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The past 3 years have witnessed tremendous change in graduate medical education, including neurology residency and fellowship education. All medical specialties in recent years have witnessed the introduction of the core competencies and resident duty hour restrictions, shrinking reimbursements, and increased administrative burdens. The Accreditation Council on Graduate Medical Education (ACGME) has initiated an ambitious project to document what works and what does not in graduate medical education (the “Outcomes Project”1), which has led to an increase in research related to medical education. While it is still too early to know exactly what benefits these efforts have brought, it is clear they have engendered change—as well as a fair share of comment and resistance.
Changes specific to neurology are occurring, as well. First, there is more and more neurology to learn, due to the strides of neuroscientists and clinical researchers. The era of therapeutic nihilism in neurology has, thankfully, ended; neurologists in training must incorporate into practice new medications, clinical trials, and guidelines on an ever expanding basis. As a result, subspecialization is also increasing. The ACGME and the United Council for Neurologic Subspecialties (UCNS) have been rapidly expanding the number of subspecialties with formal certification processes to include vascular neurology, neuro-intensive care, neuro-oncology, headache medicine, and others. At the same …
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