Neurology: Education Programs
The Division - both faculty and residents - has always played a significant role in the preclerkship portion of the MD Program, overseeing teaching for over 250 medical students each year at both the St. George and Mississauga campuses. Our faculty has won a W. T. Aikins Faculty Teaching Award in recognition of excellence in course/program development and coordination or in the development and use of innovative instruction methods.
The preclerkship curriculum is known as the Foundations Curriculum. Within the Foundations Curriculum, the Concepts, Patients & Communities 3 (CPC 3) is a 16-week course in Year 2 of the MD Program that employs the organizing structure of the human body’s physiological systems to offer students an integrated approach to clinical medicine. The 16 weeks cover the musculoskeletal system (3 weeks), neurologic system (6 weeks), psychiatry (4 weeks), and special senses (ophthalmology and otolaryngology/head & neck surgery; 3 weeks). Our faculty and residents were integral in developing e-learning materials (videos, self-learning modules), delivering lectures, leading small-group workshops, facilitating case-based learning (CBL) and health science research (HSR) tutorials, acting as Academy Scholars as part of the Portfolio component, and developing assessment questions for weekly quizzes and mastery exercises.
Our residents are also regularly involved in teaching small-group workshops in CPC 3 and, if time permits, CBL (formerly problem-based learning) tutoring as well. Many of them have also been involved in developing content (e.g., lecture videos, self-learning e-modules, CBL case modules and case guides) for the Foundations Curriculum. Our faculty and residents also participate in clinical skills teaching within the Integrated Clinical Experience (ICE) component of the Foundations Curriculum, including, but not limited to, the sessions on the Neurological Examination.
In clerkship, our divisional faculty members also participate in teaching activities during the Medicine rotation, including the preceptorship program, seminars, bedside physical examination sessions, the ambulatory clinic component, and integrated OSCE.
Our faculty also regularly supervise medical students in projects encompassing both basic neuroscience and clinical research, including the Comprehensive Research Experience for Medical Students (CREMS).
Student Interest Group in Neurology (SIGN)
Dr. Aaron Izenberg, Site Director for Sunnybrook Health Sciences Centre, is also involved in the sustained undergraduate mentorship in neurology through SIGN, an initiative sponsored by the American Academy of Neurology.
This group meets regularly for a variety of activities including ward walks, case discussions and social events with staff neurologists and neurology residents. The primary goals are to help students gain further insight into the specialty of neurology and to foster their interest in considering neurology as a career choice.
On an annual basis, Dr. Izenberg arranges for an event where the student members of SIGN can engage directly with the Division Director of Neurology, Program Director, Deputy Program Director, members of the NEC, and resident representatives for each year. This event provides an opportunity for students to learn more about the neurology residency program and a career in neurology.
Electives in Neurology
Our program accepts medical students for 2 to 4 week electives in neurology. Electives can be on the in-patient clinical teaching units or outpatient subspecialty neurology.
Neurology is a 5-year entry-level accredited residency program. It is the largest adult neurology program in Canada with 38 residents in the program.
Resident Selection Process
We receive both Canadian Medical Graduate (CMG) and International Medical Graduate (IMG) candidates on an annual basis through the Canadian Residency Matching Service (CaRMS) process. Applicant file reviews and interviews of potential candidates are conducted via a formal process involving members of the NEC, chief residents, and the Program Director and comply with Best Practices in Application and Selection (BPAS). Currently, the adult neurology program at UofT receives the highest number of applications through the residency matching CaRMS process.
Residency Half-Day Curriculum
We deliver a comprehensive curriculum encompassing all aspects of clinical, subspecialty neurology and basic neuroscience over a 2 year cycle in our mandatory academic half-day, attended by both adult and paediatric neurology residents. The curriculum is organized into subspecialty “teaching blocks” and each block typically spans 4 to 6 weeks. Teaching of intrinsic CanMEDs roles is integrated within lectures, supplemented by specifically-assigned time slots dispersed over the entire curriculum (e.g., medicolegal aspects of neurology practice, breaking bad news).
The last hour of the weekly academic half-day is dedicated to “Professor’s Rounds” directed by the Departmental Division Director (DDD), and other selected teachers when the DDD is unavailable. Here, case presentations are discussed and related topics reviewed in a relaxed and “entertaining” format.
Inpatient and Outpatient Experiences
The residency program is a mixture of both inpatient and outpatient services. The first two years of the program (PGY1 and 2) are concentrated on learning internal medicine and other related disciplines (e.g., neurosurgery, critical care medicine).
Although there are some neurology-specific months during these years, the bulk of the neurology training occurs in years 3 to 5. Hospital service includes spending time on inpatient general neurology services, inpatient stroke services and hospital consultation services at all of our teaching hospitals.
All PGY2 and 3 residents attend a longitudinal ambulatory clinic with one of the neurology faculty, focusing on seeing a wide range of general neurology patients and acquiring solid clinical skills.
During PGY4 and 5, the ambulatory experience is focused on exposure to different subspecialties across the teaching hospitals (cognitive/behavioural neurology, movement disorders, epilepsy, stroke/cerebrovascular disease, headache/pain, neuromuscular disease, multiple sclerosis, neuro-ophthalmology/neuro-otology, neuro-oncology, sleep neurology, and general). These are chosen as electives by the residents.
Unique Strengths of the Program
- A PGY1 ambulatory half-day in a general neurology clinic with the main purpose of establishing and refining their neurological examination skills before PGY2. The emphasis is on direct observation on the performance of these skills with real-time feedback.
- A mandatory 2-month rotation in outpatient subspecialty neurology clinics in each of the PGY2, 4 and 5 years where residents will spend time in different subspecialty clinics every half-day during this rotation in order for them to obtain experience that will start as an exposure/how-to approach (PGY2), to competence (PGY4), and eventually mastery and independence (PGY5).
- “Women’s Neurology” elective, which is the only one in North America that addresses the issues specific to managing women (especially young women of childbearing age) with various neurological conditions (e.g. stroke, epilepsy, multiple sclerosis).
- PGY4 one-week neuromuscular disease course organized and taught by Dr. Gyl Midroni (SMH). The teaching is highly interactive due to the small number of learners, with the major highlight being the exposure to patients with less common neuromuscular conditions (e.g., genetically-determined conditions), which the residents might otherwise not have encountered during their residency training.
- NIRVE (Neurology International Residents Videoconference Exchange) - a resident-led initiative founded by the Division of Neurology at the University of Toronto in 2008. Its main goal is to promote resident education and leadership through international collaboration. Currently, the NIRVE rounds occur monthly and has attracted thus far more than 300 trainees in more than 10 sites from different countries across the world.
All residents are encouraged to undertake research activities with neurology division faculty throughout the program. In addition, PGY-4 residents are required to undertake a research project and present the results of their research at the annual Silverside's Day in June of each year.
Annual resident retreat where the residency program is assessed by all residents first discuss various aspects of the training program without faculty’s presence. The faculty then join the residents to have an interactive discussion regarding suggestions to improve the training experience and how to implement them.
Annual Neurology Summer Social in July – a welcoming event to encourage faculty, residents, fellows, and their families to meet each other as well as to introduce our new residents and fellows. In December, we hold a holiday dinner for all the residents that features research presentations by our PGY4 residents.
Open-door policy where all of the residents can meet with the Program Director and/or hospital site directors regardless of the circumstances. In addition, the Program Director meets with all of the residents and reviews their performance at least twice a year. During these meetings, the residents’ research projects, career/fellowship goals, career counselling, and resident well-being are also discussed. The DDD also frequently meets with PGY5s to assist in their career planning.
The Division of Neurology offers clinical and research fellowship training in all of the neurology subspecialties, including epilepsy, movement disorders, headache and pain, neuro- ophthalmology, neuromuscular, neuro-oncology, cognition disorders/dementia, headache/pain, multiple sclerosis, stroke/TIA, neurophysiology, and sleep neurology. Approximately 20-25 fellows admitted to a variety of subspecialty programs per year, with a total of 50-65 fellows in the Division at any given time.
Some of the fellowships are multi-site fellowships, allowing trainees to obtain a comprehensive experience of certain subspecialties at the different clinics and hospitals throughout the city. Fellows trained in our programs have successfully taken up academic faculty positions around the world as well as in industry.
The priority for each fellowship program within neurology is to provide world-class clinical expertise in that particular subspecialty. While this occurs primarily in the outpatient setting, all fellowships take place at tertiary referral centres or hospitals where there is access to inpatient neurology services, including neurocritical care at the 3 major teaching hospital
sites. Clinical trial groups in all the subspecialty programs are also active at all teaching sites, and fellows gain experience in all aspects of performing clinical research. In addition to the experience in managing clinical neurology patients, clinical fellows at the UHN site also obtain experience managing patients participating in epilepsy and deep brain stimulation surgical programs as part of their training. The behavioural neurology fellowship at Baycrest offers the experience to 2 fellows per year in an inpatient behavioural ward, the only one of its kind in Canada. Clinical neurophysiology training including experience reading and performing EEGs and EMGs are part of epilepsy, neuromuscular and neurophysiology programs, after which fellows are prepared to write national examinations of clinical neurophysiology for either Canadian Society of Clinical Neurophysiologist (CSCN) or American Board of Neurophysiology examinations. Procedures including botulinum toxin injection for dystonia, percutaneous muscle biopsy, transcranial magnetic stimulation and neuromuscular ultrasound are taught as part of the movement disorder, neurophysiology and neuromuscular programs.
Fellowships are usually 1-2 years but fellows have stayed in training programs for up to 5 years to complete a doctoral thesis. Formal training in Master’s Programs is often pursued concurrently with fellowship programs, most commonly through the Institute of Health Policy, Management and Evaluation at the University of Toronto.
Management and Evaluation at the University of Toronto
A number of our faculty members have appointments in the Institute of Medical Sciences. All clinical fellows are encouraged to participate in clinical research during their time at U of T and several faculty members also offer pure research fellowships, for example involving neurophysiology, imaging or wet laboratory research. Research conducted by fellows is highlighted at Silversides/Residents' and Fellows' Day along with resident research, where fellows present their projects in poster format. The presentations are judged by faculty members and an award for best fellow presentation, the James Sharpe Award, is given to the fellow with the best presentation. In addition to local activities, fellows are active in presenting research at national and international conferences, publishing scientific articles and securing young investigator grants from funding agencies.
The Division of Neurology organizes several university rounds throughout the academic year. These include:
UofT Neurology Grand Rounds (monthly from September to June, excluding Dec, Jan and Mar) - Either visiting professors or faculty from the division present on any neurology subspecialty topic. Previous rounds were telecasted through the Ontario Telehealth Network and now archived through Vimeo. (previously citywide grand rounds)
Neurology National Grand Rounds - These quarterly videoconferenced national rounds provide an excellent opportunity to highlight faculty and exciting clinical and research programs at a national level. They also provide a wonderful opportunity for neurologists across Canada to interact and to facilitate collaborative opportunities.
McEwan-Jones Lecture and the Faculty Research Day (December) - The McEwan-Jones lecture always precedes the event with a 1-hour lecture from an eminent MS specialist. An event featuring the research endeavours from members of the Division of Neurology.
Richardson/Lang Day (February) - A half-day event featuring topical and entertaining debates within subspecialties.
Neuromuscular Day (March) - An annual single-day event highlighting advances and research in neuromuscular disorders.
Silversides Lecture & Residents’ and Fellows’ Day (June) - An event that features the research work of residents and fellows and is held in conjunction with the Silversides lecture. It is also the graduating ceremony of the PGY5 residents and fellows.
The Division of Neurology organizes several CME events throughout the academic year. Baycrest and the Division of Neurology at the University of Toronto invite neurologists and other healthcare professionals to view recordings of our weekly International Behavioural Neurology Videoconference Rounds. International Videoconferenced Behavioural Neurology Rounds (Baycrest).
Toronto Neurology Update - A biennial 2-day event featuring clinical and practical information for non-neurologists to help with their practice. This conference is directed to helping non-neurologists like general practitioners, general internists, psychiatrists, geriatricians, emergency physicians and others improve their clinical skills and knowledge with regards to evaluating patients with common neurological presentations.