This retrospective study evaluates the frequency of common and uncommon diagnoses in resident neurology clinic.

Resident-led “continuity clinics” provide a valuable service to patients and a vital learning experience for residents. The Accreditation Council of Graduate Medical Education (ACGME) bases its Neurology Patient Care 4 (PC4) subcompetency on the ability to diagnose conditions that are common, atypical presentations of common conditions, and uncommon.

Primary visit diagnoses associated with resident clinic visits were compiled from a period of 1/1/21 to 12/30/22, then sorted using a faculty-developed list of common and uncommon diagnoses.

Of 2,618 primary diagnoses, 167 (6.38%) were non-neurologic (e.g. medical diagnoses). Another 734 (28.04%) were symptoms such as “diplopia” rather than specific diagnoses.

Of 1,717 remaining specific neurologic diagnoses, 1,337 (77.87%) were common, 66 (3.84%) were atypical presentations of common disorders, and 279 (16.25%) were uncommon. Another 35 (2.04%) were uncategorized, of uncertain rarity. The categories were as follows: 403 Headache, 55 uncommon (13.65%); 150 Cognitive Impairment, 20 uncommon (13.33%); 197 Seizure/Spell, 8 uncommon (4.06%); 22 Dizziness, 2 uncommon (9.09%); 234 Tremor, 23 uncommon (9.83%); 7 Vision Change, 4 uncommon (57.14%); 18 Altered Mental Status, 16 uncommon (88.89%); 281 Weakness, 66 uncommon (23.49%); 351 Pain/Numbness, 84 uncommon (32.93%); and 19 Functional, 1 uncommon (5.26%). Regarding symptoms versus specific diagnoses, Vision was an outlier with 26 symptomatic visit diagnoses and only 7 etiologic diagnoses.

The data suggest somewhere between 1 in 10 to 1 in 5 specific diagnoses in resident clinic are uncommon, which we feel provides adequate variety to foster achievement of the ACGME PC4 subcompetency. The relative frequency of “symptomatic” diagnoses may be related to a higher prevalence in new-patient encounters, which comprise 25% of our clinic visits. Vision complaints are particularly prone to symptomatic diagnoses, which could potentially be addressed with targeted resident didactics in the future.