General Neurology Residency Program
Curriculum
The Adult Neurology Residency Program at the University of Rochester is a four-year categorical program in neurology that includes a preliminary (PGY-1) year of internal medicine training. This preliminary year is supervised by both the neurology and internal medicine program directors. The core curriculum of the first year is identical to that of the First Year Categorical Medicine residents.
The following provides an overview of program goals and philosophy and an outline of our curriculum and teaching schedule. No website can answer every candidate's questions. Therefore, we encourage you to call us if we can clarify or expand on any components of our program.
Preliminary Year in Internal Medicine (PGY-1)
The central educational experience of the preliminary year Internal Medicine is the individual patient encounter. Residents interview and examine patients in a wide variety of clinical settings, define each patient's clinical problems and health care needs, and develop plans for diagnosis and management. Each of these encounters is mentored by at least one faculty member and by a PGY-2 or PGY-3 Internal Medicine resident as well.
Much of the teaching happens one on one, as faculty member, resident, and patient work together toward the complementary goals of patient health and resident education. Constant attention is paid not only to the patient's illness, but also to the psychological and social context in which the illness occurs. In their discussions after seeing their patients, residents and faculty members define gaps in their knowledge and take responsibility for filling those gaps by seeking out the best available evidence from basic or clinical research. Subsequent decisions are scientifically based and, equally important, a pattern of lifelong, patient-centered learning is established.
The core curriculum for Preliminary Medicine/Neurology Residents is identical to that of the First Year Categorical Medicine residents and includes experiences in inpatient general medicine (16 weeks), inpatient hematology/oncology (4 weeks), MICU (4 weeks), CCU (4 weeks), emergency medicine (4 weeks), ambulatory general medicine blocks (8 weeks), neurology (4 weeks), geriatrics (2 weeks), and elective (2 weeks). All core experiences take place at SMH except for 4 weeks of inpatient general medicine and geriatrics experience, which take place at Highland Hospital. Throughout the year, Preliminary Medicine/Neurology residents have one half-day each week of ambulatory Neurology clinic, organized by the Neurology program director. Each first year resident also has 4 weeks of vacation.
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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 the Canandaigua Veterans Administration Hospital, and one month each on the Strong Memorial Hospital Epilepsy Service and on the ambulatory subspecialty rotation.
- Strong Memorial Hospital Inpatient Neurology Service
Strong Memorial Hospital is a 750-bed tertiary care hospital, providing care to more than 40,000 inpatients and 412,359 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 1,000 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 (HH)
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. The Strong Department of Neurology began providing full consultative neurological services at Highland Hospital in 2004. Five full-time faculty members of the Department of Neurology based at Highland Hospital participate fully in the activities of the Department, contribute to the teaching of neurology residents and provide clinical clerkships for medical students.
Second-year neurology residents spend about 8 weeks at Highland Hospital and provide inpatient and outpatient consultation for a range of general neurologic complaints. Special emphasis is on the consultative model of neurology. Residents can expect special experience in geriatric neurology (including age-related neurodegenerative disease, memory impairment, seizure, headache, and gait disorders), women's health (including management of neurologic diseases during pregnancy as well as complications of pregnancy itself, and peripheral neurological complications of obstetrics), and neurological complications of systemic illness.
The Highland rotation places special emphasis on exposure to basic neurophysiology early in residency training, primarily EEG and EMG. The neurology resident also gains experience supervising and teaching medical students and residents rotating from other services.
- Canandaigua VA Medical Center
The Canandaigua VA Medical Center, located in a beautiful Finger Lakes community about 30 minutes from Rochester, is a 240-bed chronic care facility that includes a component for patients with neuropsychiatric disorders. The neurology unit consists of 25 inpatient beds dedicated to the treatment of patients with Alzheimer's disease and other dementias. Also in operation are a General Neurology outpatient clinic at the medical center, and a modern outpatient facility located in Rochester. Residents spend approximately 8 weeks on this rotation.
- 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 long-term monitoring unit located on the neurology inpatient unit of Strong Memorial Hospital. Since the epilepsy service was established in 1990, more than 4,000 patients have been evaluated and approximately 500 epilepsy surgeries have been performed.
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.
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Third Year of the Neurology Residency Program (PGY-3)
The third-year neurology resident spends most of the year on the adult and pediatric neurology consultation services. One month of psychiatry and two months of electives round out the second-year experience.
- Strong Memorial Hospital General Neurology Service
The third-year neurology resident spends approximately 10 weeks on this busy service. Neurological consultations are provided throughout Strong Memorial Hospital, most commonly involving the ED, ICUs, and the internal medicine, psychiatry, and surgical services. Approximately three new consultations are requested daily. The general neurology consultation team consists of the third-year neurology resident, two medical students, and a full-time neurology faculty member, plus any internal medicine residents on elective. A wide range of acute and chronic neurological disorders is seen during this time period.
- Strong Memorial Hospital Stroke Service
The Strong Memorial Hospital Stroke Service provides consultations to all patients with cerebrovascular disorders throughout SMH, including the ED, medical and surgical ICUs, and general medical and surgical services. Approximately two new consultations are requested daily. The third-year neurology resident spends approximately 10 weeks on this busy service. The stroke team consists of the third-year neurology resident, two medical students, and the designated stroke attending, plus any anesthesiology and neurosurgery residents on elective.
- Pediatric Neurology Service
Residents spend 12 weeks on the busy Pediatric Neurology Service at Strong Memorial Hospital. The service covers 124 pediatric beds, 12 pediatric intensive care beds, and 52 neonatal intensive care unit bassinets. There are approximately 40 consultations requested each month and 50 outpatient visits weekly. Children with a wide variety of neurological disorders are evaluated and treated in both inpatient and outpatient clinic settings.
- Psychiatry
The four-week psychiatry rotation for neurology residents has been designed to teach fundamentals of psychiatry most beneficial for the practice of neurology. This rotation is directed by a board-certified psychiatrist and consists of two 2-week experiences: the SMH Psychiatric Emergency Department and the SMH Inpatient Consult Liaison Service.
During the psychiatry ED component, the neurology resident will play a primary role in the evaluation of a wide range of individuals with varying degrees of psychopathology. With direct supervision by attending psychiatrists, along with an experienced staff of psychiatric nurses and social workers, the resident will develop emergency room skills, such as rapid acquisition of data through directive interview techniques.
During the Inpatient Consult Liaison component, the neurology resident will develop skills in the assessment of psychiatric problems in a medical setting, master the understanding of the interaction of medical and neurological conditions with psychiatric disorders, and begin to develop the skills of a specialty consultant.
- Electives
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, sleep disorders, pallitive care, pain medicine and neurosurgery. In addition, a wide range of opportunities is available for residents to participate in clinical or basic neurological research.
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Fourth Year of the Neurology Residency Program (PGY-4)
The fourth-year neurology resident has about three months of elective time available to pursue subspecialty and basic science interests. The remainder of the year includes the chief resident rotation, advanced neurophysiology (EEG), EMG, and the subspecialty ambulatory block. In addition, all fourth-year residents spend nine weeks teaching second-year medical students in the Mind, Brain and Behavior course.
- Chief Residency
Each fourth-year neurology resident spends approximately 10 weeks as chief resident. Responsibilities include supervision of first-year neurology residents on the Strong Memorial Hospital inpatient service and overseeing the care of acutely ill patients with neurological disorders in the intensive care unit. The chief resident supervises sign-in rounds and sign-out rounds daily, during which the clinical care of the patients on the neurology service is reviewed. The chief resident monitors hospital admissions and discharges, conducts teaching rounds and conferences, arranges Neurology Grand Rounds, and is responsible for maintaining an overall high quality of neurological care provided by residents on all of the neurology services.
- Subspecialty Ambulatory Rotation
The fourth-year neurology resident spends four weeks in the ambulatory subspecialty clinics. Seven subspecialty clinics operate weekly and include epilepsy, multiple sclerosis, stroke, neuromuscular diseases, dementia, movement disorders, and neuro-oncology.
- Advanced Neurophysiology (EEG)
The Advanced Neurophysiology rotation is an eight-week block devoted to the study of epilepsy and EEG. The resident functions as a junior fellow on the Epilepsy service and directly supervises the care of patients on the epilepsy service under the guidance of the epilepsy attending. The resident also develops skills in interpreting EEGs and long-term EEG monitoring videos of patients with intractable epilepsy.
- EMG
The EMG rotation is an eight-week block devoted to the study of electromyography and disorders of nerve and muscle. During the rotation, the resident learns how to use nerve conduction studies and electromyography to precisely localize lesions of the motor unit and determine the pathophysiology of these lesions. Didactic rounds and lectures in neurophysiology round out the learning experience for the resident. Residents also attend weekly neuromuscular clinic during this rotation.
- Mind, Brain and Behavior Medical Student Course
The Mind, Brain and Behavior course is a nine-week introduction to neural sciences, neuropathology, neuropharmacology, and psychopathology. Fourth-year residents participate as faculty for this course, attending all lectures and all anatomy and pathology laboratories, and leading a problem-based learning group. This experience provides them with an opportunity to re-learn the basic sciences underpinning neurology, and also to learn the theory and practice of teaching.
- Electives
The elective schedule for fourth-year residents remains flexible to allow residents to individualize their schedules in order to suit their career plans best.
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Night Call
Beginning in July 2004, a neurology night float system was instituted at SMH, covering all neurology consultations called in between 8:00 p.m. and 8:00 a.m. Sunday through Friday. The night float rotation is two weeks in length. second-year neurology residents spend six weeks as the night float, and third-year residents spend four weeks as the night float.
Evening call (4-8 p.m.) and weekend call are covered by second- and third-year neurology residents on the SMH inpatient rotation, the stroke and general neurology consultation services, and the pediatric neurology service. Evening call is limited to once per week and weekend call to once per month for second- and third-year residents only.
No night call is required during the Highland Hospital or VA rotations. Fourth-year neurology residents are on pager call from home for 10 weeks during their chief resident rotation.
The night float resident and the evening call and weekend call neurology residents at SMH are responsible for all adult Emergency Department patients triaged to neurology, as well as for all adult and pediatric neurology consultations in the hospital, the ED, and the ICUs.
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Neurology Resident Block Schedules
View Neurology Resident Block Schedules [Word doc]
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