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Department of Neurology

 




Neurology Residency

 

Clinical Rotations,

Conferences and Rounds


OVERVIEW OF THE RESIDENCY PROGRAM

The success of this program is evident in the careers of individuals who have participated in it. Almost all of our graduating residents take fellowships either at Case or at other major institutions, including Massachusetts General Hospital, Columbia, Cornell, University of Pennsylvania, Johns Hopkins, and University of California San Francisco. About half of our graduating residents go into academic medicine and the other half into private practice. Recent graduates have full-time faculty positions locally or at other distinguished institutions including Harvard, Johns Hopkins, and Cornell. Individuals associated with the Department have gone on to take important roles in clinical neurology, including Chairmanships of Neurology at Bowman Gray, the Cleveland Clinic Foundation, Johns Hopkins, the Massachusetts General Hospital, St. Louis University, George Washington University, University of California, Irvine, and University of Arkansas. Additionally, those that wish to pursue private practice have obtained attractive positions throughout the United States.

Ten residents are selected annually for the 4-year categorical program. The PGY-1 year is identical to that of the first year residents in the Internal Medicine Residency Program at Case. During the first year of Neurology training (usually PGY-2), the resident is focused on activities in direct patient care in a hospital setting. The rotations include inpatient blocks on the Cerebrovascular, General Neurology, Epilepsy and the Neuro-Critical Care Services at the Cleveland Medical Center, inpatient ward/consult blocks at the VA, one block of night-service, one block of Neuro-rehabilitation at the VA, and one-half block of Neuroradiology.

Department of Veterans Affairs, United States of AmericaTeaching in the second year of neurology residency (usually PGY-3) is organized as blocks within the various subspecialties of Neurology in addition to learning basic neuroscience. The year includes  attending the 6-week Neuroscience Course for second year medical students at Cleveland Medical School. Residents attend the lectures and conduct small group sessions for medical students. The remaining year, residents attend blocks in EEG/Epilepsy, EMG/Neuromuscular, and Pediatric Neurology. Residents also spends some blocks as the Assistant Senior resident on the Cerebrovascular and General Neurology Services. This is a transitional role preparing the resident for their senior responsibilities.

During the third year of training (usually PGY-4), the emphasis is on management of patients on the neurology services, on teaching of fellow residents and rotating medical students, and on preparing the resident to practice neurology as an independent physician. The responsibilities include overseeing the care of patients admitted to the Cerebrovascular, General Neurology and Epilepsy Services at Cleveland Medical Center and the combined Ward and Consult Service at the VA. In addition, residents complete their Pediatric Neurology rotation, as well as spend time on Neuropathology, Neuroradiology, and Psychiatry, and Outpatient Neurology Block in addition to several elective blocks. One block is spent as the Night Service Senior. One block is spent in the UH Quality Institute learning risk management, quality and process improvement, and patient safety.

In addition to learning through direct patient care and attending rounds, there is a strong didactic curriculum. Residents in all years of training participate in a core series of seminars and lectures. Each year contains one 4-week block of vacation time.

CLINICAL ROTATIONS
Consult Rounds in the Neuroscience ICU Conference Room

First Year Neurology - PGY2 (Sample Schedule):

UH Cerebrovascular Service: This is a combined primary inpatient and consultation service that cares for patients with cerebrovascular disorders.

UH General Neurology Service: This is a combined primary inpatient and consultation service that cares for patients with a variety of neurological disorders.

VA Neurology Service: This is a combined primary inpatient and consultation service that cares for veterans with cerebrovascular and general neurological disorders.

UH Epilepsy Service: A block working with the Epilepsy Service helping manage inpatient Epilepsy consults and admissions.

Neuro-Critical Care: This is a combined ICU for neurology and neurosurgical patients that required intensive care.

Neuroradiology: A half block of time in the Neuroradiology Department, learning to interpret MRIs, CTs, and other common neuro-imaging.

Neuro-rehabilitation: This is a comprehensive introduction to rehabilitation on a variety of neurological patients. The experience includes working in the spinal cord unit, multiple sclerosis clinic, stroke rehabilitation and gait laboratory.

Night Service: One block covering consultations and new admissions at night. The junior resident is on a team with a supervising senior resident.

Vacation: One block.
 

Second Year Neurology - PGY3 (Sample Schedule):

Case Neuroscience Course: 1.5 blocks

EEG/Epilepsy: Two contiguous blocks, learning clinical epilepsy, reading EEGs and rotating on the Epilepsy Monitoring Unit.

EMG/Neuromuscular:  Two contiguous blocks, learning clinical neuromuscular disorders, and learning and interpreting EMGs.

Assistant Senior, Cerebrovascular Service:  One-two blocks working on the UH Cerebrovascular Service in a transitional role between Jr. and Sr. residents.

Assistant Senior, General Neurology Service:  One-two blocks working on the UH General Neurology Service in a transitional role between Jr. and Sr. residents.

Pediatric Neurology: One and a half blocks of working on the pediatric neurology service, both inpatient and outpatient.

Electives: One block in learning individually selected areas of neurology.

Vacation: One block.
 

Third Year Neurology - PGY4 (Sample Schedule):

UH Cerebrovascular Service Senior: A block or two of running the Cerebrovascular inpatient and consult service.

UH General Neurology Service Senior: A block or two of running the General Neurology inpatient and consult service.

UH Epilepsy Service: A block working with the Epilepsy Service helping manage the Epilepsy Monitoring Unit (EMU) and inpatient epilepsy patients.

VA Senior:  Overseeing care of inpatient veterans and handling consultations from other services.

Pediatric Neurology: One and a half blocks of working on the pediatric neurology service, both inpatient and outpatient.

Psychiatry Consultation Service:  One block on the consultation-liaison service.

Neuropathology/NeuroRadiology:  One block of learning and reviewing both microscopic and gross neuropathology, half time, and the other half time, learning neuroradiology.

Ambulatory Neurology Block:  One block dedicated to outpatient neurology with an emphasis on behavioral neurology and movement disorders.

Quality Institute Block:  One block of learning risk management, quality and process improvement, root cause analysis, and patient saftey.

Electives: At least two blocks in learning individually selected areas of neurology.

Night Service: One block covering consultations and new admissions at night. The senior resident is on a team supervising a junior resident.

Vacation: One block.

CONFERENCES AND ROUNDS
Neurology Grand Rounds in Kulas Auditorium

Resident Conferences:

Bootcamp: One week full time introduction to the Neurology residency at the start of the PGY2 year. The week includes a review of neuroanatomy and neuroradiology, in addition to simulation training in lumbar puncture and fundoscopy. Other topics include an introduction to EEG and EMG, documentation, hand-offs, and other practical aspects of being a Neurology resident.

Introductory and Emergency Neurology: Eight-week set of lectures at the start of the academic year, reviewing the neurologic exam, neuroimaging and several common neurological patient presentations, in addition to focusing on the major neurological emergencies.

Neuroscience Grand Rounds: Clinical and scientific lectures of current interest.

Neuropathology CPC: A clinical-pathological correlation conference consisting of a case-based discussion of neuropathologic topics.

Chairman Rounds: A Friday conference covering a variety of topics, including clinical trials and case presentations to the Chairman or senior faculty.

Journal Club and Evidence Based Medicine: Dissection of a current paper of interest, organized by residents and professors with an expertise in biomedical statistics. In addition, there is a comprehensive series of lectures on all aspects of Evidence Based Medicine.

Visiting Professorships: Throughout the year distinguished members of the neurological community provide teaching sessions for residents and faculty.

Stroke Conference: A resident led discussion of current research on topics related to cerebrovascular disease.

Morbidity and Mortality Conferences:  Senior UH Stroke and General Service residents present their cases from the month before.

Neuro-Ophthalmology Conference. Clinical conference on various topics in Neuro-Ophthalmology.

Comprehensive Epilepsy Conference: Includes acute management of seizures, diagnosis of epilepsy, long term management of epilepsy, and an introduction to the interpretation of electroencephalograms.

Neuromuscular Grand Rounds: Discussion of the fundamentals and clinical application of EMG and other neuromuscular topics.

Movement Disorders Video Rounds: Current cases and classic movement disorders discussed at a monthly conference.

Resident Core Competency Conference: Includes a variety of important topics, including bioethics, palliative care, and neuro-rehabilitation.

Neuroradiology Conference: Discussion of recent patient scans on the neurology and neurosurgical ward and consult services.

CNS Tumor Board: Discussion of active neuro-oncology patients among the neurology, neurosurgery, and radiation oncology services.

Resident Research Day:  Day long event in the spring where residents, fellows and graduate students from Neurology, Neurosurgery, Pediatric Neurology, Neuroradiology, Psychiatry, and Neuroscience  present their research projects, either as posters or oral presentations. The event starts off with the Garson Visiting Professor address, given by a distinguished alumnus of the program.