Rotation Description and Goals
At UNMC, the inpatient team consists of three neurology residents. There are two PGY-2 residents and either a PGY-3 or a PGY-4. Additionally, there is almost always an internal medicine resident rotator. On occasion, there is an additional rotator from Psychiatry, Neurosurgery, Family Medicine, or Geriatrics. The team is completed by medical students, observers and international rotators. The attending supervises the activity of the whole team and rounds daily. The senior neurology resident on the service is in charge of overseeing and organizing the assignment of patients to the team. For patients followed by the internal medicine resident and other rotators, they are also overseen by the senior neurology resident. The medical student follows patients along with the neurology resident. The rounds take place daily, seven days a week. On the weekends, the on-call resident rounds with attending. For the rest of the week, the whole team is present. Sometimes, according to the needs, the rounds can take place more than once, particularly when there are emergency room or ICU consultations.
At CUMC, the team is composed of neurology resident, an internal medicine resident rotator, a resident rotator from Psychiatry and medical students. Rounds take place once or more daily, seven days a week according to the needs with the attending. The neurology resident is in charge of overseeing and organizing the distribution of the workload and overseeing the rotators’ and medical students’ work. Additionally, it is ultimately the responsibility of the attending physician to oversee the activities of the whole team.
At the OVAMC, the team is composed of two neurology residents and an internal medicine resident from CUMC. This is overseen by a neurology attending with rounds taking place daily, Monday through Friday and as needed over the weekend. It is the neurology resident’s responsibility to oversee the team and see those patients prior to discussion with the attending physician.
At Children’s Hospital & Medical Center, the team consists of a PGY-3 Neurology Resident who is supervised by the Pediatric Neurologists on service. The inpatient child neurology rotation takes place either at UNMC or at the Children’s Hospital & Medical Center. The neurology resident has a similar role in the care of child neurology patients as for adult neurology patients. The resident takes a history, performs a neurologic examination, and collects and reviews available laboratory data. The resident also reviews imaging studies and other investigations. This is reviewed with the pediatric neurology attending who confirms findings at the bedside. A diagnostic and treatment plan is discussed and implemented. The neurology resident follows up on the progress of the patient, response to treatment and results of any diagnostic testing. With the attending, the neurology resident communicates findings and recommendations to the family and to other physicians involved in the care of the patient.
Emergency calls are frequent to the neurology inpatient service either at UNMC or CUMC. It is the neurology resident’s responsibility to be first respondent or delegate a rotating resident under his/her supervision to respond to emergency department consultation. After the patient is examined and interviewed, then the attending neurologist on the service gets involved and discusses and reviews with the resident the diagnosis and recommendations. If the patient needs to be admitted to the neurology service, then the neurology resident takes charge of arranging that. If the patient should be admitted to other services, then the neurology team follows in consultation.
At the OVAMC, there is urgent care but no emergency services at that facility. The neurology service is primarily a consulting service.
At all three hospitals, the neurology resident is primarily responsible for responding to an acute stroke code and sees the patient with immediate evaluation by the attending physician.
During the entire residency our residents have the opportunity to receive 8 months of dedicated training in the following specialty areas:
- EMG/Neuromuscular Medicine
In addition, residents have 3 months of elective time to do rotations of their choosing. In addition to the specialty areas listed above, there are opportunities in:
- Behavioral Neurology
- Dystonia and Spasticity
- General Neurology
- Geriatric Neurology
- Movement Disorders
- Multiple Sclerosis
- Research Elective
- Vascular Neurology/Stroke
The residents do two half day clinics per week. One is the continuity clinic and the other is a subspecialty clinic of their choice. The subspecialty clinic choices include Behavioral/Geriatric Neurology, Epilepsy, Movement Disorders, Multiple Sclerosis, Neuromuscular, and Vascular Neurology.
In their continuity clinic at OVAMC, the neurology residents have primary responsibility for the management of patients. They are supervised in their provision of care by an attending neurologist. Residents present their history and examination along with their formulation of treatment and diagnostic plan. The attending neurologist advises the resident on the plan of care and confirms the findings in each individual patient. The resident is responsible for implementing the plan of care.
In the subspecialty clinics, residents rotate for 3 months at a time in different subspecialty clinics. The resident is responsible for taking the history, examining the patient, reviewing the records, reviewing the diagnostic evaluations, formulating the localization, differential diagnosis, and a proposed plan for evaluation and management with the attending, who is ultimately responsible for discussing the case with the resident, providing teaching pointers, and finalizing the plans for diagnosis, evaluation and management. The resident is responsible for dictating a consultation that is reviewed and/or attended by the attending physician. These patients include those that were inpatients and are now being followed up in the subspecialty clinics.