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Second Year of the Neurology Residency Program (PGY-2)
During their second year of the Neurology Residency Program, the resident is exposed to an unusually wide spectrum of neurological disorders, including those that are acute and chronic, and common and rare. First-year residents spend four months at Strong Memorial Hospital on the inpatient neurology service, two months each at Highland Hospital and at Rochester General Hospital one month each on the Strong Memorial Hospital Epilepsy Service and on the ambulatory subspecialty rotation, two weeks on the neurosurgery rotation, and a 2-week elective block.
Strong Memorial Hospital Inpatient Neurology Service
Strong Memorial Hospital is a 739-bed tertiary care hospital, providing care to more than 39,000 inpatients and 1,300,000 outpatients, annually. The hospital has a wide referral base, including northern and western New York State, northern Pennsylvania, eastern Ohio, and southern Ontario, Canada.
The Neurology inpatient unit (5-1600) consists of 24 beds. Approximately 1,500 patients are admitted to the unit each year, with an occupancy rate that averages 100%. Patients represent a broad spectrum of acute and chronic neurologic disorders, and come from the emergency department and private practices of staff neurologists, and as referrals from other physicians, the neurology clinic, the intensive care unit and other hospital units. There are two clinical services on the neurology inpatient unit: one specializing in the care of patients with strokes and general neurological diagnoses, and the other specializing in the care of patients with epilepsy.
The second-year neurology resident spends about four months (four 4-week blocks) on the stroke and general neurology inpatient service of Strong Memorial Hospital. This service is divided into two resident teams, each consisting of an assistant resident in neurology (PGY-2), an internal medicine intern (PGY-1), and one medical student. The chief resident in neurology (PGY-4) supervises and oversees both of these teams. The average team size is 8-10 patients. About three patients are admitted each day to the neurology inpatient service.
The neurology residents at Strong Memorial Hospital manage all aspects of patient care and perform all procedures, under faculty supervision, for all patients admitted to the neurology inpatient service. Neurology residents are given progressive responsibility for patient care in cooperation and close communication with attending neurologists. No distinction is made among patients with regard to patient care, teaching, or resident responsibilities.
Highland Hospital is a 261-bed, full-service hospital established in 1889. It became part of the Strong Health system in 1997, and has developed centers of excellence in geriatric medicine, women's health, obstetrics, joint replacement surgery, and bariatric surgery. Highland Hospital is a New York State designated Stroke Center. The Strong Department of Neurology began providing full consultative neurological services at Highland Hospital in 2004. Full-time faculty members of the Department of Neurology staff the Highland Hospital consultation service and teach the neurology residents and medical students on service.
The goal of this rotation is to use Highland’s “community hospital” atmosphere to simulate the consultative feel of the private general neurology practice environment in which most neurologists work. Second-year neurology residents spend 8 weeks at Highland Hospital and provide inpatient consultations for a range of general neurologic complaints. Residents develop expertise in geriatric neurology (age-related neurodegenerative disease, memory impairment, seizures, headaches, and gait disorders in the elderly), women's health (management of neurologic diseases during pregnancy and neurologic complications of pregnancy), and neurological complications of systemic illness. The neurology resident also gains experience supervising and teaching medical students and residents rotating from other services.
Rochester General Hospital
Rochester General Hospital (RGH) is a 528-bed, full service hospital that serves the northeast community of Rochester. It is the second largest hospital in Monroe County and is recognized for its cardiology services, oncology services and nursing magnet status. RGH is a New York State designated Primary Stroke Center. The stroke service at RGH consistently wins national recognition for quality, and the percentage of eligible patients who receive TPA is almost double national standards.
The RGH Department of Neurology provides a wide range of inpatient and outpatient services. Inpatient activities include a general neurology and a stroke consultation service, as well as a neurorehabilitation service. Outpatient activities encompass a broad range of general neurology and subspecialty clinics. The department also has a wide range of inpatient procedures available, including an excellent accredited ultrasound service, EEG and EMG. Clinical research trials are currently underway at RGH for stroke, dementia and movement disorders, and expansion into other realms is planned.
The RGH Department of Neurology includes full-time faculty members who all participate in teaching neurology residents, internal medicine and psychiatry residents, as well as medical students on the neurology clerkship. Most RGH attendings rotate through SMH subspecialty clinics, and many are also actively involved in research at the University.
Neurology residents rotate at RGH for eight weeks. Residents are exposed to a high volume of acute neurological disorders typical of a community hospital setting, such as epilepsy and stroke. They also actively contribute to the teaching of UR medical students rotating on the neurology clerkship.
Strong Memorial Hospital Epilepsy Service
The Strong Epilepsy Center (SEC) provides evaluation, management, and treatment of children and adults with intractable epilepsy. The SEC consists of an eight-bed adult and a four-bed pediatric long-term monitoring unit located within Strong Memorial Hospital.
Since the epilepsy service was established in 1990, more than 8,000 patients have been evaluated and a variety of epilepsy surgeries are performed each year.
The primary goal of the second year epilepsy rotation is to introduce the resident to the field of epilepsy and EEG. Each first-year neurology resident spends four weeks on the epilepsy service. He or she is responsible for the care of all epilepsy service inpatients in consultation with the epilepsy attending, an epilepsy fellow, and a nurse practitioner.
Subspecialty Ambulatory Rotation
The second-year neurology resident spends 4 weeks in the ambulatory subspecialty clinics. Rotation through these clinics provides the resident with a unique opportunity to see large numbers of patients with common as well as unusual neurologic diagnoses. Full-time neurology faculty, who are often internationally recognized authorities in their fields of interest, staff the clinics. Many patients admitted to the neurology inpatient service come from these specialty clinics.
The University of Rochester Department of Neurosurgery is a busy academic department with extensive clinical, translational, and basic science programs. The clinical faculty practice, through Rochester Neurosurgery Partners (RNP), provides city-wide neurosurgical coverage to all four Rochester hospitals (Strong Memorial Hospital, Rochester General Hospital, Unity/Park Ridge Hospital, and Highland Hospital) in all three health care systems. RNP faculty also staff outreach clinics throughout Western New York.
The Neurosurgery rotation for PGY-2 neurology residents is a two-week rotation that takes place in a multidisciplinary inpatient unit as well as in the outpatient clinic of Rochester Neurosurgery Partners. The goals of this rotation are to (1) understand the clinical features of common neurosurgically treated disorders; (2) develop sufficient familiarity with CT/MRI to allow basic recognition of fundamental neurosurgical pathology; and (3) develop introductory familiarity with common neurosurgical procedures.
Elective schedules, including the choice and duration of particular electives, are arranged to meet the career plans of the individual resident and to satisfy requirements of the American Board of Psychiatry and Neurology. A wide range of electives is available, including neuroradiology, neurorehabilitation, neuropathology, neuro-oncology, psychiatry, EEG, EMG, neuro-ophthalmology, cognitive and behavioral neurology, headache medicine, sleep disorders, palliative care, and pain medicine. In addition, a wide range of opportunities is available for residents to participate in clinical or basic neurological research.