UCLA Neurology Residency Program: A Comprehensive Overview

The UCLA Neurology Residency Program stands as a nationally recognized program dedicated to training future leaders in the field of neurology. It combines comprehensive clinical training with mentorship from leading experts across all neurological subspecialties. The program emphasizes curiosity, compassion, and a commitment to excellence, ensuring residents provide high-quality care to a large and diverse patient population across multiple facilities.

Introduction

The UCLA Department of Neurology is deeply committed to the education of undergraduates, medical students, and residents. The program offers numerous opportunities to gain experience in clinical, translational, and basic science research, with dedicated faculty willing to mentor students at all stages of their careers. For medical students and residents, clinical shadowing opportunities are also available.

Program Overview

The residency program at Harbor-UCLA Medical Center is uniquely designed to provide residents with a robust educational experience while ensuring high-quality patient care. The program's curriculum is structured to optimize educational outcomes over four years, progressively building residents' knowledge, skills, and responsibilities in neurology.

Curriculum Breakdown

The four-year residency program is carefully structured to build expertise progressively.

PGY 1: Foundational Year

The first year (PGY1) focuses on foundational medicine and clinical skills. Key components include:

Neurology wards (12 weeks)
Emergency department (8 weeks)
Medicine ward (8 weeks)
Medical ICU (4 weeks)
Neurosurgery (4 weeks)
Elective rotations (4 weeks)
Medicine clinics (4 weeks)
Vacation (4 weeks)

PGY 2: Enhanced Clinical Responsibility

The second year (PGY2) enhances clinical responsibility, including:

Neurology wards (10 weeks)
Neurology consults (15-16 weeks)
Electives (4 weeks)
Clinical rotations in various subspecialties, including movement disorders and neuromuscular clinics.
Night float rotations are implemented for better workload management.

PGY 3: Specialized Roles

During the third year (PGY3), residents begin to take on more specialized roles and responsibilities. The schedule includes:

Electives (10-14 weeks)
Neurology consults (4 weeks)
Pediatric neurology (8 weeks)
Research opportunities.

PGY 4: Leadership and Senior Roles

The final year (PGY4) emphasizes leadership and senior resident roles, with responsibilities that include:

Acting as chief residents on wards or consult services.
Participation in teaching junior residents and medical students.

Clinical Rotations

Rotations occur across multiple facilities, including Harbor-UCLA Medical Center, various clinics, and the VA Long Beach. This ensures broad exposure to diverse patient populations and neurological conditions. Residents are given a broad range of clinical experience by virtue of the large and diverse population of patients served, the multiple facilities through which residents rotate, and the broad scope of faculty expertise. UCLA Neurology offers fellowship programs across 11 subspecialties, combining research and clinical practice at eight locations.

Research Opportunities

The program encourages resident participation in research, supported by full-time faculty who are active in various areas, including clinical trials and basic science. Residents can pursue research projects as part of their electives during PGY3, allowing them to build a foundation for a potential career in academic neurology. The UCLA Department of Neurology is strongly invested in the training of undergraduates, medical students, and residents. Our faculty offer many opportunities to gain experience in clinical, translational, and basic science research. We have dedicated faculty willing to mentor students across all stages of their careers. For medical students and residents, we also have opportunities for clinical shadowing.

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Unique Aspects of the Program

Harbor-UCLA emphasizes caring for underserved communities, with a patient demographic that is diverse ethnically and socioeconomically. This focus enhances the learning experience by providing residents with the opportunity to engage meaningfully with a wide variety of neurological disorders.

Wellness Support

Recognizing the challenges of residency, the program provides wellness support, including housing stipends, educational funds, and opportunities to engage in recreational and social activities, contributing to a balanced lifestyle. Life as a UCLA Neurology resident is defined by both professional excellence and a strong sense of community. Residents form lasting bonds through shared dedication, support for one another, and a genuine love for neurology.

Visa Support

The program sponsors J-1 visas for international medical graduates, which supports their residency training and pathway to eventual board certification.

Competitiveness and Application Requirements

The neurology residency program is considered highly competitive. Applicants must submit three letters of recommendation, including at least two from neurology. osteopathic schools. Specific application requirements are in place, including eligibility for the USMLE Step examinations and adherence to a timeline that encourages early applications. We value curiosity in the pursuit of knowledge, compassion for the patients we serve, and commitment to excellence in all we endeavor.

Addressing the Need for Earlier Outpatient Exposure

There is a recognized need for earlier outpatient exposure in neurology training. In 2017, a significant percentage of residents on the American Academy of Neurology (AAN) Graduating Resident Survey expressed concerns about the timing of the fellowship process and the adequacy of outpatient exposure before making fellowship decisions. Neurology residencies have long struggled with providing adequate outpatient training. A 1994 survey of American neurology residency program directors reported a consensus that “current approaches to teaching in the outpatient setting fall short of an educationally ideal system.” It was reported that residents were spending 23% of their time in outpatient clinics, an amount thought to be inadequate.

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In 2017, 90% of residents on the American Academy of Neurology (AAN) Graduating Resident Survey reported that they would be pursuing a fellowship. However, 54% felt that the fellowship application process started too early, and 46% did not feel that they had adequate outpatient exposure before making a decision. Eight of the top 10 most commonly pursued fellowships were outpatient specialties. Currently, the majority of US neurology residencies place an emphasis on inpatient training during Post-Graduate Year 2 (PGY-2, first year of neurology training). This is notable given the ongoing accelerated timeline for fellowship applications.

The X + Y Model: A Solution for Enhanced Outpatient Training

To address this need, an X + Y model was implemented within the UCLA Neurology Residency Program in the 2020-2021 academic year. The goal was to increase outpatient exposure earlier in training. The program used a preintervention/postintervention design to assess measures of resident satisfaction, outpatient clinic exposure, the number of inpatient handoffs, resident work hours, and scores on the resident in-training examination (RITE).

The hypothesis was that outpatient clinic exposure would increase, handoffs would diminish, work hours would be reduced, measures of resident satisfaction with inpatient care, outpatient care, and well-being would improve, and that RITE scores would improve.

Implementation of the 4 + 2 Schedule

In the 2020-2021 academic year, the UCLA Neurology Residency Program adopted a 4 + 2 schedule for the PGY-2 class, with 2 weeks of outpatient rotations for every 4 weeks on inpatient rotations. This specific variation of X + Y was used to create appropriately sized resident cohorts for the PGY-2 class size and different sites requiring coverage. Schedule templates were created using variably spaced 2-week inpatient neurology blocks at 3 different hospital sites interspersed with 2-week outpatient clinic blocks.

In the traditional model, PGY-2 residents primarily covered inpatient teams at the VA, County, or the main university hospital with limited dedicated outpatient time, and rotations were 4 weeks long. In the 4 + 2 schedule, all continuity clinics were removed from inpatient rotations for the PGY-2 class and scheduled within the +2 clinic weeks. In both years, residents each had their own cohort of clinic patients. The PGY-2 residents all continued to meet the ACGME requirements of 40 continuity clinics/y, not separated by greater than 5 weeks (with the allowed exception of vacation). Finally, the clinic blocks had additional subspecialty clinics built into the mornings and afternoons during which residents were not in their continuity clinics.

Outcomes of the X + Y Schedule

The primary outcomes assessed were resident perceptions of inpatient care, outpatient care, and overall well-being, as well as outpatient exposure. The validated Learners’ Perception Survey was used to assess attitudes, and outpatient exposure was measured by the number of resident continuity clinics and total weeks on an outpatient rotation.

The number of resident clinics and the total outpatient time before and after implementation of the X + Y schedule were tabulated via analysis of the online schedule. Inpatient handoffs were also examined.

Results of the Intervention

The results of the X + Y schedule implementation were significant.

Increased Outpatient Exposure: Average clinic half-days increased significantly. Across all residents, this totaled an additional patient appointment slots added to the postintervention year.
Reduced Inpatient Handoffs: There was an overall reduction in inpatient handoffs.
Improved Resident Satisfaction: A greater percentage of satisfied responses in the postintervention class for each question compared with the preintervention class and resident responses regarding their outpatient experience improved significantly.
Enhanced Well-being: Responses regarding resident well-being improved significantly.
Fellowship Decision-Making: A higher percentage of residents reported satisfaction regarding "Being able to confidently make a fellowship decision".

Notable Faculty

The UCLA Neurology program boasts a distinguished faculty, including:

Dr. S. Thomas Carmichael: A neurologist and neuroscientist.
Dr. Charles C. Flippen II: The Richard D. and Ruth P.
Adrienne Keener: A neurologist whose primary clinical focus is movement disorders.
Dr. Katherine Fu: A neurologist focused on movement disorders with a particular interest in deep brain stimulation and neuromodulation.
Dr. Cara Siegel: A neurologist and palliative medicine specialist who leads the UCLA Neuropalliative Care Program.
Dr. David Shattuck: A Professor at the Department of Neurology at the Geffen School of Medicine at UCLA.

Recent Achievements

Congratulations to Drs. Sebastian Green, Elaine Ramirez, and Edith Yuan for their appointments as the 2025-2026 UCLA Neurology Chief Residents!

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