In the R3 (PGY4) year, the emphasis is on leadership, as our senior residents play a pivotal role in supervising our inpatient services at SIUH and LHH. Residents continue to hone their neurological decision making skills in their outpatient continuity and subspecialty clinics and continue to master pediatric neurology on their third and final rotation. Residents also join our Neurocritical Care team for their second Neurocritical Care Unit rotation to further enhance their skills in managing highly acute, complex neurologic conditions. Senior residents will take on more educational responsibilities, supervising and presenting at resident-led didactic sessions. They will also assume more leadership responsibilities including administrative duties and participation in various committees. This is the year for residents to solidify their career plans for after residency. Residents are also encouraged to delve further into their academic pursuits and interests with a dedicated research elective in addition to 3 months of elective time.