Curriculum

Throughout the Adult Neurology Residency Program, resident physicians take on extensive clinical responsibilities under close, individual supervision by senior residents and attending staff members. Daily patient teaching rounds provide in-depth discussion of all patients seen on the neurology unit, in addition to consultations and weekly conferences and lectures. The rotations are divided into two week-half blocks with a total of 13 full four-week blocks for the year in order to provide residents with a variety of clinical experiences in each year of training. The following is a breakdown of the curriculum for each year of the Adult Neurology Residency Program:

PGY-1

The PGY-1 year is a preliminary year spent as an integrated member of the Rutgers, New Jersey Medical School Internal Medicine Department. During this year, residents gain a solid foundation in general internal medicine. The following is an example of what the first year in internal medicine would look like:

PGY-2

The aim of the PGY-2 year is to provide residents with comprehensive exposure to clinical neurology including inpatient and outpatient diagnosis and treatment management. During their PGY-2 year, residents begin working as junior members of the healthcare team, but progress in their clinical training in order to function as senior residents by April of their PGY-2 year. During this year of training, residents learn how to manage a health care team, handle errors, be cost-effective, and provide compassionate care to all patients. Additionally, residents participate in a quality assurance and improvement project and learn how to present a patient based lecture. Since teaching is fundamental to the clinical training provided, all residents are responsible for teaching the students on their team the basics of neurology.

PGY-2 residents experience the following rotations:

PGY-3

In their PGY-3 year, residents expand on their clinical knowledge and are given increased responsibilities including functioning as consultants to other services. During this year of training, residents serve as senior members of the healthcare team. As such, residents become proficient in management and care of uncommon neurologic problems in addition to maintaining the responsibilities and expectations of the PGY-2 year.

PGY-3 residents experience the following rotations:

PGY-4

By their PGY-4 year, residents have increased responsibilities and expectations including being able to efficiently diagnose, manage, and care for a wide array of common and uncommon neurologic conditions such as cognitive/behavioral disorders, headache syndromes, movement disorders, and neuromuscular disorders. With additional time for elective rotations, PGY-4 residents are able to develop their professional clinical and research interests in preparation for independent practice.

PGY-4 residents experience the following rotations:

General Neurology:

PGY-2 residents rotating on General Neurology learn to manage the inpatient care of patients with neurological problems, including managing implementation of the work-up and treatment plan for each inpatient. PGY-2 residents provide primary evaluation of all patients admitted to the General Neurology service at the UH and the Neurology Service at the VA, and for neurology consults as requested by the senior resident. PGY-3 residents extend their knowledge of proper evaluation of neurological problems requiring hospitalization and are responsible for supervising the junior residents and students rotating on their service. By their PGY-4 year, residents are fully responsible for supervising the junior residents and students rotating on the General Neurology service and demonstrating teaching skills at the bedside and during rounds.

Stroke Neurology:

PGY-2 residents provide primary evaluation of all patients admitted to the service, and for stroke consults. PGY-3 and PGY-4 residents show increased leadership and responsibility for the care of all stroke patients and extend their knowledge of proper evaluation of complex stroke syndromes. In their third and fourth years, residents assume responsibility of the care of acute stroke patients during BAT (brain attack) calls and are responsible for supervising the junior residents and students rotating on the stroke service.

Emergency Department Consult:

During their PGY-2 year, residents begin to work at UH in the Emergency Department. Residents rotating on Emergency Neurology learn to provide an initial evaluation of patients presenting in the ED requiring urgent neurologic analysis, diagnosis, and treatment. Residents also gain experience with acute neurologic conditions, including Brain Attacks. During their PGY-3 and PGY-4 years, residents master initial evaluation of patients presenting in the ED and provide initial evaluation, treatment, and management of uncommon acute neurologic conditions.

Neurology Night Float:

PGY-2 residents work at the VA in the Neurology Night Float Rotation, at which time they learn to provide initial evaluation of patients presenting in the Emergency Ward or on other services. During this rotation, residents are expected to progress in order to handle the higher demands of the UH Night Float by April of their PGY-2 year. By their PGY-3 and PY-4 years, residents master initial evaluation of patients presenting in the Emergency Department or on other services requiring urgent care and continue to treat acute neurologic conditions.

Ambulatory Neurology:

PGY-2 residents learn to manage the outpatient care of patients with neurological problems by ensuring implementation of the work-up and treatment plan for each patient. During this rotation, residents help the attending by providing a problem focused evaluation and formulating a treatment plan for each neurological outpatient. PGY-3 residents gain increasing skills in managing the outpatient care of patients with neurological problems. PGY-4 residents take on a more managerial and supervisory role by ensuring a smooth workflow in the clinic in addition to mastering skills learned in the previous two years.

Pediatric Neurology:

In their PGY-2 year, residents rotating on Pediatric Neurology learn to manage the inpatient and outpatient care of pediatric patients with neurological problems from newborn to adolescent. Residents assist the senior resident and attending by providing primary evaluation of patients admitted to the pediatric neurology service at UH and for neurology consults from others services. During their PGY-3 and PGY-4 years, residents demonstrate increased leadership and responsibility for the care of pediatric neurology patients in the inpatient and outpatient setting.

Psychiatry:

During their fourth year, residents rotate on the Psychiatry consult service and learn to diagnose common psychiatric conditions and psychiatric emergencies. Residents also learn how to perform a psychiatric examination and formulate a DSM multi-axial differential diagnosis and are expected to be able to develop a biological, psychological and social treatment plan.

Neuropathology:

PGY-4 residents rotating on the Neuropathology elective learn how to recognize normal central and peripheral nervous system structures in gross pathology and on microscopical examinations. In this rotation, residents learn to approach brain cutting by participating in autopsy demonstrations. Residents acquire knowledge of staining techniques (routine and special stains, as well as immunocytochemistry) and their indications in microscopical diagnosis, as well as recognizing the gross and microscopical pathology of neurological illness of the central and peripheral nervous system.

Continuity Clinic

All residents participate in a weekly Continuity Clinic, which allows them to follow patients over an extended period of time. The continuity clinic at UH consists of 2 attendings, 6 residents, and 2-4 medical students, while the continuity clinic at the VA consists of 2-3 attendings, 4-6 residents (including ambulatory, continuity, floor residents along with rotating medicine/psychiatry residents) and 3-4 rotating medical students assigned to each clinic. Continuity clinics for all neurology residents are in the afternoon on Monday and Thursday from 12:30 – 5:00PM at UH and on Monday, Tuesday, Thursday and Friday from 1:00– 5:00PM at the VA. During the course of training, residents complete 2 consecutive years at each location in order to have exposure to both healthcare systems.

Electives

Our residents have several months over the course of their residency to select electives. This time is provided to help explore specific research and clinical career interests. Some of the choices for an elective rotation include:

Neuroradiology/Neuroimaging:

Residents rotating on the Neuroradiology elective expand and deepen their knowledge of neuroimaging techniques, the anatomy

of the brain and spinal cord, and common and uncommon pathology on CT and MRI of neurological problems.

EEG/Epilepsy:

Residents rotating on the EEG/Epilepsy elective learn to manage the inpatient and outpatient evaluation and treatment of adults and children with epilepsy and will be introduced to the interpretation of routine, extended, and video EEG recording in adults and children.

EMG/NCS:

Residents rotating on the EMG/NCS elective learn to manage the outpatient evaluation and treatment of adults and children with neuromuscular and peripheral nervous system disorders and gain a fundamental understanding of the indications and interpretation of EMG/NCS.

Neurosurgical ICU:

Residents rotating on the Neurosurgical ICU elective learn to manage patients with central nervous system dysfunction requiring critical care and intensive monitoring and learn the application of critical care principles in the care of patients with acute neurosurgical conditions.

Specialty Clinic:

Residents rotating on the Specialty Clinic elective learn to manage the outpatient care of neurology patients with attention to a problem focused approach in the specialty areas in neurology, including neuromuscular diseases, movement disorders, multiple sclerosis, epilepsy, and neurofibromatosis.

Neuro-ophthalmology:

Residents rotating on the Neuro-Ophthalmology elective learn to recognize, evaluate, and treat common clinical presentations of optic neuritis, anterior ischemic optic neuropathy (arteritic and non-arteritic), papilledema, pseudotumor cerebri, ocular myasthenia, third nerve, fourth nerve and sixth nerve palsies, internuclear ophthalmolplegia, pituitary tumors, lesions of optic tracts, menigiomas with ophthalmic manifestations, thyroid eye diseases, anisocoria, and ophthalmoplegias.

Endovascular Neurology:

Residents rotating on the Endovascular Neurology elective will learn the indications as well as modern techniques and possibilities for interventions used to manage large vessel occlusions, stenosis, aneurysms, and other types of vascular malformations. Working with the fellow and attending, residents will also learn the basics of prepping catheters, lines, and contrast for an intervention.

Research:

Residents rotating on the Research elective gain a greater understanding of the scientific method and the acquisition of new knowledge through a mentored research experience. Residents learn to develop a research question and assess, appraise, and assimilate the current medical literature pertaining to the research topic. In this rotation, residents design and write a research protocol, and learn to conduct the research and acquire skills necessary to complete the project, such as laboratory techniques, computer skills, biostatistics and data analysis as appropriate to the project.