How hard is neurology residency?

You are interested in neurology, but maybe the ”neuro” you have learned at Med School scares you. What does the neurology residency entail? It’s hard?

In this post we are going to answer the question ‘’How hard is neurology residency?’’ We will explain what makes neurology a difficult specialty and we will present you the main activities that you will carry out during your residency

How hard is neurology residency?

Neurology is one of the hardest specialties. This is because the anatomy of the nervous system is too complex and in addition, there is almost no exposure to clinical practices.

Neurology is the medicine division that deals with nervous system disorders, which involve the brain, blood vessels, muscles, and nerves. Neurology’s core fields are: the autonomic, central, and peripheral nervous systems. A neurologist is considered a doctor who works in the field of neurology; a neurosurgeon treats neurological conditions by surgery.

Nervous system disorders are responsible for a staggering 28% of all years of life spent with an impairment. The prevalence and public health effects of neurological disorders will continue to grow as our population ages.

Hospitalists and primary care doctors treat a growing number of patients with neurological illnesses. In fact, most of these patients are treated in the community by Primary Care Physicians and are never referred to a neurologist.

Some reports show that the detection and treatment of patients with neurological disorders is especially difficult for medical students and residents alike. Recent data from the United Kingdom and Ireland indicates that among the medical specialties surveyed, students and junior doctors consider neurology to be the most difficult.

They feel that they have little experience in this area and lack confidence in their abilities to deal with patients with neurological complaints. The reasons for these outcomes range from the perceived complexity of neuroscience during the preclinical and clinical years.

Is neurology difficult?

A study carried out by BMC Med Education indicates that it is felt that neurology is a difficult topic. In our research, neurology was viewed by both medical students and residents as the most complicated medical specialty and the one they had the least knowledge of.

On the other hand, when diagnosing, examining and treating patients with neurological conditions, participants felt less secure in contrast with seven other specialties typically found in primary care environments.

Across multiple learning systems, these results tend to be valid. Similar findings were obtained by investigators in Europe and there are accounts of ‘neurophobia’ from Australia and Singapore. These results are significant because this fear and lack of trust can translate into practice.

There is no evidence that clearly connects interpretation and performance, data indicate that patients with common neurological disorders such as seizures and back pain may be suboptimally treated and referred to in primary care settings.

Checking previous studies, neuroanatomy was identified in their study as one of the main reasons why neurology, particularly among students, is a difficult subject. More than 50 % of respondents said progress in this field would be a valuable way to enhance neurological teaching.

In particular, relative to students, neuroanatomy was a smaller contributor to the challenge of neurology for residents. Given that the knowledge of neuroanatomy during medical school years is higher for an average trainee than in residency training, these results indicate that comprehensive knowledge of neuroanatomy may not be sufficient for the functional management of patients with fundamental neurological problems.

Based on the findings of this report, the absence of sufficient integration of basic neuroscience and clinical neurology is an obstacle for trainees, not just because of the lack of exposure and teaching.

The overall neurological teaching score was average, but there was a doubling of “very poor or poor” teaching scores during the transition from preclinical to clinical years. For both students and residents, this pattern was the same, indicating that the shift from preclinical to clinical years is the crucial time for acquiring functional neurological expertise.

These results provide further evidence that the integration of basic neuroscience, anatomy and clinical neurology must be strengthened by educators.

Why is Neurology so difficult?

First of all, in neurology, most signs are complex in nature and the success of gathering these signs depends not just on the power of observation, but also on skillful elicitation. Most medical students, for example, can easily say whether a patient is jaundice or not only by passive observation.

To identify irregular pupil reflex, on the other hand, fine coordination between the simultaneous skillful presentation of adequate light stimuli and astute real-time monitoring of pupil changes is required.

Furthermore, neurological testing also relies heavily on the patient’s collaboration. Strong communication capacity is therefore essential.

Neurological discovery is like a ‘3D holographic picture’ in the same way. Using a broad range of inspection methods, it encompasses nearly every aspect of the human body. Often we have to use our sense of sight, sometimes they have to use their sense of touch; sometimes they have to detect changes on a very small scale, such as searching for eye signals, and sometimes, like gross gait disruption, they have to identify anomalies on a very large scale.

Therefore, as they do neurology research, they are continually changing their focus to pick up all the hints

Finally, their ability to present a neurological diagnosis depends not just on the recognition of a series of clearly unrelated deficits, but also on the ability to succinctly synthesize all our results. In other words, one has to switch from seeing patterns to seeing patterns.

Neurology residency: program structure


Intern year, either preliminary or transitional medicine, but if you do the latter, there are a few neuro-specific criteria that you need to look out for. Residents were expected to have at least eight months of internal medicine, or six months of internal medicine, and at least two months of emergency room, pediatric, internal, or family medicine.

These requirements should be met by all medicine prelims, but not all transitional years do so. In fact, it is critical for residents this year; patients in their care also need simple treatment of more general medical conditions, and many medical conditions are otherwise associated with neurological diagnoses.

Many programs understand the value of a strong internal year (and how much pain it can be to do a separate program for your first year) and offer a preliminary year with the medicine program of that organization.


Since many services front-load the inpatient rotations, this is also the busiest year. Residents are likely to spend a lot of time on inpatient neurology rotations during this year preparing to provide treatment for patients admitted for neuro bread and butter as well as some of the less common circumstances.

During this year, there is usually a hospital call, but it will depend on the program. That said, it would destroy your residency if you hate working nights or weekends and need to do so. For inpatient and outpatient electives, the non-inpatient period is generally left alone. So citizens will give them more time.


In most services, when time typically begins to open up for electives. In certain instances, elective time would be half a year or more, with the other time spent between senior floats and night floats.

Neurology is very flexible with requirements: you need to have six months of inpatient neuro, six months of outpatient neuro, three months of baby neuro, and a month of psychiatry by the end of your residency. There are additional criteria for certain services to do any EEG, EMG, and neuropaths, plus or minus other choices.

At the beginning of the year, several programs will let you concentrate on more electives, and during PGY-3, some fellowship applications require application. In later years, calling appears to be lighter, with more home calls where you are the back-up to chat about their inpatient months with your junior resident about their cases.


The last year of Neuro N3. If you have not applied for a mid-late PGY-3 fellowship, you will now be applying. Otherwise, if not lighter, the year appears to be equivalent to PGY-3, with plenty of time for electives to supplement or help train you for your fellowship or private practice.

In neurology, electives are varied and can be hospitalized (neurocritical treatment, intra-operative monitoring), outpatient (EMG, headache, neuroimmuno, sleep, behavioral and cognitive, motion), or mixed (vascular, EEG / epilepsy)

So, is neurology residency hard?

Yes, ‘’neuro’’ is such a hard thing, but, if you love your career, you shouldn’t worry.

Do you experience neurophobia? Studies of medical students around the world have shown that neurophobia is widespread , affecting up to 50 percent of students at some stage in their medical education. Neurophobia is a fear of neural sciences and clinical neurology.

We suggest that you become acquainted with the assessment of these symptoms and concerns prior to your neurology residency. Note carefully the potentially life-threatening causes of these symptoms, as a significant part of your initial examination will focus on evaluating these conditions for your patients.

We recommend during your years of residence:

1. Create a solid foundation in neuroanatomy

2. Practice makes perfect.

3. Read clinical vignettes

4. Spend extra time studying boards

5. Find other medical students who share your interest in neurology.

6. Find a mentor.

7. Consider doing research

8. Imagine You were First one the scene.

9. Read!

Good luck!

FAQS: How hard is neurology residency?

How many years is a neurology residency?

Residency in neurology typically takes 4 years: 1 year of internal medicine (internship) and 3 years of neurology (residency). Some programs concurrently admit students into internship and residency; others only accept residency students and have to find a different internship.

Do neurology do residency programs?

Yes. Residencies in neurology, including an internship year, are four-year programs. DO graduates can apply to all AOA-approved residency programs, including neurology,

How competitive are neurology residencies?

Not competitive at all.  In general, neurology programs concentrate on the entire candidate for a residency, making it less competitive than other specialties. It’s also one of the last few NRMP Matches’ most IMG-friendly specialties. … Overall, once the residency training is complete, neurology is a specialty with a diverse range of career opportunities.

Is Neurology a hard specialty?

Yes, it’s one of the hardest.

What is the shortest residency?

Family Practice: 3 years.

In this post we answered the question ‘’How hard is neurology residency?’’ We explained what makes neurology a difficult specialty and we presented you the main activities that you will carry out during your residency

If you have any questions or comments please let us know!


Cheong-Leen, R. (2020). Why is Neurology so difficult? Retrieved November 6, 2020, from The BMJ website:

Schon, F. (2002). Is clinical neurology really so difficult? Journal of Neurology, Neurosurgery & Psychiatry, 72(5), 557–559.