Residency Training Programs

Adult Neurology
Combined Neurology and Internal Medicine

The Neurology Department strongly believes that trainees can best develop their knowledge and skills within a structured educational framework. To accomplish this, a Clinical Neuroscience Course has been designed specifically to meet the needs of the Residents. The Course begins in the first week of Residency, when the Neurologic Exam is taught in detail. This is followed by an intensive summer course on Neurological Emergencies. One hour each week is devoted to a didactic session followed by a second hour featuring case vignettes. In the fall, the Course introduces trainees to the basic and clinical Neurosciences which are comprehensively reviewed in three year cycles. The topics include Neuroanatomy, Neurophysiology, Neurochemistry, Neuropharmacology, Neuropathology, Neuroradiology, Epilepsy, Neuro-opthalmology, Diseases of Nerve and Muscle, Neurologic Disease of Aging, Neurodegenerative Diseases, Neuroimmunology, Neurogenetics, Behavioral Neurology and Stroke. Faculty from multiple departments participate, and to facilitate learning, teaching is informal, interactive, problem-oriented and, whenever possible, clinically relevant. Every effort is made to assure that the Residents assimilate the most important material. This includes periodic written and oral examinations that have proved very popular with our residents since most do very well, and the exams provide an objective measure of their intellectual growth. Over a three year period, the Residents acquire a solid foundation in the Basic and Clinical Neurosciences to meet the future demands of their neurology practice and to pass the certification exams of the American Board of Psychiatry and Neurology.

It is important that the residents become proficient in the diagnostic method as practiced by the seasoned neurologist. To achieve this, a senior neurologist presents the Case of the Month featuring the most interesting or diagnostically challenging patient selected from the five local University Hospitals. Videotapes and live patients are presented in such a way that residents are actively involved in trying to make the diagnosis. At the end, the senior neurologist summarizes the pertinent aspects of the case. With lunch provided, attendance and enthusiasm are always excellent. In addition, faculty members conduct bedside Resident Teaching Rounds on the diagnostically interesting cases. Whenever possible, the discussion frames the clinical issues in a scientific perspective. These Rounds are restricted to Residents so that sufficient time can be devoted to teaching the nuances of neurological skills (as opposed to teaching the basics of neurology to medical students who have separate tutorials for this purpose). The discussion therefore proceeds at a more sophisticated level and is invigorated with pertinent references from the literature. Finally, to test their diagnostic prowess and to foster scholarship, the residents conduct a monthly Clinical Pathological Correlation Conference. Each submits a three to five page discussion of the CPC with references, and then, a resident is selected to lead the discussion. These CPCs are modeled after the New England Journal CPCs, but the atmosphere is much more informal (lunch is often provided). Each CPC is taken from a different area of neurology, so the residents are challenged to review a major field in depth and to learn to use MEDLINE and other library resources for their citations. This is a very popular session with the residents, most of whom manage to come up with the correct diagnosis.

Most importantly, the quality of the training depends heavily on the quality of patient care as practiced at the bedside and in the clinic. Trainees receive individual, practical bedside teaching by faculty who supervise their patient management on a daily basis (Work Rounds). With managed care upon us, considerable time is spent in teaching Residents how to contain costs while improving the quality of care and patient outcome. Residents actively participate in the Department's Quality Assurance/Quality Improvement programs. The Residents do not function as mere technicians who carry out the bidding of the staff. Residents are regarded as professional colleagues who are expected to think independently, to identify key questions regarding their patients, to seek solutions through their own initiative and independent reading, and wherever appropriate, to challenge the staff intellectually in collegial fashion. Residents are encouraged to teach the teacher and thereby enrich everyone's education.

To round-out their education, the Department provides the Residents with a wide variety of required and optional conferences. Speakers are drawn from within and outside the University. These conferences include Neurology/Neurosurgery Grand Rounds, Brain Cutting, Neuroradiology Conference, Pediatric Neurology Conference, Center for Neuroscience Seminar, Epilepsy Conference, Neuro-ophthalmology, Nerve/Muscle Conference, and the Breakfast Journal Club. Many of these conferences are informal with lunch or breakfast provided by the hospital. Eight to ten hours of conference time are carefully scheduled each week to avoid conflicts with Clinics and other service demands so that the residents can attend these conferences. The Department also offers subspecialty electives and research opportunities that prepare the Resident for postdoctoral fellowships. The Department thus immerses trainees in an intensive academic environment that permits each trainee to learn and progress to the best of his or her ability.

Link Building

The Department of Neurology is located in the Link Building overlooking the Medical School's historic courtyard and Forest Park. The facility joins two renovated buildings that house state-of-the-art laboratories for Neurology, Neurosurgery, Pharmacology, Anatomy and Neurobiology. Together, this large complex forms the nucleus of the Center for Neurosciences which brings together over 50 faculty members from various disciplines and which receives competitive funding for research in excess of $7,000,000 each year. The Medical School Library, conveniently located next door, includes among its many services a comprehensive selection of books and journals devoted to the Clinical and Basic Neurosciences. The Planetree Center offers sophisticated educational software in the Neurosciences (eg. the 3 dimensional Hyperbrain program for learning Neuroanatomy). The Center for Neurosciences thus affords outstanding research and educational opportunities for interested Residents and Fellows in the Department.

The Department of Neurology, the Health Sciences Center and the University's five affiliated hospitals are located within walking distance of each other. This health complex comprises the major Medical Center serving the Mid-South and draws from a state area 200 miles in radius containing approximately 2.5 million people. Clinical training in neurology takes place in these five hospitals within the Medical Center.

Methodist University Hospital

Methodist University Hospital is a modern, private 696-bed facility and is the principal adult private teaching hospital for the University of Tennessee. It has a Neurology teaching service with approximately 600 admissions per year. The newly constructed Memphis Veterans Administration Hospital has approximately 300 admissions per year. The Regional Medical Center has approximately 700 admissions to the neurology service per year. These three inpatient adult neurology services provide a broad neurological experience for trainees during their first year of Residency. In the Regional Medical Center, residents participate in an active consulting service annually evaluating 900 patients with acute neurological problems. LeBonheur Children's Medical Center has 225 beds with an average daily census of 15 on the Pediatric Neurology Service. St. Jude's Research Hospital for Children is internationally reknown for its research and treatment of cancer, AIDS, and other severe illnesses of childhood. All of these hospitals have active outpatient services. At the Regional Medical Center and the Veteran's Administration Hospital, residents follow selected outpatients throughout their three years of training. They also rotate through specialty clinics in epilepsy, movement disorders, stroke and neuromuscular diseases.

The MED

Memphis VA Hospital

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Medical Internship (PGY-1)
Three positions are available each year for combined PGY-1 medical internship and PGY-2 neurology residency. The PGY-1 position offers 8 months of training in Internal Medicine, 1 month in the Emergency Room, 1 month in the Intensive Care Unit, 2 months of elective. These fulfill the current minimum requirements for admission to an accredited Neurology Residency training program. Back to Contents

First Year of Residency (PGY-2)
The purpose of the first year is to provide Residents with broad patient exposure and comprehensive training in the basics of clinical neurology. These include data gathering, case formulation, diagnosis and management of both inpatients and outpatients. To achieve this goal, Residents spend most of their time caring for inpatients on the Neurology Services of the Methodist University Hospital, the Regional Medical Center, and the Veterans Administration Medical Center (VAMC). In addition, they attend two afternoon outpatient continuity clinics at the Regional Medical Center and the VAMC. One month is devoted to Neurophysiology (EEG) so that residents become familiar with the epilepsy classification, interpretation of common EEGs, the diagnosis of status epilepticus and brain death, the indications and usefulness of EEG video monitoring and epilepsy surgery. One month is spent in Neuroradiology where residents learn how to interpret CT, MRI, cerebral angiograms, myelograms, and plain spine x-ray studies. Two months are spent on Night Float in which residents cover the wards, consults, ER and ICU from 5 PM to 7 AM during the week. When not on Night Float, residents take night and weekend call on average of once per month throughout their residency training. Hence, our residents are very well rested. Back to Contents

Second and Third Years of Residency (PGY-3 AND PGY-4)
During their second year, residents refine the skills and consolidate the knowledge gained during their first year of residency. They assume new responsibilities by rotating through the Neurology Consultation Services (including emergency room coverage) of the Methodist University Hospital, Regional Medical Center and the VAMC. The Resident's intellectual growth and maturity are strengthened by handling cases of increasing diagnostic and therapeutic complexity while working closely with a Staff Neurologist. The Residents further expand their clinical experience by rotating through Pediatric Neurology (three months), Neuropathology (one month), Psychiatry (one month) and Neuro-Rehabilitation (one month). They take one month of Night Float in the second year. Residents also begin to serve in a teaching and leadership capacity as ward chief at the Regional Medical Center. The ward chiefs are freed of writing orders, patient notes and other daily duties that are the responsibility of the junior Residents and medical students. Instead, they supervise patient care, actively participate in the teaching of first year Residents and medical students, and work closely with Staff. The senior Residents help in the planning, structure and scheduling of teaching conferences and the educational program for students, Residents and faculty. During the second and third year, residents have approximately 6 months of elective time to pursue specific subspecialty and research interests. Subspecialty electives are available for Neuro-ophthalmology, Neuromuscular/EMG, EEG/Evoked Potentials, Sleep Disorders, Neuroradiology, Neurosurgery, Movement Disorders, Pediatric Neuro-oncology, and Geriatric Neurology. Night call occurs once per month on average throughout the three years of training.

Thus, during the three years of training, each resident spends approximately 10 months on the ward (junior resident), six months on consultations, six months as ward chief, and fourteen months on subspecialty rotations and electives.

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Required Subspecialty Rotations

EEG
Neuroradiology
Neuropathology
Psychiatry
Child Neurology
Neurorehabilitaion and Pain
Neuromuscular and EMG Rotation
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EEG directed by Bola Adamolekum, M.D.

Residents spend one month early in the first year of training so that they become familiar with EEGs and the classification of epileptic syndromes. They spend part of their day on the 4 telemetry bed Video-EEG Center located in Methodist University Hospital. This unit delivers specialized care to patients with intractable epilepsy. The Center provides diagnostic video-EEG telemetry, surface and depth electrode EEG monitoring, investigational drug treatments and epilepsy surgery. The remaining time is spent reading EEGs in tutorial with Dr. Adamolekum or one of the faculty. They spend at least one afternoon per week with Dr. James Wheless at LeBonheur to learn fundamentals of Pediatric EEG. The Residents learn the basic technical factors involved in the EEG recording, their function and usefulness in the interpretation of the EEG findings. The Residents have an EEG performed on themselves so as to obtain personal knowledge of the experience. They learn to identify the basic components of an EEG, its normal variants, technical artifacts, age related changes, the basic types and significance of abnormal EEG patterns, especially in status epilepticus and in brain death.

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Neuroradiology directed by James Wood, M.D. and Robert Laster, M.D.

The principal goal of this one month rotation is for Residents to gain greater experience and precision in the interpretation of neurodiagnostic studies. Under the direct supervision of a Neuroradiologist, Residents review the daily MRI, MRA, CT, myelograms and cerebral angiograms performed at Methodist University Hospital or the VAMC. Residents have the opportunity to observe interventional radiologists perform intracranial angioplasty, regional intracranial thrombolytic therapy and embolization of aneurysms and arteriovenous malformations. They attend weekly Neuroradiology conferences at the VAMC and Methodist hospitals. Residents also have the opportunity to observe and learn carotid and transcranial ultrasound. They review the departmental neuroradiology teaching files so as to provide a broad overview of the field.

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Neuropathology directed by Curt Dohan, M.D.

Neurology Residents participate in weekly brain cuttings, sign-outs (at which time the autopsy brains are examined microscopically), Nerve/Muscle sign-outs (Dr. Bertorini) and Neuro-oncology Tumor Board meetings. They study slides of tumors and other CNS lesions from the teaching collection for discussion with the Neuropathologist. Residents present a brief report once a week on a neuropathological topic of their own choosing. They also attend the monthly Neuropathology Conference organized for the Departments of Neurology and Neurosurgery, prepare and present the history for a CPC case given at the conference. All neurology Residents participate in a 6 hour series of neuropathology lectures given as part of the Clinical Neurosciences Course. This rotation, complimented by the lecture series, prepares Residents for their Boards and covers the general principles of neuropathology, the most important aspects of brain tumors, infections, trauma, and neurodegenerative diseases.

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Psychiatry directed by Richard Johnson, M.D.

Neurology Residents spend one month on the psychiatry inpatient service at the Veterans Administration Medical Center (or at Baptist Memorial) or join the psychiatry consultation team at the Regional Medical Center. The ward is staffed by a psychiatrist, psychologist and social workers. The neurology Resident shares in patient care with the junior psychiatry Residents under the supervision of a Staff psychiatrist. Each Resident assumes primary responsibility for six to ten inpatients and supervises the medical students. Residents become familiar with the DSMIV-R diagnostic terminology (American Psychiatric Association's Diagnostical and Statistical Manual of Mental Disorders, 3rd ed. revised), learn the general principles of the psychiatric interview, special interviewing techniques in emergency, psychotic and severely depressed patients, patients with hysteria versus organic brain syndrome. Residents attend the Psychiatry Teaching Conferences which include VAMC Grand Rounds, Case Conferences, Departmental Grand Rounds, and Journal Club. Departmental audiotapes of the American Academy of Neurology "Essential Psychiatry for Neurologists" are required listening.

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Child Neurology directed by James Wheless, M.D. A three month rotation features the inpatient consult service at Le Bonheur Children's Medical Center and the Newborn Center, the outpatient service at the Physician's Office Building (across from Le Bonheur) and experience with childhood neuromuscular disorders in the Muscular Dystrophy Clinic. Residents are responsible for seeing all inpatient consults, formulating their diagnostic and treatment plan, and writing the initial consult note. The diagnosis and plan are reviewed with the Child Neurology Attending. The Residents evaluate general pediatric neurology outpatients and present the patients to the attending Child Neurologist in one or more of the daily clinics. They attend the weekly Muscular Dystrophy Clinic and present the patients they have evaluated to their Attending. Afterwards, residents spend one month at St. Jude's Research Hospital for Children where they address neurological complications of brain tumors, chemotherapy, AIDS, and other diseases.

Lebonheur Children's Hospital

The primary conference is the weekly Child Neurology Conference. In addition, Neurology Grand Rounds and Pediatric Grand Rounds have regularly scheduled presentations devoted to child Neurology. The Pediatric Neurology department contains relevant texts and journals, an EEG reading table for teaching Residents pediatric EEG, a VCR and monitor for reviewing educational tapes on pediatric neurology topics.



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Neurorehabilitation and Pain directed by Carlos Cyrus, M.D.

The Neurorehabilitation rotation aims to increase the Residents' awareness of the rehabilitation needs of neurological patients and to develop the skills necessary for the clinical management of rehabilitation patients. Residents rotate through the Rehabilitation Center of the VAMC, which treats patients with many forms of neurological damage, including traumatic brain injury, stroke and spinal cord injury. Residents pass through the various divisions and learn the multi-subspecialties comprising Neurological Rehabilitation. Residents view videotapes and read assigned chapters from standard textbooks available in the Rehab Department.

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Neuromuscular and EMG Neuromuscular and EMG Rotation directed by Tulio Bertorini, M.D. and Daniel Menkes, M.D.

Two months of intensive training in Neuromuscular Diseases and EMG are offered at Methodist Hospital. Residents learn to perform nerve conduction and electromyographic studies under close staff supervision. Approximately 6 cases a day allow ample opportunity to learn. Also, selected cases are studied from the weekly Muscular Dystrophy Clinic, where Residents see a wide variety of neuromuscular diseases, including hereditary neuropathies, dystrophies, polymyositis, myasthenia gravis and motor neuron disorders. Residents are exposed to a variety of sophisticated electrophysiological techniques (eg. single muscle fiber recordings) and have the opportunity to participate in clinical research projects. They also view Muscle Pathology video tapes, and twice a week, they examine muscle/nerve biopsies and review teaching file specimens with staff.

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Neurology Subspecialty Electives

EEG/Evoked Potentials
Movement Disorders
Multiple Sclerosis
Sleep Disorders
Neuro-ophthalmology
Neurosurgery
Neuro-geriatrics
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EEG/Evoked Potentials directed by Bola Adamolekum, M.D.

Residents may elect to spend additional months in EEG/Evoked potential training and/or research at Methodist University Hospital, Regional Medical Center or at the VAMC. The elective increases the Resident's practical experience while expanding his understanding of basic electrophysiological concepts behind the EEG and Evoked Potentials. The Resident reviews all daily adult EEGs and evoked potentials under the supervision of Dr. Adamolekum or one of his associates. Pediatric EEGs are read with Dr. Wheless or one of his associates at Le Bonheur. Residents attend the weekly Epilepsy Clinic at the Regional Medical Center. Residents research the primary literature to address questions that arise regarding specific patients.

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Movement Disorders directed by Ronald Pfeiffer, M.D. and Mark LeDoux, M.D., Ph.D.

During the Movement Disorders elective, the resident receives in-depth exposure to the clinical management of Parkinson's disease, dystonia, ataxia, essential tremor, and other movement disorders. The Resident receives instruction in The resident assists in weekly Movement Disorders clinics at the Semmes-Murphey Clinic, UTMG and the Veteran's Administration Medical Center. The resident is exposed to Parkinson's Disease Support Groups, thus gaining further insight regarding the impact Parkinson's disease has upon both patients and families. Videotape review sessions are held during the rotation. The resident is encouraged to complete a research/review project as a part of the rotation. For those residents interested in exposure to basic laboratory research, special arrangements can be made.

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Multiple Sclerosis directed by Michael Levin, M.D.

The resident learns outpatient and inpatient management of multiple sclerosis and other demyelinationg diseases. The Resident assists in the weekly MS clinic at Semmes-Murphey. There is opportunity to perform a chart review and make suggstions regarding the management of MS patients at the Medplex Clinic and the Veteran's Administration Medical Center. The resident is encouraged to complete a research/review project as a part of the rotation.

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Sleep Disorders directed by Jaime Avecillis, M.D.

Residents may elect to spend one months in the Sleep Disorders Center of the VAMC. The four bedroom complex contains overnight polysomnographic and video-EEG monitoring instrumentation. Residents diagnose and treat patients with insomnia, excessive sleepiness, narcolepsy, sleep apnea and a wide variety of other medical and psychiatric sleep related disorders. Over the course of the month, the Resident learns to conduct full evaluations, including the initial interview and laboratory testing, diagnostic formulation and treatment plan, and the preparation of a final report.

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Neuro-ophthalmology directed by Andrew Lawton, M.D.

The elective exposes Residents to a wide range of systemic and neurological disorders with ophthalmologic manifestations. Residents perfect their skills at history taking and examination of the visual system. They are introduced to a variety of specialized techniques including indirect ophthalmoscopy, slit lamp biomicroscopy, automated threshold perimetry, contact lens examination of the fundus, red lens testing for diplopia, and the use of Lancaster red-green goggles. They refine their bedside funduscopic exam and learn to use specialized instrumentation for a more detailed funduscopic evaluation. They perform and interpret a number of visual field tests. The Resident evaluates patients in a private referral practice and consults from Methodist University Hospital, Regional Medical Center and Le Bonheur. Each Resident prepares one or two cases for the monthly Neuro-ophthalmology conference. Residents attend Ophthalmology Grand Rounds and Neurology Grand Round devoted to Neuro-ophthalmology topics.

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Neurosurgery directed by Jon D. Robertson, M.D.

Neurology Residents rotate through the Neurosurgical Service either at the Methodist University Hospital, the Regional Medical Center or the VAMC. They see new patients and assist the neurosurgeons in their initial evaluation and implementation of a therapeutic plan. They scrub in on their cases as observer/assistants and participate in their post-operative care. They attend the weekly Neurosurgery conferences, including Semmes-Murphey Case Conferences, VAMC Neuroradiology Conference, Neurosurgery Grand Rounds, and monthly Morbidity/Mortality Conferences.

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Neuro-Geriatrics directed Mark Brint, M.D.

Residents treat a large variety of neurologic and medical problems unique to the elderly on the Geriatrics Unit of the VAMC. This includes problems with ambulation, dementia, incontinence and behavioral disturbances. The Resident may wish to visit long-term care nursing homes in the community to see how medical care is provided locally to the neurologically impaired elderly patient.

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Research Opportunities

During their first year of Residency training, Residents are expected to identify one or two specific areas of research interest. Under faculty supervision, they engage in a research project during the remainder of Residency training. Up to six months of elective time can be devoted to research during the second and third years of Residency. The effort is expected to culminate in an abstract presented at a national meeting (eg. American Academy of Neurology) and a publication in a peer-reviewed journal. The Resident arranges a research project with a faculty member and specifies research objectives that are realistic for the duration of time devoted. The research project must be approved by the Program Director and by the Chairman.

The Cerebrovascular Disease Center, Elias Giraldo, M.D., Director; Thaddeus Nowak, Ph.D. Laboratory Director

The Cerebrovascular Disease Center performs experimental and clinical research in the area of ischemic stroke. Research focuses on molecular mechanisms responsible for brain cell injury following cerebral hypoxia (eg. cardiac arrest), ischemia (eg. focal stroke) and altered cerebral perfusion (eg. effect of cardiac bypass pump). The Center also offers experimental therapies (eg. thrombolytic agents) and clinical expertise for a wide variety of cerebrovascular disorders.

Brain Injury Research Center, Shelly Timmons, M.D., Director

The Center is a consortium of twelve local institutions whose aims are to standardize clinical therapies, assess new (experimental) therapies, facilitate clinical and basic research in brain injury, and to heighten community awareness. Research is focused primarily on head trauma, subarachnoid hemorrhage and hemorrhagic stroke.

Interventional Neuroradiology, Scott Williams, M.D., Ph.D., Director

The Radiology Department, working closely with Neurology and Neurosurgery, offers therapeutic modalities including intracranial angioplasty, regional intracranial thrombolytic therapy and embolization of aneurysms and arteriovenous malformations.

Memphis Movement Disorders Center, Ronald Pfeiffer, M.D., and Mark LeDoux, M.D., Ph.D.

A variety of clinical projects studying Parkinson's disease, dystonia, ataxia, essential tremor, and other movement disorders are available to the resident. For those residents interested in exposure to basic laboratory research, special arrangements can be made.

Neuromuscular Disorders, Tulio Bertorini, M.D. and Daniel Menkes, M.D.

Residents interested in muscle diseases can participate in clinical research at the Methodist University Hospital and Wesley Clinic (Dr. Bertorini) and at the Regional Medical Center and the UT Peripheral Neuropathy Laboratory (Dr.Menkes).

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Instructions for Applicants
Neurology resident applicants should apply through the ERAS/AAMC Match Service. You can find the relevant information at: www.aamc.org/eras

If you are applying for a post-Match position (usually not available), you may apply by printing the online Application for Neurology Residency Training and returning the completed form to:

Mail:	Attn: Ms. Carol Blackman Neurology Residency Training Coordinator Department of Neurology University of Tennessee, Memphis 855 Monroe Avenue, Room 415 Memphis, TN 38163
Phone:	901-448-6661
Fax:	901-448-7440
E-Mail:	cblackman@utmem.edu
Online:	Application for Neurology Residency Training