As a health sciences university, UCSF closely aligns clinical care, medical discovery, and teaching.

Central to this mission is the education of physician residents, doctors who have received a medical degree and are undergoing training in a specialty.

In 2007, when the Department of Neurology unveiled its flexible residency program, it directly addressed one of the most important challenges for modern academic medical centers: balancing clinical education and training with the mission of training future researchers in neurological disease.

“Medicare funding of teaching hospitals includes resources for clinical training, but not for the research training of future medical investigators,” says John Engstrom, MD, director of the Department of Neurology’s education division and residency program. A number of factors, including educational debt and lack of substantive research opportunities, can discourage many residents from pursuing this much-needed career path.

In response, Engstrom created flexible residency to support neurology residents so they can pursue research training and experience during “an early, optimal stage of their professional career development.” The program provides residents with mentors and six months of protected time to conduct research and research training, which decreases the time spent in postresidency research fellowships and allows graduates to begin their research careers much sooner.

“Graduates of this program are uniquely positioned to apply for funding earlier than their traditionally trained peers, thanks to the data and experience gleaned from studies conducted during their residency,” says Stephen Hauser, MD, chair of the Department of Neurology.  In just a few short years since the program’s inception, UCSF residents have pursued work that is relevant to stroke, Parkinson’s disease, dementia and neurorehabilitation.

The Department of Neurological Surgery provides rich educational programs, including a world-class residency program and a number of advanced fellowships.

Moreover, the program has proven to be time-effective and cost-efficient, and similar programs are gaining prominence nationwide in many different medical residency settings. The National Institute of Neurological Disorders and Stroke recently recognized the importance of this innovation and UCSF’s leadership in this area by awarding the UCSF Department of Neurology a highly competitive R25 grant.

The five-year grant is based in the Department of Neurology and allows residents in neurology, neurosurgery, neuroradiology and neuropathology to obtain research training that begins in residency and includes the first year of fellowship.

Engstrom believes UCSF is uniquely positioned to grow this program. “We have enough neurology residents that we can provide enough hospital coverage to honor our clinical service commitments, while carving out the necessary research blocks,” he says. “In addition, the rich research environment in neuroscience at UCSF provides unique opportunities for residents to pursue clinical science or laboratory science research training and experience.”

Beyond the Flexible Residency

Innovative educational opportunities in clinical and laboratory neuroscience, matched with adequate resources, characterize the educational efforts in the neurosciences at UCSF. Residents and fellows who finish at UCSF are well prepared for careers in basic and clinical research, academia, clinical neurology, neurosurgery, and public health and policy.

The neurosurgery residency training, established in 1951, has grown into an innovative, six-year program that ensures a thorough immersion in every subspecialty of neurosurgery. The program focuses on teaching the most cutting-edge practices in both research and clinical medicine, while encouraging residents to take advantage of the many collaborations the department has established to lend insight into how to succeed in a university environment. More than 70 percent of graduating residents go into this type of neurosurgery setting.

“We offer a very structured education program, and we are one of the only places that pulls residents out of all clinical exposure one day a week to spend 10 hours in didactic sessions that focus on such things as how to think about disease in a structured way, systems-based practice and the need to minimize resources,” says Berger. “We believe this makes them better physicians who are better equipped to efficiently deliver care. We know they do extremely well on their boards.”

Similarly, UCSF’s neurology training provides residents and faculty with the experience of managing the most challenging of clinical cases. In the process, there is access to some of the most respected neuroscientists and neurology clinicians in the world today.

“Our residents receive broad-based clinical experience across three hospitals and a tremendous variety of subspecialty areas,” says Engstrom. “The specific goal is to produce excellent clinical neurologists capable of providing the highest-quality care – and to develop in them qualities of intellectual honesty, curiosity and inquiry in preparation for lifelong continuing medical education.”

Fellowships and Continuing Medical Education

Beyond the residency period, UCSF offers an expansive list of potential postdoctoral education opportunities.

In neurology, postdoctoral students can choose from 27 different neurology-related basic and clinical research units, generously supported by both NIH grants and private philanthropy. Neurological surgery also offers a number of advanced fellowships, including positions in neuro-oncology, neurotrauma, and spinal and movement disorders. Both groups also offer continuing medical education courses for all health professionals.

“The education and training of our medical students, residents and postdoctoral students remain one of our highest priorities,” says Hauser.

This emphasis has made UCSF one of the top institutions in the country for graduate program training in neuroscience and neurobiology. Consistently on the “best” list in the annual survey of the nation’s top graduate schools and programs by US News & World Report, UCSF ranked third nationwide for this training program in the 2010-11 report.