I may be in the old-school minority here, but in my opinion you learn by seeing patients. You shouldn't be so overworked that you don't have time to think, but you want to see a ton of patients with varied presentations. In my opinion, you should be looking for the program that gives you the most hours possible devoted to actual clinical care, which is cushy in a way since you won't be pushing stretchers and drawing AM labs, but maybe not so cushy in that you should be close to the hours limit for the majority of the year.
Then again, I'm in neurocritical care, and I use internal medicine all day every day. I think these new ACGME regulations hurt prelims a lot, because you have even less time to get a good medicine foundation in that measly one year.
I'm sure some of the neuromuscular people will start chiming in that you don't need an intensive medical year to manage basic medical issues in the clinic (as long as the patient has a PCP), and they're right. But are you certain of what you want to eventually become already? Neuro-onc, stroke, neuroIR, and neurocritical care all deal with a lot of pure internal medicine issues every day.
Additionally, the patient population on neurology inpatient wards has gotten increasingly ill in recent years, as measured by a variety of JCAHO metrics, and during your residency you will be expected to competently care for these people without getting a medicine consult on them. I'm not just talking Afib with RVR, but also metastatic cancer on chemo with marrow failure and adrenal insufficiency and SVC syndrome and a venous cerebral infarct. At what WBC count or ANC are you going to start sending CMV titers, and are you going to prophylax with acyclovir, or gancyclovir/foscarnet? Do you really need medicine and ID consults to answer that for you?
Sorry for the rant. This issue comes up every year, and the malignant side of me does not tolerate people looking to minimize their effort during their training. Dare to be hard-core.
