Neurology Residency - Research Track
Academic neurologists and neurosurgeons have a keen interest in nurturing and
supporting trainees in residency programs who are interested in pursuing careers
in academic medicine. The neurology residency program at The University of Chicago
Medical Center is now offering prospective neurology residents the option of
completing their training as part of a "research
track." Residents
on this  track
will meet all of the ACGME requirements of neurology residency training and will
be board eligible upon completion. However, trainees on this special research
track will also accomplish the following objectives:
- participate in the generation of new knowledge in the neurosciences;
- gain a better understanding of the relationships between basic neuroscience and clinical medicine; and
- develop strategies for diagnosis and treatment of diseases of the nervous
system.
It is our premise that neuroscientists and epidemiologists, also trained in clinical neurology or neurosurgery, represent our best hope for the
future in developing and translating knowledge to expand treatment options in clinical neuroscience.
The clincial and academic neurologist and neurosurgeons at The University of Chicago
Medical Center have developed an organizational structure and educational program
for training neurology and neurosurgery residents in the day-to-day conduct of
research, the ethical considerations that lead to honest science that is respectful
of humans and animals, experimental design and statistical analysis that lead
to interpretable results with impact, and the writing of grant proposals that
contain important questions and clearly stated methods of answering them.
Eligibility Criteria
Research
training will be offered to residents based on identification of an appropriate mentor and development of a promising research proposal.
 During the first phase of research education, neurology residents will perform
six to 12 months of mentored research in a clinical or basic neuroscience laboratory
within their PGY-III and PGY-IV years of training. Neurosurgery residents will
perform 12 months of mentored research during their PGY-IV year of training.
The majority of training
during this Phase I will take place within the research laboratory of the
mentor, and include basic technical research skills and scientific communication,
including oral and poster presentation and writing research reports. As part
of Phase I, research track residents will also participate in a weekly evening
seminar course that covers issues of experimental design, research implementation,
ethics, and biostatistics.
The second phase of research training will occur during a neurology fellowship
year, after the neurology resident has completed residency training, or in
the PGY-V year of the neurosurgery residency. In addition to consolidating
research and communication skills acquired in the previous year, the focus
of Phase II will be a year-long seminar course in grant-writing, which incorporates
the actual writing of an NIH K08 or K23 research proposal. By learning how
to develop questions and organize research methods to answer them, all in a
setting of interactive discussion and mutual supportive criticism, the trainee
will gain the skills necessary to compete for research funding in a competitive
environment. Phase II also includes a one-quarter course in the responsible
conduct of research, as well as optional neuroscience and/or epidemiology
coursework.
At the end of Phase II, all participants will have completed an NIH research
application (K08 or K23 application) that can be submitted to the NIH for peer
review.
Background and Significance
Although our country needs community neurologists and neurosurgeons, the long term needs of society also include the generation of new knowledge in
the neurosciences, greater understanding of the relationships between basic neuroscience and clinical medicine, and better tools for diagnosis and
treatment of diseases of the nervous system. It is our premise  that
neuroscientists and epidemiologists, also trained in clinical neurology or neurosurgery, represent our best hope in developing and translating knowledge
to expand treatment options in clinical neuroscience.
The Long Range Planning Committee of the American Neurological Association (ANA) recently published the results of a two year investigation into the
causes and possible solutions to this problem (Hauser & McArthur, 2006). A major recommendation was to permit some residents to have significant
research exposure during the earliest part of their careers while there remains time for them to gain confidence and experience as researchers. Their
proposal for a “flexible residency” (Engstrom,
2007) has been approved by the ACGME, and such an option has been initiated at a number of
institutions, including at the The University of Chicago Medical Center.
The final benchmark for our program will be a grant proposal written by each trainee during a one year seminar course that anchors the second half of
the training program. In Neurosurgery, all programs include one to two years for training in research or other activities related to neurosurgery or
the neurosciences. Residents typically work in basic laboratories or on clinical research projects during that time. Neurology and neurosurgery
residents will participate in identical mentorship and training activities, although the time lines will differ slightly. In addition, neurology
residents will be encouraged to apply for and participate in the summer school offered by the ANA on clinical neuroscience. This course was developed as
a direct consequence of the second recommendation of the Long Range Planning Committee, which aimed to address directly a perceived educational need of
the flexible trainees.
The third recommendation of that committee was to improve mentoring and career guidance. Both junior and senior faculty can play mentorship roles. All
trainees will have a mentor and a co-mentor; the co-mentor of junior faculty be a highly experienced senior faculty member. We have developed
post-residency training programs in clinical research and have incorporated an option for trainees in the second half of their program to acquire formal
certification in clinical research.
History
Neurology and neurosurgery have a long and interwoven history at the The University
of Chicago. The University of Chicago was founded in 1892, and that very same
year, Harold Donaldson started a Neuroscience program at the University. The
American School of Comparative Anatomy, which linked brain structure with behavior
and function, was born here several years later. The close relationship between
Neurology and Neurosurgery at our institution was embodied early in Percival
Bailey, an illustrious neurosurgeon, who was also intensely interested in neurology
and neuropsychiatry. He moved to Chicago after training with Harvey Cushing in
Boston and worked closely with many members of the University of Chicago neurological
faculty. One of these Chicago neurologists was Paul Bucy, who together with Heinrich
Klüver,
a morphologist and behavioral scientist, paved the way for a major understanding
of the temporal lobe by describing the Klüver-Bucy syndrome. A. Earl Walker,
under the stimulus of Steven Polyak, laid the foundation for all subsequent understanding
of the thalamus. W.H. Sweet made remarkable contributions to the study of pain.
Ralph Cloward developed the use of titanium plates in brain surgery and bone
grafts in lumbar disc surgery. Later, Theodore Rasmussen summarized and analyzed
the existing body of information on the response of the human cortex to electrical
stimulation, and with others (Penfield, Jasper, and Feindel) laid the basis for
the modern surgical management of epilepsy.
Neurological Surgery
Percival Bailey founded the Neurosurgery service in 1928. Neurosurgical training
began during Bailey’s tenure, and had a major impact
internationally. Francis Murphy and Joseph  Evans, both of whom interned in Chicago,
and Oscar Sugar, who worked in basic science, were early trainees. From abroad
came John O'Connell, who later returned to head St.Bartholemew
in London, Stender in Berlin, Araki and Tanaka in Kyoto, and Juntendo in Tokyo.
Shimuzu went on to become the chairman at the University of Tokyo. Clovis Vincent,
Marcel Kline, and Pierre LeBeau came from Paris and returned to establish the
second major neurological school in France. Additional international trainees
in the post WWII period included Shozo Ishii, Chairman of Neurosurgery at Juntendo
University in Tokyo and later President of that University; Charas Suwanwela,
Chairman of Neurosurgery at Chulalongkorn University in Bangkok and later Dean
of that medical school; Professor Mimo Vailati of Bari, Italy; and Professor
Boris Klun of Lublijana, Yugoslavia. Several University of Chicago medical students
from that period became prominent neurosurgeons, including Joseph Ransohoff,
who became chair at the New York Hospital and Nicholas Zervas, later chief of
Neurosurgery at the Massachusetts General Hospital. John Jane, who became chair
at the University of Virginia, underwent part of his neurosurgical residency
training at the University of Chicago. Since the start of the modern training
era in 1952, the Division of Neurological Surgery has graduated 39 residents,
nine of whom remain active neurosurgical faculty members across the country.
Over the past decade, the number of neurosurgery trainees interested in academic
careers has unfortunately declined. The recent appointment of David Frim MD PhD,
to head the Division, marks a new era for Neurosurgery at the University of Chicago,
with new approaches to resident recruitment and changes in the training program.
Neurology
Since the start of the modern training era in 1943, the Department of Neurology
has graduated 213 residents. Between 1951 and 2005, including all residents
on which we have some information, and excluding those from 2006 to the present
(who are still in fellowship training), there are 155 graduates in the sample
we examined for purposes of this analysis.  Many
of these former residents remain active neurology faculty members in a large
number of institutions in the United States. A large number of these alumni
of our program are well funded by the NIH and other organizations, and many have
positions of academic leadership. Our own department chair in Neurology, Christopher
Gomez MD PhD,
trained as a resident at the The University of Chicago before his highly successful
academic career at the University of Minnesota. The trends in our Department
of Neurology have not changed much over the past half century. Overall, in the
years 1951-2005, we graduated 155 residents and 62 of these remain in academic
neurology (40%). These academic neurologists are at many institutions, including
the The University of Chicago Medical Center (10/62), Rush (7), Illinois (4),
Pittsburgh (3), BU (3), MGH (2), Cleveland Clinic (2), UCLA (2), NIH (2), deCode
Genetics (2), and one each at BI-Deaconess, British Columbia, Colorado, Dartmouth,
Duke, East Ramon (Philippines), Georgetown, GW, Johns Hopkins, Kentucky, MCW,
Michigan, Minnesota, Missouri, Nevada, Penn, Rochester, Rutgers, Scripps, UAB,
UMDNJ, USC, USF, UT Southwestern, and at the ACGME. Many others are in research
careers in industry. The current chairs of neurology at Chicago (Christopher M. Gomez)
and Colorado (Donald Gilden) trained in our program, as did the former chair at
Pittsburgh (Robert Moore) and possibly others. Several former heads of pediatric
neurology, including at MGH (Charles Barlow) and the Mayo Clinic (Emanuel Gomez),
and the current head at UCSD (Doris Trauner) trained at the The University of
Chicago. The director of NIH NCMRR (Michael Weinrich) is a former
resident. The funding record
of these former trainees is quite strong.
The most recent ten years (1996-2005) reflects only a slight decline in the number
of academic neurologists, perhaps distinguishing our program from those programs
around the country that have had a steeper decline. During this 10-year period,
we had 46 graduates from the residency program, and of these, 16 are currently
in academic positions (35%). Our fellowship programs have also been successful
at training academic clinician-scientists. Particular strengths in the history
of neurological training include neuroimmunology (multiple sclerosis, myasthenia
gravis, peripheral neuropathy, paraneoplastic syndromes), neurophysiology and
sleep, and neurodegeneration and amyotrophic lateral sclerosis. In the first
group, 20/23 have gone on to academic careers, and the majority are academic
thought leaders pertaining to the diseases of their expertise. Recently, our
strong neurological critical care fellowship has also been successful. Among
the fellows in neurophysiology and sleep medicine, 76 fellows were trained between
1976 and the present, and of these, 33 are in full-time academic positions,
and another 8 have part-time academic appointments.
Leadership
Research Track Program Director
Steven L. Small
MD PhD is Professor of Neurology at the The University of Chicago
Medical Center. He is also Professor of Psychology and Senior Fellow at the Computation
Institute, and is on the graduate training
faculties in Neurobiology, Computational Neuroscience, and Psychology. Dr. Small
completed his undergraduate training in mathematics at Dartmouth College, his
PhD in cognitive science and  artificial
intelligence (Computer Science) at the University of Maryland, and his MD at
the University of Rochester. He completed a residency in neurology at the University
of Pittsburgh, where he served as Chief Resident. He came to the The University
of Chicago in 1999 to found the Brain Research Imaging Center.
His major efforts are devoted to research and teaching in the area of higher
cortical function. His recent work aims to use physiological methods to remediate
language disorders and hand motor dysfunction in stroke. His laboratory is currently
funded by five NIH grants, including grants from NINDS, NIDCD, and NICHD. Four
of these five grants involve the neurophysiological study of both interventions
and natural course of recovery for adults with hand motor dysfunction after
stroke (NINDS: R01NS054942; PI: Dr. Ana Solodkin), aphasia (NIDCD: R01DC007488,
R33DC008638) and for children with perinatal stroke (NICHD: P01HD040605: Project
IV). The fifth grant (NIDCD: DC003378) funds basic
scientific work on the neural basis of human language. Previous funding includes
work on the neural reorganization after motor stroke (1997-2002: NINDS: NS037195),
among the largest functional imaging studies on stroke recovery (Small
et al., 2002). Dr. Small has considerable experience as an educator. Prior to attending
medical school, he was a full-time faculty member at the University of Rochester,
where he was given strong marks as an undergraduate teacher. Subsequently, he
has had the opportunity to teach undergraduate, graduate, and medical students
as a member of a variety of departments and interdisciplinary PhD programs, including
Neurology, Psychology, Psychiatry, Neurobiology, Computational Neuroscience,
Physiology, Computer Science, and Radiology. He has participated in numerous
training grants in neurobiology and psychology, and in the MSTP programs at Pittsburgh,
Maryland, and Chicago. Dr. Small has given many lectures and laboratories in
medical school courses, including Neuroscience, Pathology, and Radiology, and
given numerous lectures to Residents and Fellows in Neurology, Neurosurgery,
Radiology, Pediatrics, and Otolaryngology. Dr. Small also plays an international
role in scientific scholarship, reviewing manuscripts for over two dozen scientific
journals and grant proposals for numerous NIH study sections, international agencies,
and foundations, participating in program and local arrangement committees for
international conferences, and similar activities. He is the Editor-in-Chief
of the international journal Brain and Language. Dr. Small was the recipient
of a K award in 1991, and has since been mentor or co-mentor on at least 4 K
awards, including awards from NINDS (K01: Catherine Ojakangas), NIDCD (K08: Daniel
Llano), NIMH (K01: Ana Solodkin; K23: K. Luan Phan), as well as NRSA and private
foundation awards. He is widely sought after as a teacher and lecturer, and has
lectured at universities worldwide, including a number of named lectures.
Research Track Program Co-Director
Anthony Reder MD is Associate Professor of Neurology at the The University of Chicago
Medical Center. He is interested in the immunologic cause of multiple sclerosis. Laboratory efforts have centered on studying the clinical effects of
immune dysregulation on neurological diseases, especially MS. Recent work has demonstrated the neuroendocrine  effects
on immunity in MS, fluctuations in immune cell surface proteins and cytokines that correlate with disease activity (and may represent drug targets),
and discovery of a defect in Ser-STAT1 phosphorylation during progressive MS that may prevent effective interferon therapy. Dr. Reder has been a
committed educator. From 1989 to 2003, he served first as associate director and then director, of the Neurology residency program at The The University
of Chicago Medical Center, selecting residents, supervising and helping to guide their progress in the program, handling program evaluation by
internal and external committees (receiving full 5 year ACGME accreditation at each such review), dealing with personal crises of individuals and
organizational issues at a programmatic level. psychological intervention, in every aspect of residency training. During Dr. Reder’s tenure,
residents were encouraged to write papers and to assist in clinical trials. Dr. Reder has been PI or Co-I in 35 clinical MS trials over 15 years,
including two NIH-funded studies, two investigator-initiated projects, and 31 sponsored by pharmaceutical companies. He currently supervises all MS
clinical trials at the The University of Chicago Medical Center. He helped design and execute the pivotal trial of interferon-b-1b in MS. His clinical
studies have led to new treatments for MS (IFN-β, glatiramer acetate, mitoxantrone, anti-VLA-4) and ways to ameliorate MS symptoms (tizanidine
for spasticity; misoprostol for trigeminal neuralgia). Working with Dr. Reder, residents and fellows obtain hands-on experience in design, management,
and analysis of trials. Over the past 25 years, Dr. Reder has trained 9 Post-Docs, 22 Neurology residents, 3 graduate students, 10 medical students,
and 52 undergraduate students in various clinical and basic projects. Most of these trainees have been involved in clinical trials, and others have
participated in patient-oriented research in the laboratory. Residents serve as blinded examiners in clinical trials, an excellent exposure to the
methodology and analysis of controlled investigations with human subjects.
Optional Coursework for Trainees
(during the second portion of the training program [Neurology: Fellowship year; Neurosurgery: PGY6])
Epidemiology |
Neurobiology |
| Principles of Epidemiology |
Neuroethology |
| Epidemiologic Methods |
Behavioral Neurosciences |
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Vertebrate Neural Systems |
Biostatistics |
Cellular Neurobiology |
| Introduction to Biostatistics |
Molecular Neurobiology |
| Applied Regression Analysis |
Developmental Neurobiology |
| Analysis of Categorical Data |
Genetic Approaches to Neurobiology |
| Biostatistical Methods |
Synaptic Transmission |
| Design & Analysis of Clinical Trials |
Animal Nodels of Neuropsychiatric Disorders |
| Topics in Bayesian Statistics |
Excitable Membranes and Ion Channels |
| Introduction to Survival Analysis |
Advanced Topics in Theoretical Neuroscience |
| Longitudinal Data Analysis |
Neurobiology of Disease I |
| Bayesian Methods for Biostatistics |
Neurobiology of Disease II |
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Health Services Research/Outcomes |
Computational Neuroscience |
| Introduction to Health Services Research |
Mathematical and Statistical Methods for Neuroscience I |
| Demography of Aging and the Life Course |
Mathematical and Statistical Methods for Neuroscience II |
| The US Healthcare Industry |
Computational Neuroscience I Single - Neuron Computation |
| Cost Effectiveness Analysis |
Computational Neuroscience II - Vision |
| Health Outcomes and Quality of Medical Care |
Computational Neuroscience III - Cognitive Neuroscience |
| 38000 Health Status Assessment: Measurement Inference |
Neuromechanics of Human Movement |
| Applied Regression Using Small Area Variations |
Neuroprosthetics |
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Electronics |
Links
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