Curriculum Innovation: A Master Clinician Residency Track in Neurology

While academic centers have traditionally valued faculty research and educational accomplishments, clinical excellence is often assumed or underappreciated. Accordingly, neurology residency programs frequently offer structured pathways for aspiring clinician-scientists or educators, but few offer dedicated training to launch residents into academic careers focused on clinical mastery. Guided by self-regulated learning principles and the Master Adaptive Learner framework, the aim of this curriculum was to equip neurology postgraduate year (PGY)-4 residents with the foundational skills of the master clinician by advancing the following: (1) clinical acumen and diagnostic reasoning; (2) a scholarly and evidence-informed approach to their work; (3) outstanding communication, professionalism, and humanism; and (4) effective navigation and leadership within complex health care systems.

Using the Kern six-step curriculum design framework, we developed a 6-month Master Clinician track that included didactics, customized clinical rotations, reflective patient portfolios, and a scholarly project. Didactics addressed topics such as cognitive bias, adaptive expertise, communication, and clinical uncertainty. Clinical rotations were learning-focused experiences tailored to resident interests. Track residents maintained 2 patient portfolios: one for in-depth case analysis ("depth" portfolio) and another to track diagnostic accuracy ("breadth" portfolio). The scholarly project reinforced a reflective approach to patient care and promoted academic inquiry skills. Assessments of the track included an exit survey on completion, patient portfolio audits, and post-track surveys for 3 years after graduation from residency.

Five residents completed the track in the first 5 years (2017-2022). Baseline residency milestone ratings were similar between participants and nonparticipants. Track components received high ratings (≥4.6 on a 5-point scale), with didactics on cognitive bias and teaching skills rated highest. Portfolios averaged 32 cases (breadth) and 8 cases (depth). Residents highlighted clinical uncertainty, communication, and cognitive bias as the most relevant sessions for patient care. Over 3 years of follow-up, high satisfaction with the track persisted and most enrollees elected academic clinical or clinician-educator careers.

A residency track that used didactics, customized clinical experiences, case-tracking, and reflective practices to foster clinical excellence was well received by residents. Neurology programs should consider similar tracks to develop academic clinicians focused on excellence in patient care.