The fourth year of neurology residency marks a transition to senior-level responsibilities. Residents are expected to demonstrate advanced clinical competency in the independent management of complex neurological cases, develop leadership in academic and clinical settings, and serve as role models and mentors for junior colleagues. Clinical duties include managing patients in ICU, neurophysiology labs, and neurology inpatient/outpatient/emergency services, with greater emphasis on decision-making, system-based practice, and teaching.