Researchers for the Future: Flexible Neurology Residency at the University of California, San Francisco (UCSF)

May 12, 2008


By John W. Engstrom, MD, FAAN
Professor of Neurology, Neurology Residency Program Director, University of California, San Francisco
Author Disclosure


Encouraging the long-term career development of neurology residents interested in disease-based research will promote the cultivation of neurology research leaders for the future. The Neurology Flexible Residency has been designed to improve "the pipeline" of neurologic disease-based physician scientists by offering research experience for neurology residents in laboratory or clinical science research. Efforts by the American Neurologic Association (ANA) Leadership Group to address this challenge of developing young neurology research investigators eventually resulted in a program model presented to the Neurology Residency Review Committee (RRC) of the ACGME. Work by both groups has facilitated implementation of this new program. This article discusses the early experience with the Neurology Flexible Residency at UCSF.


Neurology Flexible Residency provides choices for neurology residents ready to explore clinical science or laboratory science research as early as the second year of neurology residency. Both MD and MD/PhD residents (three total in the 2007–2008 year) have entered the program at UCSF. Special attention to appropriately matching projects, residents, and mentors has maximized the probability of success. The six-month experience engages interested residents at an earlier stage than fellowship, allows them to "test-drive" research as a possible career focus, energizes trainee interest in research during residency, and can give trainees a competitive edge for research grant funding at the end of training. Residents continue patient care "continuity clinics" (three half-days per month) during the research to comply with neurology residency training requirements. The classic neurology residency training option of three clinical years—with a subsequent clinical fellowship—remains an equivalent choice for many residents.

Obstacles Overcome

The UCSF Department of Neurology has overcome several obstacles to implementation of the Flexible Residency:

  • The neurology residency program is now able to meet clinical patient care obligations to our medical center for resident manpower as a result of recent residency program expansion. Accreditation Council of Graduate Medical Education (ACGME)—the national organization responsible for neurology residency education oversight—has recently acknowledged the attractiveness of Flexible Residency for some residency training programs. View examples of available programs.
  • The total cost of a research training experience, per trainee, is $50,000 for six months, including salary, benefits, and equipment/supplies. It is not widely known that no resident research can be funded by Medicare, the largest source of medical education funds for residency training. The Flexible Residency Program in Neurology at UCSF has secured funding for the research experiences; consistent long-term funding mechanisms are desirable for the future. For example, National Institute of Neurological Disorders and Stroke (NINDS) is considering funding some resident research experiences through a nationwide program.

Other research programs currently exist for laboratory research in internal medicine and child neurology that reduce clinical training time, but the program structure is different. Commitments are usually made prior to residency. One advantage of Flexible Neurology Residency is that the decision to engage in a specific research area can be driven by interests developed during early trainee clinical experiences.

Other advantages of Flexible Residency are summarized by two of our first trainees:

"As I near the completion of my R4 year and look forward to the next stage of training, I am very glad to have been a part of the Flexible Residency Program at UCSF. It offered a unique opportunity to pursue my interest in the multidisciplinary field of neuroprosthetics. Only through such a protected research experience was I able to plan for a smooth transition from residency to the laboratory setting. During my six months in the laboratory, I was able to generate preliminary data for future projects as well as for grant applications. In addition, I was able to apply for and secure funding. Given how seemingly effortless it has been to plan the next stage of my career, I find it difficult to imagine a path without the program."Karunesh Ganguly, MD, PhD

"I am grateful for having had a chance to try my hand at clinical research before making decisions about fellowships and future training. This time has allowed me to figure out that I really do want to pursue an academic career, and it will definitely speed the process of obtaining grants and getting started in academia. It's also allowed me a chance to take several courses in statistics and epidemiology, which will serve me for the rest of my career. In the end, there's no better evidence of how well our Flexible Residency program is succeeding than the fact that almost all of our younger residents are eager to sign up."Hooman Kamel, MD

The Future

Additional clinical training options for the Neurology Flexible Residency program at UCSF will be developed in the next one to two years. For example, residents may choose to develop specific expertise in clinical education, global health, or hospitalist neurology. The concept of increasing the efficiency of clinical and academic training for the next generation of neurologic physician-scientists and academic leaders has been well received by many potential future neurology trainees. The greatest benefits for physician training will be realized when the Neurology Flexible Residency becomes a standard model nationwide for the training of academic neurologists.

Editors' Note: This informative article represents the experience of the Neurology residency at UCSF. We would like to hear from other residencies that have a Flexible program in place and in particular from any trainees, past or current, in those programs. Please write to us about your perceptions and experiences in the Comments function below.—John W. Henson, MD, FAAN, and Daniel B. Hier MD, MBA, FAAN

Author Disclosure

Within the past 24 months, the author received personal compensation from the Allergan Scientific Advisory Board 4-07, and was asked to provide advice regarding the use of botulinum toxin. However, he had no relationship to the neurologic education of trainees. Additionally in that period, he has given occasional testimony and depositions as an expert witness in medical malpractice cases, which that have no relationship to neurologic education of trainees. Dr. Engstrom performs occasional expert witness work that has no relationship to educational issues.