Residents are promoted and graduated by consensus of the faculty after demonstrating satisfactory performance in all their clinical rotations and basic competencies in procedures and professionalism.
Clinical Rotations
Residents are exposed to a variety of inpatient and outpatient rotations to enhance learning, collaboration, and patient interaction.
Inpatient Exposure
In their first year of training, neurology interns gain experience in internal medicine in the inpatient and outpatient settings; they also receive early exposure to neurology by rotating through the inpatient neurology service.
Inpatient exposure to neurology occurs mainly during the PGY-2 year. PGY-2 residents lead the wards team on either the general neurology service or the stroke service. They’re responsible for evaluating and managing (under the attending physician’s supervision) all patients on the service and 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 calendar through the year is divided into thirteen, 4-week blocks. PGY-2 residents spend seven blocks in the inpatient setting/wards (three on general neurology and three on stroke and one in the neuro ICU) and work with an intern from our internal medicine department. During the first three blocks of the PGY-4 year, residents return to the wards to serve as “supervising seniors.” During this time, the PGY-4s help the new PGY-2s as they learn to lead the team and manage the patients.
Outpatient Exposure
Residents begin working in the outpatient subspeciality neurology clinics during the PGY-2 year, and this continues throughout their residency training. Residents have a continuity clinic, a half day per week, and have increasing autonomy for patient management as they progress in seniority.
Residents also rotate through the faculty’s specialty clinics. This includes clinics in multiple sclerosis, headache, epilepsy, movement disorders, neuromuscular disease, sleep, neuro-behavioral, neuro-oncology and general neurology.
Residents can also work in other clinics outside of our department, such as pain management, during their elective blocks. Additionally, each resident spends at least three blocks learning nerve conductive studies and electromyography (NCV/EMG) and at least two blocks dedicated to reading electroencephalography (EEGs). Finally, each resident does three blocks of pediatric neurology, where they rotate through the pediatric neurology clinics and gain experience seeing pediatric consults.
Consult Service
The neurology inpatient consultation service is the responsibility of the third- and fourth-year residents. There is always a PGY-3 and PGY-4 resident on the service. The PGY-4 is responsible for managing the team. The consult residents see all old consults and round with the attending on all new consults.
In order to develop the skills they will need for independent practice, residents are encouraged to make management and treatment plans prior to rounding with the attending. All plans, however, are discussed with the attending physician, usually during formal rounding on new and follow up patients.
The PGY-4 resident on consults is a great resource for the PGY-3 resident if they need additional assistance with developing their plans or interpreting results. Additionally, there is always a neurology attending on-call to provide advice. All patients are discussed with the on-call attending.
- Seven inpatient medicine blocks
- Night float call system
- Four “no-call” outpatient blocks
- Two 3-week rotations on inpatient neurology
- One block neurology outpatient clinics at the VA
- One block neurosurgery
- Six blocks wards (three months general and three months stroke neurology)
- One block Neuro ICU
- Two blocks outpatient epilepsy/EMU
- One block outpatient neurology subspecialty clinics
- Three blocks electives
- Intermittent night float coverage on outpatient/elective blocks
- Three blocks consults
- Three blocks outpatient EMG/neuromuscular
- One block outpatient VA neurology
- Two blocks pediatric neurology: clinic and consults
- Four blocks elective
- Intermittent night float coverage on outpatient/elective blocks
- One-block supervising senior ward resident
- Three blocks consults
- Two blocks neuroscience
- One-block pediatric neurology consults
- One block VA psychiatry
- Five blocks electives
- Intermittent night float coverage on outpatient/elective blocks
- Additional exposure to any standard rotation
- Research elective
- Interventional radiology
- Sleep disorders
- Neurovascular Ultrasound
- Neurotoxin therapeutics
- Pain management
- Neuro-ophthalmology
- Medical genetics
- Neuropsychology
- Intraoperative evoked potentials
- Introduction to private practice
On-Call Duties and Night Float
All residents will have periodic on-call duties throughout their training. During the PGY-2 year each resident typically has 9 total in-house calls, and they cover all adult neurology issues. During the PGY-3 year, the residents have six in-house adult calls. In the PGY-4 years there are three in-house adult calls.
By implementing a night float system for adult and pediatric neurology coverage, we have eliminated 24-hour in-house adult calls. Adult calls are 18-hour shifts and end at midnight. To reduce the overall patient load per resident, there is overlap between the night-float and on-call resident shifts.
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 and attending who can provide assistance.
Teaching Opportunities
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 lectures 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 give formal grand rounds presentations during their PGY-4 years. Residents also present the noon didactic lectures periodically, particularly during EMG, epilepsy and pediatric neurology conferences.
Teaching sessions for residents occur several times during a normal week. There is a weekly EMG case conference on Mondays led by residents and fellows. Attendings are present and help work through the differential diagnosis, workup and treatment of the patient. Additionally, Tuesday afternoons are dedicated for didactic sessions with pager coverage provided by program leadership, to ensure residents can attend without interruptions.
Friday noon didactic sessions cover a wide variety of topics, such as neuroradiology cases, board preparation, journal clubs and root cause analysis. One noon per week we have grand rounds, during which there is a presentation from a faculty member frequently from another institution or another department from the School of Medicine.