As a four-year integrated program, the first postgraduate year is included in the residency match program. This traditional categorical medicine training is shared between the Neurology and Internal Medicine residencies as well as the Internal Medicine Service at the Kansas City VA Medical Center in Kansas City, Missouri.

The major objectives for the first year of training are:

• To develop proficiency in the evaluation and management of hospitalized patients with acute and sub-acute illnesses.
• To become proficient in basic medical procedures.
• To pass USMLE Part 3.

The first year of neurology training is weighted toward teaching the resident patient care responsibilities. Here are some of the skills our residents learn during this year of training.

• Perfect their neurological exam
• Evaluate patients with neurological problems
• Develop a plan of evaluation
• Initiate treatment

As the year progresses, residents achieve greater levels of autonomy and take more responsibility in teaching medical students and residents rotating on the neurology service.

The major objectives for this year of training are:

• To develop proficiency in the neurological interview and examination.
• To use these findings to generate a broad differential diagnosis starting with the most likely diagnosis.
• To understand the appropriate use of clinical and laboratory testing, and their indications, cost, specificity and sensitivity. Residents also learn how to prioritize the tests based upon the ordering of their differential diagnosis, the prevalence of disease states and the likelihood ratio of the tests.
• To triage, stabilize and manage patients presenting to the Emergency Department with acute neurological disease.
• To competently perform lumbar punctures.
• To learn how to coordinate and supervise a clinical team as well as partner with allied health team members to optimize patient care.
• To conduct appropriate literature searches and understand electronic patient information systems.
• To explain information about patients' disease and prognosis to patients and families in a clear and respectful manner.
• To understand gross and microscopic pathology and correlate it with clinical and neuroimaging information.

Training activities and sites
This year includes the following training experiences and affiliate sites:

• University of Kansas Health System
  • Neurology Ward
  • Stroke
  • Consult
  • Night float and clinic services
• Kansas City VA Medical Center
  • Clinic
  • Consult
• Leavenworth VA Medical Center
  • Combined consult and clinic service
• Elective

This second year of neurology training continues to refine the resident's abilities in patient care and also educates the resident about the specialized skills required of a neurologist. Elective time is individualized based on the resident's career plans.

The main objectives are:

• To further refine the neurological interview and examination and to demonstrate a problem-focused approach.
• To demonstrate a broadening fund of knowledge in neurological disease.
• To develop skill in reading electroencephalograms and evoked potentials.
• To acquire proficiency in reading neuroimaging studies.
• To teach and manage a clinical team with medical students and residents from other programs rotating on service.
• To demonstrate knowledge of the principles of evidence-based medicine.
• To learn the basic principles of research under the guidance of a faculty mentor.
• To make informed decisions about diagnostic and therapeutic interventions based on patient preferences, current scientific evidence and clinical judgment.
• To understand the performance, utility and limitations of electrodiagnostic studies.
• To work effectively as a neurological consultant and be responsive to the patient's referring physician(s).
• To develop and to sustain a therapeutic and ethically sound relationship with patients.

Training activities and sites
This year includes the following training experiences and affiliate sites:

• University of Kansas Hospital
  • Ward Supervisor
  • Consult service
  • Night float/clinic
  • Neuro ICU
• Kansas City VA Medical Center
  • Consults and clinics
• Children's Mercy Hospital
  • Pediatric neurology (three continuous months)
• Leavenworth VA Medical Center
  • Combined clinic and consult service with introduction to clinical neurophysiology
• Electives

The final year of training is weighted toward rounding out the resident's education with continued exposure to the disciplines of pediatric neurology, psychiatry, and elective time, though two to three months are also spent on consult services. Elective time is individualized based on the resident's career plans.

The learning objectives are:

• To demonstrate an increasing ability to function independently as a neurologist.
• To demonstrate an extensive fund of knowledge of common neurological disorders, some familiarity with rare disorders, and the ability to research the differential of a rare disorder based upon his or her own clinical evaluation.
• To provide advanced teaching of neurological disorders and exam techniques and to mentor junior neurology residents.
• To demonstrate sensitivity to pediatric patients and their families, and understand the different needs of the pediatric patient and their parents.
• To demonstrate proficiency in reading EEGs, neuroimaging studies, and performing EMG/NCV studies.
• To complete a research project with faculty guidance and present it in a scholarly fashion.
• To apply the methods of evidence-based medicine to the analysis of medical literature.
• To learn and make the best use of different services provided by ancillary members of the pediatric health care team, including developmental specialists, geneticists, and behavioral psychologists.
• To develop their career path through seeking and evaluating job opportunities in fellowships and in practice.

Training activities and sites
This year includes the following training experiences and affiliate sites:

• University of Kansas Health System
  • Consults
  • Psychiatry (one month as required by the American Board of Psychiatry and Neurology)
  • Neuropathology/Neuroradiology
• Kansas City VA Medical Center
  • Consults and clinics
• Electives