X + Why: Rethinking the Neurology Residency Curriculum
Toni Cao1, Jasmine May2, Carolyn Bevan3, Katherine Carroll4, Danny Bega5
1Stanford Health Care, 2Northwestern McGaw, 3Jesse Brown VAMC, 4Northwestern Department of Neurology, 5Northwestern University
Objective:

To improve outpatient neurology and continuity clinic experiences in a Neurology Residency program by designing an X+Y schedule.

Background:

Recent surveys have shown that many neurology residents report inadequate subspecialty exposure, feel unprepared to make fellowship decisions, and experience same-day conflict between inpatient and outpatient rotations. Similar challenges in the field of Internal Medicine (IM) led to the adoption of the X+Y schedule by many IM Residency programs. Increased use of the X+Y schedule by Neurology Residency Programs may help address the current challenges in outpatient neurology education.

Design/Methods:

The framework for the X+Y neurology curriculum was based on schemas originally created by IM residency programs and included “X” number of inpatient weeks followed by “Y” number of outpatient weeks. Practical considerations included securing enough clinic space, as well as ensuring faculty and ancillary staff availability for clinics to operate successfully.

Results:
A 4+1 schedule for PGY2 neurology residents in the 2023-2024 academic year was created and implemented on July 3, 2023. The basic structure included 4 weeks of inpatient service followed by 1 week of ambulatory neurology. The outpatient week incorporated 2 subspecialty clinic days, 2 continuity clinic days at 2 separate sites, as well as 1 administrative day. A pre-intervention survey was sent to PGY2 residents in the 2022-2023 traditional curriculum, which will be compared to post-intervention survey results from PGY2 residents in the 2023-2024 X+Y curriculum.   
Conclusions:

The implementation of a 4+1 Neurology Residency schedule is feasible. The X+Y schedule may address challenges in outpatient neurology education by providing increased and earlier outpatient exposure while reducing same-day conflict with inpatient services. Additionally, these changes may improve resident wellness by dividing up long stretches of consecutive inpatient time. Pre and post-intervention surveys will help assess the impact of the X+Y schedule on various aspects of outpatient neurology education.

10.1212/WNL.0000000000204501