Residents are promoted and graduated by consensus of the faculty after demonstrating satisfactory performance in all of their clinical rotations and basic competencies in procedures and professionalism.
Residents are exposed to a variety of in and out patient rotations and consult services to enhance learning, collaboration, and patient interaction.
Inpatient exposure occurs mainly during the HO-II year. HO-II residents lead the wards team on either the general neurology service or the stroke service. They’re responsible for evaluating and managing (under attending physician supervision) all patients on the service, and to develop differential diagnoses and plans.
Neurology residents are encouraged to order necessary tests without direct prior attending approval, although invasive diagnostic testing is typically discussed with the attending.
The HO-II residents spend six months on the wards (three on general neurology and three on stroke) and work with an intern from our internal medicine department. During the first month of the HO-IV year, residents return to the wards to serve as “acting attendings.”
Residents begin working in the outpatient clinics during the HO-II year, and this continues throughout the residency training. All residents have a continuity clinic that meets a half day per week, and have increasing autonomy for patient management as they increase in seniority.
Residents also rotate through the faculty’s specialty clinics. This includes clinics in multiple sclerosis, headache, epilepsy, movement disorders, neuromuscular disease, sleep, neurosurgery and general neurology.
Residents can also work in other clinics outside of our department, such as pain management and neuro-oncology, during their elective months. Additionally, each resident spends at least three months learning Nerve Conductive Velocity and Electromyography (NCV/EMG) and at least four months reading electroencephalography (EEGs). Finally, each resident does four months of pediatric neurology, and the majority of the time on this rotation is spent in the pediatric neurology clinic.
The neurology inpatient consultation service is the responsibility of the third- and fourth-year residents. There is always an HO-III and HO-IV resident on the service. The HO-IV is responsible for managing the team. The consult residents see all old consults and round with the attending on all new consults.
As part of developing independent patient care responsibility, residents are encouraged to make workup, management and treatment recommendations prior to rounding with the attending. All plans, however, are communicated to the attending physician, usually during formal rounding on new patients.
The HO-IV resident on consults is the initial resource for the HO-III resident when patient recommendations are made. Additionally, to further prepare the residents for independent patient care, the HO-IV resident on consults is on-call from home Monday through Thursday until midnight each night to “staff” inpatient consults seen by other residents. This provides the HO-IV resident experience in initial management decision-making in an acute patient care setting.
If the HO-IV resident is unsure of the appropriate management for an inpatient consult, then there is always a neurology attending on-call to provide advice. All patients "staffed" over the phone by the HO-IV will be seen by the consult attending the next day for formal attending staffing.
House Officer - I
House Officer - II
House Officer - III
House Officer - IV
All residents throughout their training will have periodic on-call duties. During the HO-II year each resident has between four and seven calls per month, and they cover all adult neurology issues. The majority of these call nights are in-house, but there is some home-call. During the HO-III and HO-IV years, the residents have between one and four calls per month, with all of the calls being home-call. The majority of the calls during the HO-III and HO-IV years are for pediatrics only.
When residents see a patient in the emergency department, they are responsible for triaging the problem as either a general neurology or a stroke-related issue and then contacting the appropriate attending for disposition. All residents are expected to have formulated a differential diagnosis and plan of management prior to contacting the attending.
If the resident is unsure of correct disposition, then there is always an upper-level resident or attending who can provide assistance.
Teaching is an integral part of the residency training program and is crucial to developing the residents' knowledge base. The ward residents are the primary teachers for the medicine interns and the third-year medical students. Senior residents provide teaching and assistance for junior residents and help to supervise procedures as needed.
Senior residents participate in the recurring lecture series for third-year medical students and are encouraged to participate in teaching opportunities for first- and second-year students as well. All residents are required to prepare case presentations for grand rounds during their HO-II year and to give formal grand rounds presentations during their HO-III and HO-IV years. Residents also participate in the noon didactic lectures periodically, particularly during EMG and pediatrics conferences.
Teaching sessions for residents occur several times during a normal week. Three mornings of the week we have morning report, where an interesting case is presented by a resident. Attendings are present and help work through the differential diagnosis, workup and treatment of the patient.
One morning per week we have grand rounds, during which there is a presentation from a faculty member from another institution or another department at the School of Medicine. It is typical to have a didactic teaching session during the lunch hour. These sessions are directed towards the residents and cover a wide variety of topics. Finally, there are different sessions on Fridays, such as morbidity and mortality conference, oral boards preparation and journal club.