Overview by year
Our neurology residency is a four-year categorical program that integrates residents early, allowing them to focus on learning neurology. The first year of internal medicine training at Barnes-Jewish Hospital provides a strong foundation in clinical practice. Interns rotate through the medical intensive care unit (MICU) and inpatient floors, including cardiology and other specialty services. They also participate in internal medicine electives and the hospitalist procedures team. The internal medicine department is “resident run,” and the complexity of patients at Barnes-Jewish ensures interns become proficient in managing common illnesses that prompt admission.
The psychiatry requirement is fulfilled during the intern year, freeing up elective time during neurology training. Interns lead an inpatient psychiatry service under attending supervision and gain experience in acute primary psychiatry.
Interns are well-integrated into the neurology department and spend several weeks on inpatient neurology services, including consult, primary neuro-hospitalist general neurology and primary vascular neurology. They also gain early exposure to EEG and patient care on the epilepsy monitoring unit.
To support fellowship and career planning, interns rotate through subspecialty attending clinics in neuroimmunology, neuroinfectious diseases, movement disorders, neuro-oncology, epilepsy, sleep medicine, neuromuscular medicine, neuro-ophthalmology and cognitive neurology. Those pursuing the physician-scientist track may begin research electives during the intern year.
This is the first formal year of neurology training and the most demanding, offering extensive exposure to neurological illnesses. Residents spend most of the year on inpatient general neurology and stroke services alongside neurology, pediatric neurology, psychiatry and PM&R residents. PGY-2 residents also serve as junior residents on the consult and hyperacute stroke services.
On these services, PGY-2 residents evaluate all code strokes, perform NIH Stroke Scale assessments and make decisions regarding thrombolytics and/or mechanical thrombectomy in consultation with a stroke attending or PGY-4 chief resident. Our program emphasizes resident autonomy in acute stroke decision making.
Residents complete one month in the neurology/neurosurgery intensive care unit, taking primary responsibility for critically ill neurological patients. All inpatient rotations use a night float system. By year’s end, residents function independently on inpatient services and confidently manage hemorrhagic and ischemic strokes. Additional exposure includes subspecialty clinics, EMG and EEG.
This year focuses on transitioning into the senior resident role. For 8–10 weeks, residents lead the neurology consult service with faculty supervision, managing patients from other services and the Emergency Department. They mentor team members, including PGY-2 neurology or PGY-3 pediatric neurology residents, internal medicine residents, psychiatry interns and PM&R interns. PGY-3 residents help junior colleagues make acute stroke management decisions, including administering tenecteplase (TNK).
The remainder of the year includes night float, inpatient neurology, neuro ICU and elective time. Electives may include clinical rotations, medical education teaching or clinical/basic science research. Custom electives can be arranged within the institution. Master clinician track residents collaborate with mentors to develop a personalized curriculum. Residents also rotate with community neurology partners in a Community Neurology Practice rotation. Six weeks of inpatient pediatrics at St. Louis Children’s Hospital are included in this year.
This final year includes 10 weeks as chief resident on either the inpatient stroke or general neurology service. This capstone experience allows residents to serve as pre-attending physicians, leading all aspects of the service. Chiefs manage admissions, guide junior residents, assist with acute stroke decisions and oversee a complex inpatient service. With faculty support, they lead an academic neurology team and mentor residents, interns, nurse practitioners, sub-interns and medical students.
Graduates are well-prepared for academic or community practice. The rest of the year includes electives and rotations through adult and pediatric subspecialty clinics. Residents refine clinical knowledge, complete research, write grants and gain experiences aligned with their career goals.
Electives
“If you can think of it, there’s a WashU Medicine resident who’s done it.”
Omar Butt, MD, PhD ’20
The program takes pride in providing the most elective time of any adult neurology residency program in the country — 35 weeks for exploring clinical or research interests.
ADRC dementia
EMG
EEG
Epilepsy
Genetics
Headache clinic
Medical student education
Movement disorders
Multiple sclerosis clinic
Neuromuscle
Neuro-infectious disease
Neuro-oncology
Neuro-ophthalmology
Neuro-otology
Neuropathology
Neuroradiology catheter angiography
Neuroradiology
Neurorehabilitation
Neurosurgery
Neurovascular
Psychiatry
Research
Sleep medicine
TEACH