Mission

The mission of the Madigan Army Medical Center’s Neurology Residency is to provide a 4-year categorical residency which fosters academic achievement, a strong foundation in clinical neurology, and preparedness for serving as subject matter experts for neurologic cases within the Department of Defense, support of military readiness initiatives, and proficiency as a military officer. We strive to maintain collegial associations with nearby institutions to increase exposure to less common cases and subspecialties. We require participation in process improvement (PI)/ quality improvement (QI) projects for residents and provide support for interest in clinical research and publication. Professional military education is embedded into our training experience for development of skills needed to be successful as a military officer.

Vision

To compassionately provide expert neurological care to our military members, dependents, and retirees.

Aims

• Produce exceptional general Neurologists able to practice independently with the incorporation of subspecialty skillsets anywhere in the world, including advanced assessment techniques based on their interests and experience.
• Develop analytical and self-directed learning skills through literature evaluation and research to foster lifelong learning, evidenced-based medical care, and achievement of advanced certification.
• Promote the highest levels of professionalism and adaptability including military-specific curriculum so that our graduates may serve as physicians and officers in any conditions.
• Focus on efficient, cost-effective, and family centered medical care to our patients, including through practice pattern examination and quality/process improvement initiatives.

We have resident-focused didactics on Wednesday from 8 a.m. - 12 p.m. and on Tuesday/Thursday/Friday from 8 - 9 a.m. These include basic anatomy lectures, clinical pathology lectures, journal clubs, quality improvement and patient safety sessions, and military unique curriculum. On Tuesday, we train in neurophysiology as a small group. Thursdays feature faculty-led case discussions.

Our program has 13-block rotations, at a total of five local sites: Madigan Army Medical Center, Swedish Neurosciences Institute, Harborview Medical Center, Franciscan Neurology Associates at Saint Joseph’s, Mary Bridge Children’s Hospital.

• Additional experience in any of the subspecialty-focused rotations
• Epilepsy Monitoring Unit at University of Washington
• Research elective
• Faculty Development Elective

Neurology residents in our program take “home call” after-hours on weekdays and for 24-hour periods on weekends. Home call provides exposure to tele-neurology triage skills in keeping with how a majority of Army neurology staff practice. The number of call shifts vary between Post Graduate Year (PGY) levels, with more junior residents taking more call and more senior residents taking relatively less call. As an example, our PGY2 residents often take 6-7 call shifts in a 4-week block, while our PGY4 residents often take 3 call shifts per 4-week block.

We have dedicated time in our didactics curriculum for military-specific topics. Topics include military readiness considerations in neurology care, introduction to different Army neurology practices, career mapping, and coding. If a resident is interested, military training courses are supported.

• Three months of neurophysiology (EMG/EEG)
• Three months of pediatric neurology
• One month of psychiatry
• One month of neurosurgery
• One month of neuropathology

We conduct joint simulation experiences with the Emergency Medicine residency program. The goal of the simulated cases is education, guidance, and direct feedback on management of neurologic emergencies. Topics include acute ischemic stroke, status epilepticus, intracranial bleed complicated by herniation.

There are many opportunities to develop and practice leadership skills. Our program has various leadership roles of chief resident, leading academic discussions, wellness/social representative, medical student outreach, and more. Throughout the hospital, there are leadership opportunities as well with the residency council and various GME and hospital committees. The MAMC faculty development fellowship allows residents to do electives to more formally enhance their leadership skills.

Residents have a minimum of 3 rotation blocks designated for research and scholarly activity. Faculty mentorship is available to help identify academic goals and maximize a wide variety of opportunities. In recent years, this has included development of first author cases reports, retrospective studies, and review articles, presentations at our in-house Madigan Research Days and at national meetings, and we have access to a well-supported Department of Clinical Investigation to navigate Institutional Review Board (IRB) proposals and prospective investigations. Multiple training seminars occur throughout the academic year. GME funded TDY travel is available for conference attendance.

To foster a culture of continuous quality improvement, residents lead a yearly Morbidity and Mortality session and are required to participate in at least one quality improvement initiative as a graduation requirement.

The MAMC faculty development fellowship allows residents to do electives to more formally enhance professional development. They offer training sessions both to residents and faculty to provide opportunities for growth as an educator and clinician. Our program has enjoyed a robust pathway to subspecialization and intensive mentorship is available to navigate the path both to civilian or Army sponsored fellowships.

• Madigan Army Medical Center
• Swedish Neurosciences Institute
• Harborview Medical Center
• Franciscan Neurology Associates at St. Joseph’s
• University of Washington, Montlake
• Mary Bridge Children’s Hospital

One month clerkship and sub-internship rotations are offered to both USUHS and HPSP military medical students as well as clerkships for civilian University of Washington medical students. Clerkships are typically scheduled October 15th - June 30th during the MS3 and MS4 years. Sub-internships are completed July 1st - Oct 15th. All rotations include inpatient consult and outpatient experiences and may include time in our subspecialty clinics as well based on student preference (Neuro-oncology, Neuro-ophthalmology, Neuro-Behavioral, Neurophysiology, Pediatric Neurology, et al.).All students receive formative feedback at least weekly as well as summative feedback at the end of rotation, with emphasis on hypothesis-driven histories, physical exam techniques, test interpretation, localization, formulation, and differential-informed plans. Dates and requirements vary slightly based on student’s home institution.

Interviews are typically conducted in-person during a sub-internship rotation scheduled between July and mid-October in the MS4 year. Interviews include 4 standardized questions asked by a small panel (3-5) of Neurology staff and senior residents, after which the applicant can ask any questions to the program leadership. The interview is conducted in “Class A” Army Service Uniform (either Green or Blue) and typically lasts ~30 minutes. Remote video or phone interviews may be conducted on a case-by-case basis. Contact the program director for more information.

Program graduates take the American Board of Psychiatry and Neurology (ABPN) Initial Neurology Certification Examination. This exam is offered annually. To become fully board certified, applicants are eligible to take board certification exam within seven years following graduation. To be eligible to take specialty board exams, graduates must apply at least seven months prior to the exam and complete all pre-requisites required by the ABPN by September 1st. Visit the ABPN site for more information regarding initial certification. Specialty boards are taken after graduation from residency and may be taken during fellowship if applicable.

MAMC is a core clerkship site for the Uniformed Services University and partners with University of Washington School of Medicine, so there are abundant primary teaching opportunities with medical students. Several MAMC GME programs incorporate neurology rotations for their residents, including the Transitional Year, Family Medicine, and Internal Medicine programs.

Residents participate in presenting departmental didactics, journal clubs, case discussions, and morbidity and mortality (M&M) reports and are invited to provide lectures to the Internal Medicine and Emergency Medicine residencies. Our residents are also active in joint neurologic emergency training exercises in the Sim Center in collaboration with the Emergency Medicine program. An opportunity to present a lecture to the Washington State Neurological Society is available each year and participating in national meetings is also encouraged.

Our faculty showcase a variety of sub-specialty training, including Neuro-Oncology, Neuro-Ophthalmology, Neuro-Behavioral, Neurophysiology, and Pediatric Neurology. We provide direct training in our sub-specialty clinics and procedures for medical students and residents. Our residents graduate proficient in a variety of procedures including botulinum toxin injections for migraine and spasticity, a multitude of peripheral nerve blocks, electroencephalography, electromyography/nerve conduction studies, ultrasound, skin biopsies, lumbar punctures and others depending on their interests.

Mentorship occurs both on a formal and an informal basis. Each incoming resident is assigned a senior resident mentor to help guide new trainees from personal experience. One on one resident/faculty time is deeply embedded into clinic and consult workflow. Dedicated research mentorship is available and encouraged. Residents found to be in need are also afforded additional one on one faculty time to aid in rising to academic milestones.

Our program has a wellness representative who puts a focus on surveillance and enhancement of wellness. We have quarterly program-wide potlucks for team building and morale support. The residents take an annual 2-day retreat to foster team building and relaxation.