Second Year of the Neurology Residency Program (PGY-2)
Strong Memorial Hospital Inpatient Neurology Service
- The Neurology inpatient unit (5-1600) consists of 24 beds. Approximately 1,900 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 are referred from the emergency department, private practices, referrals from other physicians, the neurology clinic, the intensive care unit, other hospital units.
- The neurology inpatient unit consists of a clinical service specializing in the care of patients with strokes and general neurological diagnoses, as well as a clinical service specializing in the care of patients with epilepsy.
- The second-year neurology resident spends three 4-week blocks on the 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, psychiatry or anesthesiology intern (PGY-1), and two medical students. 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 Neurology Consultation Service
- Highland Hospital is a 261-bed community hospital that is owned by the University of Rochester. It is also a New York State designated Stroke Center. The UR 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 eight 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.
Strong Memorial Hospital Epilepsy Service
- The Strong Epilepsy Center (SEC) provides evaluation, management, and treatment of children and adults with epilepsy. Since the epilepsy service was established in 1989, more than 8,500 patients have been evaluated and offered a variety of resective surgeries, stimulators, medications, hormones and dietary treatments each year.
- The SEC consists of an eight-bed adult and a four-bed pediatric long-term monitoring unit located within Strong Memorial Hospital and Golisano Children’s Hospital.
- First Year residents are responsible for the care of all epilepsy service inpatients in consultation with the epilepsy attending and epilepsy fellow.
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.
- Two of these weeks are devoted to the subspecialties of neuroimmunology and movement disorders, and two additional weeks are devoted to neuromuscular diseases and headache medicine.
- Many patients admitted to the neurology inpatient service come from these specialty clinics.
Neurocritical Care Rotation
- The Neurocritical Care rotation introduces neurology residents to the nuances of critical care, including neurological and general critical care and enables residents to be comfortable in the intensive care unit setting.
- The residents work with the critical care team that is composed of a critical care attending, critical care fellows, residents (from neurosurgery, neurology, anesthesia, and medicine), nurse practitioners, physician assistants, pharmacists, nutritionists, and critical care nurses.
- The emphasis of this rotation is on learning the pathophysiologic basis of critical illness, understanding and intervening in neurological emergencies and critical illness, learning how to manage ventilators, resuscitation of septic patients, managing post-arrest hypothermia, managing patients in pharmacological coma, and the management of postoperative neurosurgical patients.
- Ample opportunity is provided to the interested resident to become proficient in the various bedside procedures common to an ICU (endotracheal intubation, placement of central and arterial lines, placement of dialysis catheters, bronchoscopy, lumbar puncture, placement of naso/oro gastric tubes, urinary catheters, etc.).
- A wide variety of critical care cases are admitted to the neuromedicine ICU. These include (but are not limited to):
- Adult patients with high intracranial pressure
- Subarachnoid hemorrhages
- Intracerebral hemorrhage
- Large strokes
- Status epilepticus
- Neuromuscular disorders requiring respiratory monitoring and support
- Acute respiratory failure
- Acute lung injury
- Acute respiratory distress syndrome
- Cardiac dysrhythmias
- Post-cardiac arrest
- Renal insufficiency and renal failure
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:
- Cognitive and behavioral neurology
- Headache medicine
- Sleep disorders
- Movement disorders
- Palliative care
- Pain medicine
In addition, a wide range of opportunities are available for residents to participate in clinical or basic neurological research.