Education Research: Establishing a Postgraduate Year-1 Director Enhances Well-Being for Adult Neurology Residents.

Background and Objectives: Adult neurology clinical trainees in Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs spend their postgraduate year (PGY)-1 within the internal medicine department, potentially causing a perceived disconnect with their neurology program. Our Adult Neurology Clinical Competency Committee found this disconnect may decrease resident well-being. We hypothesized implementing a novel PGY-1 Director role focusing on unique aspects of this first year would improve resident well-being and connection to the neurology program. Methods: The PGY-1 Director was established as an associate program director in the adult neurology residency program with goals to improve wellness, advocacy, compliance with ACGME requirements, education, and communication. Anonymous surveys compared preintervention (before the PGY-1 Director role) with postintervention resident opinions on PGY-1 experience, assessing wellness, burnout, and perception of advocacy. Results: A total of 15 (75%) preintervention residents and 23 (96%) postintervention residents completed the study surveys. 53.7% of preintervention residents agreed or strongly agreed to feeling burned out, while only 17.4% of postintervention residents agreed they felt burned out and none strongly agreed. Significant improvement occurred in feeling supported clinically and emotionally and feeling validated. Most postintervention residents felt the PGY-1 Director was valuable and directly led to positive change. The relationship between the neurology and internal medicine departments was improved. Discussion: A dedicated PGY-1 Director position can improve trainee wellness outcomes and relationships between preliminary and matched departments. This mutually benefits both programs but requires substantial resources. We propose this as a best practice when feasible for ACGME programs with the following suggestions: (1) provide dedicated full-time equivalent time, (2) meet with preliminary program leadership regularly, (3) meet with PGY-1 trainees during orientation and at least quarterly, (4) serve as an advocate, and (5) facilitate mentorship in areas of interest.

Progressive Encephalomyelopathy in an Older Man: A Case Report From the National Multiple Sclerosis Society Case Conference Proceedings.

We present a case of subacute onset progressive encephalomyelopathy in a 77-year-old man with symmetric lateral column signal abnormalities on spinal MRI. We discuss the differential and presumptive final diagnosis along with a review of the postulated disease immunopathogenesis.