UTHSCSA Faculty Profiles v1.0

Palm, Michael Lee

School of Medicine
(210) 450-0500

Throughout my time at UT Health San Antonio, I have looked for opportunities to be of service to the department and the field of neurology. Coming from private practice, I was hired to direct the Robert B. Green Neurology clinic. Despite my efforts, I found that I alone could not meet the demands for neurological care, and so I helped write a 1115 Waiver grant to provide funding to improve clinic access. Unfortunately, the additional staff could not be accommodated at the Robert B. Green clinic, and the project was moved to the MARC in 2014. In this new location I had the opportunity to begin working with the neurology residency program director, and when she retired abruptly in 2014, I stepped into this new role. Since that time, the majority of my efforts have been dedicated to developing and improving this program.

It wasn?t until after I had taken over as program director that I learned the training program was facing many significant challenges. The size of the program had not changed in over 10 years, so that there were only 9 residents providing services at 2 hospitals. This was compounded by the opening of the new University Hospital Sky Tower, which increased the patient volume for a time by over 50%. The residents were overworked, discouraged and facing burnout. In addition to this, I learned that the increased workload was also taking its toll on their education. In the years leading up to my starting as program director, the first-time board pass rate of our residents had gradually declined, and had included several years of 50% or even 0% passing.

Upon learning the extent and identifying the causes of these problems, I set about trying to address them. The first cause I identified was that the residents had excessive work demands from the hospitals. In 2015 I made two requests to the ACGME to increase our resident complement, both of which were approved, allowing us to increase from our initial complement of 9 up to 24 residents. As part of this, to improve our ability to recruit residents, we requested and were granted permission to change from a 3 year to a 4 year program, which simplified the application process for students. The next step was to obtain funding for these additional positions, which involved negotiations with University Hospital, Veterans Administration and Baptist health systems. To date these efforts have resulted in obtaining funding for 20 of the 24 residency positions. This has allowed us to increase the number of residents to 19 as of the 2018-9 academic year.

While these efforts were underway, I worked with the residents to identify and address their areas of concern, which resulted in adjustments to their call schedules and in the recruitment of additional staff to provide them with support during their busiest on-call times. I also negotiated to obtain the help of other programs to assist our residents on call.

The next issue that had to be addressed was the residents? education. Clinically, I worked to increase their exposure to the outpatient neurology subspecialties, which had been reduced as the inpatient workload had increased. This has helped to provide them with a more balanced clinical education. In addition, to improve attendance at didactics, I consolidated the lectures onto one day, and worked with the UT and VA departments to protect the resident?s lecture time. Along with this I set out to create a more complete curriculum for the residents. After trying other models, we have now begun creating a two year curriculum to allow for more in-depth education for the residents. In addition to covering the major fields of neurology, this curriculum also includes business and coding education as well as ethics training. The efforts to improve the residency program has shown tangible results. The pass rate among first time test takers of the American Board of Psychiatry and Neurology certification examination in the 2017 class improved to 80%, and in 2018 it was 100%.

Throughout this time I have been worked to support and improve the residents? mental health and wellness, utilizing resources from UH and the GME office as well as designing our own activities. The main feature of this has been our quarterly sessions where the residents leave campus to pursue team-building and wellness activities as a group. We had also has sessions directly assessing and addressing stressors, fatigue and burnout. This has resulted in improved resident morale and resilience while these other improvement efforts have been underway. An important long-term strategy to improve resident resilience is to empower the residents to take an active role in running and improving the training program. Toward this end, I have worked with them to identify and pursue quality improvement opportunities that will improve their patient care and their training experiences.

My activities with the residents have led to additional service opportunities. In 2016 I w

8/2014 - Present Neurology Residency Program Director University of Texas Health Science Center at San Antonio, Neurology, San Antonio, TX
8/2010 - Present Assistant Professor/Clinical University of Texas Health Science Center at San Antonio, Neurology, San Antonio, TX
8/2010 - Present Attending Physician University Health System, San Antonio, TX