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Neurology Residency: Curriculum

The ACGME requires that each residency program provide a comprehensive learning environment by which the residents are able to learn, practice, and achieve competency throughout the training program. These requirements include adequate patient care exposure, regularly scheduled didactic learning, and research experiences.

At a minimum, the resident is expected to complete the following patient care experiences:

  • 18 months - clinical adult neurology
  • 6 months - adult neurology, inpatient
  • 6 months - adult neurology, outpatient
  • 3 months - elective
  • 3 months - child neurology
  • 1 month - psychiatry
  • ½ day per week - continuity clinic
  • Neuroimaging experience
  • Critical care unit/emergency department experience including acute neurosurgical management

Neurology-Level 1 (PGY-2)

First-year neurology residents will be introduced to the basic clinical and scholarly experiences upon which the rest of their training will be based. Residents at this level will build upon their undergraduate medical education and intern knowledge base and competencies to learn how to obtain an accurate neurological history and to perform and interpret a neurological examination. PGY-2 residents will develop thoughtful patient assessments and management plans, to include EEGs, lumbar punctures, and CT and MRI imaging of the brain and spinal cord. They will learn how to evaluate and treat both common outpatient problems (headache, dizziness, neck and back pain, peripheral neuropathies) and neurological emergencies (coma and mental status changes, stroke, seizures). Throughout their first neurology year, PGY-2 residents will continue to develop and improve their written and oral communication skills. They will also develop focused sign-out skills to facilitate continuity of care. They will also establish a framework of understanding of neurology practice that will incorporate issues of patient advocacy, preventive healthcare, clinical ethics and effective cost-containment into each aspect of their future experiences.

As they progress through their first neurology year, PGY-2 residents will promote their scientific inquisitiveness by asking insightful questions, independently seeking knowledge, and reading and critiquing the medical literature. They will expand their neurology knowledge base and will acquire initial skills as teachers for medical students as well as for patients and their families. They will also develop clinical efficiency and begin to manage the ward team to prepare them for their subsequent years as proper supervisors of lower-level residents.

Typical PGY-2 Schedule

# of  Four Week Blocks

          

Inpatient/Consult General and Stroke Neurology – DSMCUT

Outpatient Neurology – Jefferson Clinic

6 1/2

 1/2

Outpatient Neurology - VA  

            4

EEG

Elective

1

1

½ day of continuity clinic per week

 

Total

13

   

Neurology-Level 2 (PGY-3)

The second year of neurology training builds upon the skill and knowledge base established in the first year and will use evidence-based medicine to enhance patient care and self-improvement. Over the year, PGY-3 residents will refine their clinical assessment skills, as well as, perfect their history taking and neurological examination skills in infants and children. They will also broaden the scope and complexity of the healthcare problems they address to include multiple sclerosis, Parkinson’s disease and other movement disorders, neuromuscular diseases, dementia, central nervous system infections, and tumors of the nervous system. PGY-3 residents will be exposed to in-depth experiences in a variety of subspecialty areas, including EEG, EMG, neuroradiology, and neuropathology. They will show an increasing ability to practice medicine independently, and to begin functioning in an effective supervisory role towards lower-level residents.

PGY-3 residents will enhance their teaching role at the bedside and will expand their teaching efforts in the conference room. They will learn to develop effective group teaching sessions and to efficiently utilize available teaching materials and literary resources. Via exposure to a large number of neurologic experiences, the PGY-3 resident will begin to focus their career planning deliberations through discussions with faculty and mentors, and will successfully develop or confirm their future practice interests. As mid-level trainees, PGY-3 residents will affirm their role as trusted patient advocates, preventive healthcare providers, and ethical and cost-effective practitioners.

Typical PGY-3 Schedule

# of Four Week Blocks

Inpatient/Consult DSMCUT – Stroke Service

2

Inpatient/Consult DSMCUT – General Service

2 1/2

Pediatric neurology

2

Outpatient Selective

1

EMG

1

Elective

          4 1/2

½ day of continuity clinic per week

 

Total

13

 

 

Neurology-Level 3 (PGY-4)

As a senior, PGY-4 neurology residents will continue to expand their knowledge base through additional core and subspecialty rotations, including psychiatry. As they prepare for the American Board of Psychiatry & Neurology’s certification examination, PGY-4 residents will further refine their competence in clinical diagnostic evaluations and technical procedural skills, as well as their patient stabilization and office preparedness abilities. They will practice efficiently and effectively with a significant degree of independence in the evaluation and management of patients presenting with a wide variety of inpatient and outpatient neurological disorders in preparation for future practice. They also need to be able to demonstrate level-appropriate leadership, confidence, and supervisory capabilities.

As they continue to move closer to their residency commencement, PGY-4 residents will assert their preceptorial and group teaching skills as they expand their capacity to critically evaluate the medical literature and to teach other healthcare professionals and multiple-level learners in a “round” format. They will complete plans for their future careers in general neurology or in additional fellowship training, as well as establish successful life-long learning habits.

Typical PGY-4 Schedule

# of Four Week Blocks

Pediatric neurology

1

Senior Inpatient Wards/Consult - DSMCUT

4

Psychiatry

1

Outpatient Selective

2

Elective

5

½ day of continuity clinic per week

 

Total

13

Didactics and Conferences

Neurology Boot Camp
This lecture series provides the PGY-2 residents with an intensive overview of neurology as well as instruction in evaluation and management of neurological emergencies. These lectures are held in the SBSI (Seton Brain & Spine Institute) Conference room in Suite 300 of the CEC (Clinical Education Center) during orientation.

Attendance is mandatory for all PGY-2 residents and optional for all others.

Neurology Core Curriculum
These lectures are held at 1-4 pm on Tuesdays in the DSMCUT Team Room. These lectures are designed to provide the residents with the knowledge required to diagnose and treat neurology patients. Lecture topics follow a textbook and fully prepare the residents for the AAN Resident In-training Exam (RITE) and ABPN board exam.

Attendance of at least 80% of all lectures is mandatory for all residents. Attendance is monitored via an honors-based sign-in sheet and is logged into New Innovations© by the Program Coordinator. Attendance rates will be reviewed and discussed at the resident Quarterly Review meetings with the Program Director.

Grand Rounds
Grand Rounds are held every Tuesday, and is a mandatory, educationally rich conference for neurology faculty and residents. These are didactic-style presentations on clinical and basic science topics from both internal and external speakers. CME credit is provided.

Journal Club
A monthly conference designed to help residents develop skills in critically assessing the medical literature and verbally presenting their findings. Journal Clubs are usually held monthly. Attendance is mandatory for all residents. Typically 2-3 articles will be assigned for discussion and reviewed by the residents with a faculty moderator present. Residents will be provided with articles by the first of the month.

Stroke Conference
A monthly conference on stroke is given by Dr. Steven Warach. There will be case presentations, literature review, and discussion lead by the attendings from 12-1 pm.

Brain & Spine Rounds
Brain and Spine rounds are usually held the third Friday of each month at 7:00 AM. A resident will be assigned to present an interesting case from the wards, consult service, or clinics.

GME Lecture Series
These lectures were developed by the GME Office and are provided once a month. Topics will include ethical issues, professionalism, resident fatigue, and other critical subjects. Attendance is mandatory and is tracked by the GME Office.

Epilepsy Conference
Epilepsy Conference is led by one of our epileptologists. Difficult epilepsy patients are presented. Management and epilepsy surgery plans are discussed.