Objective:

To determine neurology directors’ preferred learning experiences and ideal learning objectives for PGY-1 residents. 

Background:

Neurology residency training in the USA follows a 1+3 format, with one year of Internal Medicine preceding three years of neurology. Current guidelines lack defined learning objectives for the IM experience, resulting in wide variability among programs. Despite its foundational role, the structure and utility of the IM PGY-1 for neurology residents remain unstudied. This project seeks to identify program directors’ perspectives on what constitutes the ideal IM preliminary year to optimize preparation for neurology residency and subsequent fellowship training. 

Design/Methods:

Investigators conducted semi-structured interviews with 8 current neurology residency program directors (PDs). This project was deemed exempt by investigators’ IRB. Interviews were audio-recorded, transcribed, and de-identified before analysis. Data were coded thematically through an iterative, consensus-driven approach until thematic saturation was achieved. All procedures adhered to institutional ethical standards, and participants provided informed consent electronically.  

Results:

Thematic analysis revealed three themes regarding the ideal curriculum: indispensable experiences, necessary experiences, and desired electives.  The majority of PDs asserted the ideal PGY-1 includes cardiology, critical care, and general inpatient medicine as indispensable experiences. Directors also recommended necessary experiences in the form of outpatient IM to develop clinical workflow and triage skills and emergency medicine for management of acute neurologic presentations. Necessary experiences also included infectious disease, rheumatology, and pulmonary medicine for their relevance to neuroinfectious, autoimmune, and neuromuscular conditions. Finally, desired elective experiences included physical medicine and rehabilitation, neuroradiology, and palliative care to strengthen neurologically relevant competencies. 

Conclusions:

PDs emphasized a well-balanced IM preliminary year grounded in core inpatient rotations and complemented by targeted outpatient and elective experiences best prepares trainees for neurology residency. These findings underscore the need for clearly defined learning objectives and greater structure within the PGY-1 year to better align intern education with neurology training goals.