Education Research: The current state of neurophysiology education in selected neurology residency programs
Objective Prior research has illustrated there is a knowledge gap in neurology residents' neurophysiology education (EEG and EMG), and we sought to understand whether this is still an issue and to recognize the barriers in order to create solutions and improve education. Methods Surveys were developed for adult neurology residents and one for program directors asking about confidence in neurophysiology knowledge, percent of graduates reaching level 4 ACGME (American Council of Graduate Medical Education) milestones in EEG and EMG, methods of learning used, interest in the subjects, and suggestions for improvements. Results Twenty-six program directors (19% responder rate) and 55 residents (from at least 16 different programs) completed the survey. Program directors thought that 85% of graduating residents met level 4 milestones in EEG and only 75% in EMG. Structured rotations and more time allocated to education of these topics were frequent barriers mentioned. Postgraduate year 4 residents were 60% and 67% confident in EEG and 64%, 59%, and 62.3% in EMG level 4 milestones. Learning to read EEGs was considered important throughout residents' training; however, this interest and value decreased over time with EMG. Conclusion In our study, program directors suspect up to a quarter of residents may graduate not meeting level 4 ACGME milestones, and residents expressed lack of confidence in these areas. The educational methods used to instruct residents in EEG and EMG were similar as were the barriers they face across programs. This information hopefully will help fuel curriculum design and interest in these important neurology techniques.
Neurology residency training at the millennium
Neurology training is changing because of the explosion of information and new treatment modalities that became available during the 1990s, the Decade of the Brain. The Residency Review Committee (RRC) mandated curriculum changes in 1998. During the same decade, the number of American medical graduates (AMG) who entered neurology declined. This occurred as the total number of positions was at an all-time high. An increasing number of positions in the mid-1990s were either filled by international medical graduates (IMG) or remained unfilled (Doug Perry, personal communication, 2001). Funding for residency positions has been threatened and lost because of changes in Medicare funding and reallocation of specialty residency slots to generalist slots within the Veterans Affairs (VA) system.1 In addition, the clinical income used by many academic departments to support teaching and administrative activities has been substantially reduced by managed care. Academic physicians now have less time to teach.2 Similar stresses in other specialties have led to high turnover rates among residency directors.3

In 1999, the Graduate Education Subcommittee (GES) of the American Academy of Neurology (AAN) conducted a survey of adult neurology program directors (ANPD) to ascertain the state of neurology training programs. The goal was to characterize current program content and performance, applicants and the neurology residency matching program (NEMP, “the match”), characteristics of training program directors, and type and amount of administrative support for residents. We wished to identify current trends in neurology resident education and how programs are dealing with major challenges.

The GES designed a 45-question survey to assess the issues described above. Survey questions were determined over the course of several meetings by members of the GES, the majority of whom were ANPD or had been in the past. The responses were anonymous, although members of the AAN GES staff were able …
Neurology in the next two decades
The last 20 years have seen an explosion of knowledge about the neurosciences and neurologic diseases. In the next two decades, we can expect a dramatic expansion in our ability to diagnose and treat neurologic diseases. It is necessary to maintain the quality of the neurologic workforce. This requires attracting outstanding medical students to neurology, thus maintaining a high quality of applicants to neurology residency programs. We are observing an increasing proportion of international medical graduates (IMGs) in our residency programs. There is concern about what effect changes in health care delivery in the United States will have on the number of residency positions and the utilization of neurologists in the coming years.

The Workforce Task Force (WFTF) was appointed by the American Academy of Neurology (AAN) Board of Directors to address these concerns and to recommend ways to enhance the neurology workforce in the next two decades. This report is the result of 2 years of research and deliberations, assisted by Vector Research Inc. The full report is published on the AAN’s website (www.aan.com). The report considers adult and child neurologists, MD and DO neurologists, neurologists in training and those already qualified, and all branches of the profession—namely practice, teaching, research, and administration. It deals with supply and demand, quality, and the attraction of outstanding medical students to neurology.

### Supply projections.

The projections of the WFTF and Vector Research Inc. were based on the Bureau of Health Professions Physician Supply Model, using the American Medical Association Masterfile data, estimates of age- and sex-specific death and retirement rates, and the number of graduating neurology residents. Three scenarios were projected. The Baseline Scenario assumed that the number of neurology residents graduating each year remained constant at the 375 for 1996. The High Scenario was based on the projection by the Neurology Residency Matching …