Navigating the UW Madison Neurology Residency: A Comprehensive Guide to Requirements and Expectations

Embarking on a neurology residency is a significant step in a physician's career. The Neurology Residency Program at the University of Wisconsin (UW) Madison is designed to provide residents with the skills and knowledge necessary to become exceptional neurologists. This article delves into the requirements, evaluations, and overall structure of the UW Madison Neurology Residency Program, providing a comprehensive overview for prospective and current residents.

Introduction

The UW Madison Neurology Residency Program is a comprehensive training experience aimed at cultivating highly skilled and compassionate neurologists. It emphasizes teamwork, close interaction with faculty, and the development of sophisticated clinical skills. The program is structured to address the challenges of contemporary neurology training, including the increasing trend toward subspecialty care and the importance of continuity in patient care.

Program Overview

The University of Wisconsin's Department of Neurology offers a robust residency program designed to equip physicians with the skills necessary for compassionate and effective patient care. The program seeks candidates dedicated to treating nervous system diseases, demonstrating an interest in neuroscience, and showing promise for future achievements.

Program Details

ACGME Code: 1805621119
Program Type: University-based
Total Positions: 7 categorical positions per year
Integrated Intern Year: The program includes an integrated intern year that meets ACGME and American Board of Psychiatry and Neurology (ABPN) requirements for the neurology PGY-1 year.

Training Structure

The training program is designed to be both rigorous and supportive, with a focus on individualized learning and collaborative care.

Average Hours per Week: 50
Maximum Hours on Duty: 24
Average 24-hour Off Duty: 2.00
Lecture/Conference Hours: 3 hours per week

Admission Requirements

The UW Madison Neurology Residency Program seeks well-rounded candidates with a history of academic success and the potential for future growth. Desirable attributes include strong intellectual abilities, sincere interest in neurology, and excellent interpersonal and communication skills. The program values diversity and works to foster an inclusive and respectful environment.

Read also: UW-Madison Tuition Requirements

Application Process

Interested candidates should apply through the National Resident Matching Program (NRMP). The program reviews new and newly-completed applications on a rolling basis until October 31st. Applications received after this date will not be reviewed.

Application Materials

Transcripts
Letters of Recommendation (minimum of 3, maximum of 4)
USMLE or COMLEX scores
Personal Statement

Specific Requirements

USMLE/COMLEX Scores: Applicants are required to submit either UMSLE or COMLEX scores. If an applicant submits both USMLE and COMLEX transcripts, both will be used in the review.
Letters of Recommendation: At least one letter from a clinical neurologist is strongly encouraged. Applicants currently in ACGME training programs should include a letter of recommendation from their current program director.
Clinical Experience: Applicants must have at least one letter of recommendation from a physician who can attest to their clinical experience. Inpatient settings and/or academic medical centers are preferred.
Visa Sponsorship: UW Health accepts J-1 visas sponsored by ECFMG or an Employment Authorization Document for those who are not U.S. citizens or do not have permanent residency status.

Evaluation and Assessment

Evaluation of the residents’ progress toward competence as independently practicing neurologists is an extremely important component of residency training. The evaluations include both narrative comments and quantitative assessments of the degree to which the faculty trust residents to carry out certain key responsibilities in each rotation.

Entrustable Professional Activities (EPAs)

Faculty grading of entrustment is then mapped to the various milestones based on the method published by the University of Washington’s internal medicine residency.

Key responsibilities are called entrustable professional activities (EPAs). For example, a stroke service EPA is “Can the resident respond to a stroke code and differentiate a true stroke from a stroke mimic?” Differentiating a true stroke from a mimic involves history-taking, neurological exam, knowledge of cerebrovascular disease, skill at imaging interpretation, etc.

Note that early in training, it is expected that residents will need greater supervision and that the faculty will trust the residents to function more independently over time as they demonstrate the skills necessary for independent practice. Therefore, junior residents, even very talented ones, will have relatively low EPA and milestone scores as compared to senior residents.

Read also: GPA Insights: UW-Madison

Neurology Milestones

The neurology milestones and the abbreviations used when mapping them are shown in the table below. Please see the individual rotation goals and objectives for details of how each rotation’s EPAs are mapped to the associated milestones.

Child Neurology Milestones 2.0 (updated 7/2021)

Code	Milestone	Core Competency
PC1	Neurologic and Developmental History	Patient Care
PC2	Neurological Exam	Patient Care
PC3	Critical Care	Patient Care
PC4	Diagnosis and Management in the Inpatient Setting	Patient Care
PC5	Diagnosis and Management in the Outpatient Setting	Patient Care
PC6	Neuroimaging	Patient Care
PC7	Electroencephalogram (EEG)	Patient Care
PC8	Lumbar Puncture	Patient Care
PC9	Electromyography	Patient Care
PC10	Determination of Death by Neurologic Criteria	Patient Care
MK1	Development and Behavior	Medical Knowledge
MK2	Localization	Medical Knowledge
MK3	Clinical Reasoning and Formulation	Medical Knowledge
MK4	Diagnostic Investigation	Medical Knowledge
SBP1	Patient Safety and Quality Improvement	Systems-based Practice
SBP2	System Navigation for Patient-Centered Care	Systems-based Practice
SBP3	Physician Role in Health Care Systems	Systems-based Practice
PBL1	Evidence-Based and Informed Practice	Practice-based Learning and Improvement
PBL2	Reflective Practice and Commitment to Personal Growth	Practice-based Learning and Improvement
PR1	Professional Behavior and Ethical Principles	Professionalism
PR2	Accountability/Conscientiousness	Professionalism
PR3	Self-Awareness and Well-Being	Professionalism
IC1	Patient- and Family-Centered Communication	Interpersonal and Communication Skills
IC2	Patient and Family Education	Interpersonal and Communication Skills
IC3	Interprofessional and Team Communication	Interpersonal and Communication Skills
IC4	Communication within Health Care Systems	Interpersonal and Communication Skills

Multi-Source (360⁰) Evaluations

Residents’ professionalism and interpersonal and communication skills are evaluated via electronic survey by patients, other resident colleagues, medical students, and a wide variety of co-workers. This latter category includes nurses, therapists, social workers, case managers, neurodiagnostic technicians, and schedulers.

Direct Observations

Clinical Skills Exams Chair rounds also serve as one venue for the clinical skills exams (NEX), which have replaced the oral board examination previously needed for ABPN certification. All residents are required to pass 5 clinical skills exams for patients unknown to the resident and from the following categories: ambulatory, neurodegenerative, adult neurology, neuromuscular, and critical care. At least one of the above pediatric patients must come from the following age groups; infant/child younger than 2 years old, child age 2-10 years, adolescent age 11-18. Each resident must complete at least two of the required clinical examinations by the end of PGY 4, and all prior to the final month of education. The exams will be conducted by active faculty who are board-certified by the ABPN.

Residents must be directly observed in the performance of one brain death exam (see the supervision policy above). This helps to ensure competence in a singularly important neurological task and provides another opportunity for faculty to give direct feedback regarding examination technique generally. The brain death exam may also be used to satisfy the neurocritical care clinical skills exam requirement.

Standardized Testing

Residents’ general neurological knowledge is assessed each spring via the Residency In-service Training Exam. Time off from clinical duties and call is provided for the residents in order to take the examination.

An additional self-assessment exam sponsored by the American Association of Neuromuscular & Electrodiagnostic Medicine is optional.

Resident Self-Assessment

In preparation for the semi-annual Clinical Competency Committee meeting and subsequent review with the program director, each resident is asked to complete a self-assessment based on their end-of-rotation and other feedback. This is used to develop an individualized learning plan, help the resident keep track of various requirements such as QI projects, and guide the subsequent discussion with the program director.

Semi-Annual Reviews

At mid-year and year-end, the residency program’s Clinical Competency Committee (CCC) will meet to evaluate each resident’s performance across the various core competencies and milestones; see the CCC description above. Subsequent to the CCC meeting, the program director will meet with each resident to discuss his or her progress individually.

Final (Summative) Evaluation

In addition to the usual six-month evaluation for the final six months of training, an additional form is completed by the Program Director attesting that the resident has “has demonstrated the knowledge, skills, and behaviors necessary to enter autonomous practice”.

Training Environment

The program's training institutions include the University of Wisconsin Hospital and Clinics (UW Health), the William S. Middleton Veterans Administration Hospital (VA), and the American Family Children’s Hospital (AFCH). The Ebling Medical Library at the Health Sciences Learning Center is the centerpiece of the University of Wisconsin School of Medicine and Public Health.

Faculty and Teaching

With a rich program of noontime didactic and case conferences, weekly bedside teaching rounds, neuroimaging and subspecialty case conferences, and exposure to the breadth and depth of clinical and basic neuroscience at the University of Wisconsin, the residency training program has been an interactive and interdisciplinary experience for both trainees and faculty.

The pediatric neurology faculty is consistently rated highly for teaching, and neurology residency graduates have an exceptionally high rate of passing their board exams on their first try with very high scores.

Special Features and Unique Opportunities

The University of Wisconsin offers a one-year ACGME accredited vascular neurology fellowship with a focus on individualized learning and collaborative care. Fellows take part in telestroke, inpatient primary and consultative stroke services at the comprehensive stroke center, neurocritical care, neuroendovascular surgery, rehabilitation, and stroke clinic.

Program Strengths

The current structure and organization of the training program was developed in 2003 and was designed to address several important needs which were identified by the faculty as challenges for neurology training in the contemporary environment. These challenges include the increasing trend toward therapeutic subspecialty care for neurological disorders, the importance of learning in the continuity of patient care across inpatient and outpatient settings, and the value of placing resident trainees in close working relationships with teaching faculty in their areas of major expertise.

The training program organization that emerged from the efforts to address these challenges has remained in place with minor refinements during the last few years, and includes five major combined inpatient-outpatient services in epilepsy, neuromuscular diseases, pediatric neurology, stroke, and general neurology. Residents on these services provide care for both inpatients and outpatients and work closely with faculty subspecialists in each of the areas. The epilepsy and neuromuscular services also include clinical neurophysiology experience in EEG and EMG as a part of patient care in those areas. The residents on the general neurology service also care for inpatients and outpatients through coverage of the emergency room during the day and a night float resident.

Resident Life and Wellness

During the adult neurology training year, each month, the residents have a Wellness and Administrative Business meeting with the program director, coordinator, and selected associate program directors. This serves as a venue for continuous dialogue among residents and program leadership regarding the structure of the adult neurology residency program, issues with specific rotations and faculty, and the status of the various program improvement initiatives that are underway.

During the child neurology training years a monthly meeting attended by the child neurology resident/s, the child neurology residency program director, the residency coordinator and associate program director (if necessary) will convene to address current residency issues, provide updates and serve as a forum for continuous improvement to the residency.

Twice each year, each resident meets with the program director to discuss their progress through the program, career goals, and other resident-specific matters.

Additional Information

Interview Process

All of the residency interviews are currently conducted virtually. The program schedules several interview days through the interview season between late October and early January. Applicants who are invited to interview will be able to choose from specific dates and times through Thalamus scheduling.

Key Skills and Knowledge

Incoming residents are encouraged to familiarize themselves with key concepts and scales used in neurology, such as:

NIHSS (NIH Stroke Scale): The most widely-used measure of stroke severity.
ASPECTS (Alberta Stroke Program Early CT Score): A validated way to assess the extent of early infarction visible on non-contrast head CT.
ENLS (Emergency Neurology Life Support): A program composed of modules on various topics, each consisting of a short review article, some slides, and a management algorithm.

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