Neurology is an evolving specialty with tremendous potential for diagnosis and therapies. Patients present with fascinating diseases, providing a constant challenge and a hugely varied experience for a lifetime. If you are seriously considering neurology, you should try to do your rotation early in the fourth year (preferably blocks 1,2, or 3) to confirm your decision. I found it very helpful to do my medicine sub-I early in the year as well. However, the experience for a rotation on the wards is very resident dependent and you may not get enough exposure to the attendings for a recommendation. A 1-2 week shadowing experience at one of the outpatient clinics with an attending who will be your advisor will be very helpful. And if you are not sure whom to select as an advisor, you can also do a week or two of outpatient, spending time with a different attending every day. This way you can also see what each neurological subspecialty is like, since most academic neurologists sub-specialize. If you already have a field of interest, it will narrow down your residency selection considerably.

It is not necessary, but it is very helpful to do an outside rotation. Since our institution has a relatively small inpatient facility and a very clinically oriented service, we do not have our own neurology floor or neuro-intensive care units. These extras add a very different flavor to neurology as a more intensive specialty. Other institutions also have larger research facilities, whereas we are more clinically oriented. So whether you want to stay in the academic arena or go into private practice, a different perspective is invaluable. If you are going to do one, keep in mind that there are other rotations that may be listed under other fields but interact with neurology, such as pain management, rehabilitation, ophthalmology, or some aspects of pulmonary (sleep).

In addition to general adult neurology, there are a number of combined specialties: pediatric (child) neurology, medicine/neurology, neurology/rehabilitation medicine, and neurology/psychiatry. Fellowships in neurology include cerebrovascular, epilepsy, movement disorder, clinical neurophysiology, behavioral neurology, neuromuscular, neuroimmunology, neurologic intensive care, neuro-infectious disease, neuropathology, pain management, sleep, and a few super specialized fields such as neuro-otology, experimental therapeutics (U. Rochester only), occupational neurology (BU), and research.

Applications are not yet on ERAS, and the easiest way to obtain information and applications is to register with the Neurology Matching Program through the Office of Student Affairs in the spring of third year. They will send you a complete catalogue of all neurology programs and how to get in touch with each one.

Begin requesting applications in June or July. The applications are usually very easy: name, address, name of recommenders, a CV, a photo, and a personal statement. SO PLEASE DON'T WAIT UNTIL AFTER OCTOBER! UCSF, for example, will only interview applications that are complete by early October. As it is an early match, most applications are due by mid-September, but some programs have later deadlines. Some programs will not evaluate your application until it is complete, including all letters of recommendation.

I recommend that you talk about your career with Dr. Carlos Kase, who is well known and well-respected in the field of cerebral bleed and is currently the residency director at BUMC. Another resource is Dr. Janice Weisman, the fourth year clerkship director. Some institutions require a letter from internal medicine, and you might find it useful to use that letter as one of your three for all schools.

Interviews begin in October and run through mid-January. You should expect to be interviewed by 2-6 people at each visit, and you will meet the program director and chairperson everywhere. Neurology interviews are LONG, especially at the more competitive residencies (it may be trivial, but life-saving to wear comfortable shoes and suits). You can interview straight for up to six hours and then go for a tour of the campus. This is in part due to the fact the neurology departments are usually small. They want to make sure most of the attendings have a say in choosing you and like to work with you in the future. However, the most useful time is usually the night before the interview, where many programs invite you to an expensive restaurant with its residents. This is where you can ask all the questions and get a great meal. So make sure you go! This is also where you meet your future classmates and see how happy they are in the program. In general, the program where more residents show up for dinner is a good indication for amore cohesive group of residents. There are places that offer a good meal, but only have two residents show up because the others are too busy on the wards or they can't find enough residents to give a positive view of the program--yes, it's true, and beware. All in all, take everything with a grain of salt because people have different, if not inaccurate views of everything. What helped me the most is to interview the programs back! Talk to BU grads at that particular institution or take a second or even a third look (if distance permits). The interview day is usually one of "song and dance" put on by the residency for you. So select a random day to go back because it is more difficult to be rehearsed. You can have a second look at more than one institution to compare. This way you do not have the performance anxiety of interviews and just see what a day in your future is like. Also note the number of foreign medical graduates (FMG’s), both in the program and interviewing, as that is an indication of how well a program has previously performed in the match. Some programs would rather go unmatched than fill with FMGs, although these programs are usually mediocre programs. You should realize that a lot of the pioneers of neurology are from other parts of the world, and that neurology is a very international field. For example, the most noted book on the anatomy of the brain is from Germany. So top programs in the United States bring applicants from all over the world to interview at their institutions and try to foster intellectual exchange that way. Vice versa, a lot of top residency programs encourage residents to go all over the world for electives and collaborate with other countries in research. For example, MGH has a strong tie with South America, Johns Hopkins has a major project in China. These extras are what make the residency more attractive. So keep an open mind when you see your fellow foreign applicants.

Obviously, you need to find the program that fits your needs best. Some things to keep in mind when looking at programs are:

Currently, the programs generally regarded as the best are MGH-Brigham, Columbia, Johns Hopkins, and UCSF. Others include Wash U. in St. Louis, Mayo Clinic, Cleveland Clinic, and many others. However, if you want to go into private practice, it may be more beneficial for you to do your residency in the location you want to practice to get to know the area and be affiliated with the local hospital when you practice. What make the top residencies "top" ane research dollars and a wide range of sub-specialties for fellowships. If you are clinically oriented and want to be a generalist, "name-brands" may not be very helpful. Generally, people chose either an academic or private track, and programs are geared for one type of training or the other.

Also, remember that you need a year of medicine or a transitional year with at least 8 months of medicine. It is helpful to find a neurology program that guarantees a preliminary medicine year or at least will arrange a medicine interview while you are visiting the neurology program. All preliminary and transitional programs are on ERAS. Historically, many neurology spots remain unfilled. This is in part exacerbated by the that fact neurology programs are more flexible than larger fields such as medicine or surgery. They would rather go unmatched than take the right number of applicants to spread the workload. And likewise, applicants would rather match at a neurology residency of their choice or will rather go unmatched, or go into another field. But from my experience, if you are serious about neurology, applying to more programs will not hurt you. The only steady trend is that the number of average applications by a student has almost doubled from a few years ago. (1991: 10 per student; 1999: 18.9 per student.) Look up http://www.sfmatch.org and make up your own mind about the numbers. More applicants are considering neurology (1991: 704 applicants; 1999: 1752 applicants) as a thriving specialty and you should prepare yourselves for a more competitive residency selection process and in the end you will do spectacularly.