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Training in neurology

From the Department of Neurology, School of Medicine, University of California, San Francisco.

Address correspondence and reprint requests to Dr. Michael J. Aminoff, Professor of Neurology, Department of Neurology, School of Medicine, University of California, San Francisco, CA 94143-0114 aminoffm{at}neurology.ucsf.edu

The training of clinical neurologists is undergoing profound change. Increasing subspecialization within neurology, the widening separation of clinical neurology from other branches of internal medicine, limitations of exposure to training in internal medicine, mandated restrictions in working hours, and attempts to shorten the training period are likely to have adverse effects on the next generation of clinical neurologists. Despite the need for a broad base in general medicine, discussed here, the exposure of neurology trainees to general medical disorders is diminishing. An emphasis on an algorithmic approach to patient management rather than on educating residents to use their reasoning faculties when applying new techniques and knowledge to clinical practice may adversely affect patient care. Neurologists require broad-based training in neurology, internal medicine, and psychiatry, to ensure excellence in clinical practice. It is time to question again whether they are receiving the training that they need.

Disclosure: The author reports no disclosures.

Based on a lecture delivered at the annual meeting of the American Academy of Neurology, Boston, April 2007, when the author received the A.B. Baker Award for lifetime achievement in medical education.

Received August 19, 2007. Accepted in final form October 18, 2007.