimic clinical environments, complete with examination rooms, diagnostic tools, and monitoring equipment.

Live Patient Interaction

During the simulation, residents interact directly with live patients who portray neurological cases. This interaction encompasses history-taking, physical examinations, and communication skills. The live patient element adds an element of unpredictability, closely resembling actual patient encounters.

Dynamic Feedback Mechanism

Simulation sessions are structured to provide immediate and dynamic feedback. Faculty members and experienced clinicians observe residents' performance, offering constructive feedback on clinical decision-making, communication effectiveness, and overall proficiency in managing neurologic cases.

Clinical Decision-Making

Through simulation with live patients, residents develop and refine their clinical decision-making abilities. This includes the ability to assess and prioritize neurological symptoms, order relevant diagnostic tests, and formulate appropriate treatment plans.

Communication Skills

Interaction with live patients in simulated scenarios hones communication skills. Residents learn to convey complex medical information in a clear and empathetic manner, an essential aspect of effective patient care in military neurology.

Military-Specific Scenarios

Simulation scenarios are tailored to include military-specific aspects, such as cases related to service members' unique health challenges, deployment-related neurological issues, and emergencies encountered in military settings.

Preparedness for contingencies

The live patient simulation process ensures that military neurology residents are well-prepared to handle contingencies and emergencies in the field, contributing to their readiness for diverse and challenging scenarios they may face during active duty.

The incorporation of simulation centers with live patients in military neurology training reflects a commitment to providing residents with a comprehensive and realistic learning experience. This innovative approach not only enhances clinical proficiency but also prepares military neurologists for the multifaceted challenges of providing neurological care within the MHS.

Residents have many opportunities to participate in military and academic leadership training through WRNMMC, USUHS, and NCC courses. Rising Chief Residents participate in the WRNMMC/NCC Chief Resident Training held each spring. Clinical leadership principles are also taught and reinforced through our simulation center curriculum. The role of the neurologist as leader in operational medicine is taught and reinforced throughout our clinical curriculum.

The Research Elective provides a valuable opportunity for residents to initiate and advance an academic project. Before the month begins, residents are expected to have a selected and planned project. Additionally, the following trainings should be completed during this month:

• EndNote reference management software training through the Darnell Medical Library
• CITI training for biomedical investigators
• CITI Responsible Conduct of Research training
• The Library’s PubMed course is highly recommended for those without extensive PubMed familiarity/experience.
• A research project in the form of a case report (or equivalent) is a mandatory component for all residents unless proficiency in medical research prior to residency is demonstrated. Approval can be granted by the Program Director. This project serves as an excellent opportunity to learn research techniques, understand issues related to patient rights, and gain proficiency in statistics.

During the PGY-2 year, groundwork for this project should be completed with a presentation in the spring of the PGY-4 year during Neuroscience Research Day. Plan for a 10-15 minute presentation followed by 5-10 minutes for questions. It is encouraged that residents continue their interest in research beyond this requirement, pursuing additional research interests. If the work is accepted for publication as an abstract at a national meeting, such as the annual AAN meeting, every effort will be made to ensure attendance for presentation.

Resident Research Project Results:

• Abstracts presented at national meetings.
• Papers published during the residency.

The ACGME mandates resident participation in quality improvement (QI) and patient safety programs. While there has been a historical focus on these areas in the training program, a structured program will now be implemented, concentrating specifically on quality improvement and patient safety. Each resident is required to be part of a QI project or structured patient safety initiative during their residency. The implementation of QI programs will be based on residency classes, allowing all residents to be active participants in QI and patient safety. The outline of the programs is detailed below:

Patient Safety

The first session each year will involve a review of the JC DVD on “Overcoming the Obstacles to Reliable Healthcare.” Bi-monthly, residents and key faculty will review a neurology-based case from the web morbidity and mortality site. This resident-led discussion aims to identify problems, assess the potential occurrence in our facility, determine preventive measures, and evaluate the need to examine the system within our facility. Residents should understand Hospital-Based Patient Safety reporting systems. They are strongly encouraged to actively participate in Patient Safety by reporting events when they occur. Residents are also encouraged to take on leadership roles in the hospital, representing the Residency in Patient Safety councils.

Quality Improvement

Quality Improvement is an integral part of residency and is seamlessly integrated into the curriculum. Residents will follow WRNNMC QI/PI initiatives and actively participate in resident-driven QI/PI projects throughout their training. The expectation is that each residency class will complete a hospital-based QI/PI project during their residency.

At the commencement of each year, trainees are required to attend an orientation that outline specific program requirements professional expectations.

Annual Orientation

Trainees undergo a comprehensive annual orientation, focusing on program requirements, lifestyle management, and well being. This session serves as a foundational step in shaping the professional development journey.

LIFE Curriculum Integration

The orientation underscores the integration of the LIFE curriculum, emphasizing Leadership, Innovation, Fitness, and Education. This holistic approach ensures that military neurologists are equipped with a well-rounded skill set beyond clinical expertise.

Faculty Involvement

The orientation is not exclusive to trainees; faculty members also actively participate. This inclusive approach ensures that both trainees and faculty are aligned in their understanding of program expectations and the broader curriculum.

Continuous Learning Opportunities

Beyond the annual orientation, military neurologists are provided with continuous learning opportunities throughout their training. This includes regular updates on advancements in neurology, emerging medical technologies, and evolving military healthcare practices.

Leadership Development

Special emphasis is placed on leadership development, recognizing the unique role military neurologists play within the military healthcare system. Leadership training modules, workshops, and mentorship programs contribute to the cultivation of effective leadership skills.

Research and Innovation

Professional development extends to fostering a culture of research and innovation. Military neurologists are encouraged to engage in research projects, present findings at conferences, and stay abreast of the latest developments in neurological research.

Fitness and Wellness Programs

The LIFE curriculum's Fitness component is reinforced through tailored fitness and wellness programs. Recognizing the importance of physical fitness for military personnel, these programs contribute to overall well-being.

By integrating these elements into the professional development framework, military neurologists are not only well-prepared for the clinical challenges they may encounter but also equipped with the leadership, innovation, and fitness skills essential for success in their unique roles within the military healthcare system

• Alexander T. Augusta Military Medical Center at Fort Belvoir
• Clinical Center at the National Institute of Health (NIH)
• Joint Pathology Center
• Naval Medical Center Portsmouth
• Suburban Hospital (Bethesda, Maryland)
• University of Maryland Medical Center
• Walter Reed National Military Medical Center
• Washington Hospital Center

Interested students may submit rotation requests via dha.bethesda.Walter-Reed-Med-Ctr.mbx.gmerequests@health.mil. While we make every effort to accommodate learners, we do try to limit the number of applicants rotating concurrently; therefore, please request your rotation as early as possible, especially for requests during peak months of June – September.

• The military neurology interview process is a crucial component of selecting candidates for the Neurology Residency Program.
• The Medical Operational Data System (MODS) website provides a centralized application hub for the military Graduate Medical Education (GME) application process. Application instructions through MODS are distributed by the individual services annually.
• Applicants may contact the Program to schedule an interview by sending an email to: dha.ncr.walter-reed-med-ctr.list.ncc-neuro@health.mil. Interviews can be done in-person or virtually.

Graduates of the program sit for the American Board of Psychiatry and Neurology (ABPN) examination in Neurology. This exam is offered annually. To become fully board certified, applicants are eligible to take board certification exam any time after the completion of residency.

Specific requirements and examination details can be reviewed at ABPN.org

In the Neurology Residency program, a robust framework exists to provide diverse education opportunities for residents, focusing on didactic education, teaching engagements, and bedside instruction. This multifaceted approach contributes to a comprehensive and enriching learning experience.

Didactic Education for USUHS and Rotating Medical Students

The residency program extends didactic education opportunities tailored for students from the USUHS and rotating medical students. Structured educational sessions cover a spectrum of neurology topics, ensuring a foundational understanding of neurological principles.

Didactic Teaching for Other Program Specialties

Neurology residents actively participate in didactic teaching sessions designed for other specialties within the institution. This collaborative teaching model facilitates cross-disciplinary learning, promoting a holistic perspective on neurological disorders and their implications for patient care.

Bedside Teaching with Junior Residents

The program places a strong emphasis on bedside teaching, where senior neurology residents engage in direct, hands-on instruction with junior residents. This collaborative approach aims to enhance clinical skills, fostering an environment of shared learning and mentorship.

Teaching in EEG and EMG

Neurology residents are afforded opportunities to engage in teaching sessions specific to Electroencephalography (EEG) and Electromyography (EMG). These sessions delve into the interpretation of EEG and EMG findings, technical aspects of testing, and the clinical applications of neurophysiological data.

Interactive Learning Environment

The residency program cultivates an interactive learning environment where neurology residents actively contribute to the educational process. Through teaching engagements, residents refine their communication skills, reinforce their understanding of neurological concepts, and actively participate in shaping the educational journey of their peers.

Continual Professional Development

Participation in teaching activities serves as a platform for continual professional development. Neurology residents not only receive knowledge but also evolve into effective educators, honing skills crucial for their future roles as clinicians, mentors, and leaders within the field of neurology.

Conclusion

The Neurology Residency program places a strong emphasis on resident and teaching opportunities to create a well-rounded educational experience. By actively engaging in didactic sessions, collaborative teaching, and bedside instruction, neurology residents contribute to the vibrant educational ecosystem, fostering a community of continuous learning and knowledge exchange.

• Autonomic disorders
• Behavioral neurology
• Child Neurology
• Clinical Neurophysiology
• Epilepsy
• Movement disorders
• Neurointensive care
• Neurology
• Neuro-oncology
• Neuroradiology
• Vascular neurology

Every new resident is paired with a faculty advisor, offering a personalized support system throughout residency. Establishing a meaningful connection with faculty advisors is key. This relationship spans beyond professional matters to include personal guidance, creating a holistic support structure.

• In a neurology residency, the dynamic between upper-level residents and their junior colleagues is a cornerstone of professional development.
• The "Resident Teacher of the Year" award, based on medical student feedback, highlights the impact of effective mentorship.
• Upper-level residents should actively engage with medical students, fostering an environment where questions are welcomed, and insights are shared.

The following strategies outline how faculty and upper-level residents can maximize their role as mentors and contributors to a supportive and enriching learning environment:

Supportive Role Modeling

Upper-level residents and faculty should embody qualities of professionalism, empathy, and clinical excellence, serving as living examples for their junior colleagues. This role modeling extends beyond clinical skills to include effective communication, teamwork, and resilience.

Personalized Guidance

Understand the unique challenges and aspirations of junior colleagues. Personalized guidance ensures that mentorship extends beyond clinical matters, addressing individual needs related to career planning, work-life balance, and personal well-being.

Teaching and Role Modeling

Actively engage in teaching moments with medical students and residents, sharing clinical insights and neurology expertise. Serve as a role model by demonstrating a commitment to ongoing learning, adaptability, and a patient-centered approach.

Continuous Accessibility

Foster an open-door policy, making yourself accessible to junior colleagues. Encourage an environment where questions are embraced, and discussions are encouraged. Regular check-ins can help address concerns and provide guidance.

Encouraging Collaboration

Encourage collaboration among residents, creating a culture of shared learning. Facilitate opportunities for junior colleagues to learn from each other's experiences and perspectives.

Advocacy for Well-Being

Act as advocates for the overall well-being of junior colleagues. Recognize signs of burnout or stress and guide them towards resources that promote mental health and resilience.

Effective mentorship in a neurology residency extends beyond imparting clinical knowledge. It involves shaping future leaders who embody the values of the profession. By being supportive, engaged, and proactive in mentorship, upper-level residents contribute significantly to the development of a collaborative and thriving neurology learning community.

At the beginning of every academic year, the Program Director reviews resident well-being, principles of well-being, and specific resources available at WRNMMC and through the individual services.

• Residents complete self-reflections three times a year. These reflections allow them to gauge their current well-being and open the door to communication for program leadership.
• The PD also meets with each trainee twice a year to discuss performance. During these meetings residents are encouraged to receive mentoring and discuss any concerns or issues that might affect their residency.