Description of Rotations

The inpatient neurology ward team at Yale-New Haven Hospital consists of one senior (PGY‑4) neurology resident, one junior (PGY-2) neurology resident, rotating medicine and psychiatry (PGY-1) residents, and medical students. The junior neurology residents on the inpatient ward service are responsible for all aspects of patient care under the guidance of the senior resident and attending physician. This includes evaluation of patients for admission to the ward service, management of floor patients, discharge from the hospital, and arrangement of follow-up care. The neurology residents are also responsible for supervising and educating the medical students rotating on the neurology service.

The daily schedule for the Ward service is as follows:

Time

Monday

Tuesday

Wednesday

Thursday

Friday

6:30 AM

Pre-rounding

7:30 AM

Morning Report

Morning Report

8:00 AM

Work Rounds

Grand Rounds

Work Rounds

8:30 AM

Neuro-ICU Rounds

Neuro-ICU Rounds

10:00 AM

Floor Rounds

12:00 PM

Journal Club/M&M

Yale Noon Conference

Neuropathology Conference

Yale Noon Conference

VA Noon Conference 

1:00 PM

Brain Cutting

Tumor Board

4:30 PM

Neuroradiology Conference 

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The inpatient neurology ward team at the West Haven VAMC consists of one senior (PGY-4) neurology resident, one or two junior (PGY-2 or PGY-3) neurology residents, one rotating psychiatry (PGY-1) resident, and medical students. Junior residents care for neurology patients on the neurology ward, and in the ICUs, and are responsible for all aspects of patient care under the guidance of the senior ward resident (PGY-4). Junior residents are also involved in evaluating consults on the medicine and surgical inpatient services and in the emergency department, under the supervision of the senior neurology resident and attending. The VAMC has shifted its emphasis from inpatient to outpatient care. The result is that this rotation has a large number of clinics, typically an average of 4 per week, including epilepsy, multiple sclerosis, stroke, movement disorders and neuromuscular clinics. As with all rotations, residents continue to attend their VAMC continuity clinics. Supervision is by a PGY-4 resident and attending physician. Neurology residents are also responsible for supervising and educating the medical students rotating on the neurology service.

The daily schedule for the VA Ward service is as follows:

Time

Monday

Tuesday

Wednesday

Thursday

Friday

6:30 AM

Pre-rounding

7:30 AM

Attending Rounds

Attending Rounds

8:00 AM

Grand Rounds

9:00 AM

Continuity Clinic

Attending Rounds

Movement Disorders Clinic

Seizure Clinic or MS Clinic

12:00 PM

Journal Club/M&M

Yale Noon Conference

VA Board Review

Yale Noon Conference

VA Noon Conference 

1:00 PM

Continuity Clinic

Stroke Clinic or

Injection Clinic 

Continuity Clinic

4:30 PM

Neuroradiology Conference 

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The Yale Consult team receives vital exposure to a wide range of neurological complications of systemic disease, as well as the more common primary neurological disorders. This rotation provides the senior neurology resident a valuable opportunity to practice the often complex but important skill of effective neurological consultation and team management. Due to the large size of the service a 2nd consult resident (any PGY level) assists the senior resident with evaluating consults. Together, the two residents see all inpatient consults except pediatric patients. Rounds are held daily on weekdays with the consult attending and the team usually had 1-2 medical students. The consult team acts as the main liaison between the Neurology Department and other services in the hospital for inpatient care, and thus must provide prompt, courteous, useful and thorough evaluations.

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The NICU team consists of a neurology resident (PGY-2 or PGY-3), a neurosurgery resident, two other practitioners (APRNs and/or PAs), a fellow, all supervised by an attending neuro-intensivist. The neurology resident is expected to participate in all activities of the unit, and is assigned 3-6 patients for whom s/he assumes primary responsibility. Patients may be from the neurosurgical or neurology service, and residents will be provided with a mix of patients, with attempts made to provide broad exposure to the range of neurological and neurosurgical disorders that can result in critical illness.

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The stroke team at Yale-New Haven Hospital consists of one senior (PGY-4 or PGY-3) neurology resident, one junior (PGY-2) neurology resident, medical students, a stroke fellow and an advanced practice registered nurse (APRN). The junior resident and APRN on the stroke service are responsible for all aspects of patient care under the guidance of the senior resident, stroke fellow and attending neurologist. Care includes evaluation and management of patients admitted for a broad range of neurovascular disorders. The senior resident and stroke fellow are responsible for supervising and educating other team members, including medical students. 

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This rotation is designed to give PGY-2 and PGY-3 residents intensive exposure to acute care neurology. The residents act as consultant to the ED, evaluating all patients coming in with primary neurological complaints. They are responsible for admissions, discharges, and arranging follow-up from the ED. Furthermore, the residents run all acute stroke alerts and administer tPA if indicated. The ED work hours are from 8:00 AM to 7:30 PM, Monday thru Friday. The ED block is 1 month long with all weekends off as this is often a challenging rotation. The resident does attend continuity clinic one afternoon per week and the Float resident covers ER consults during those afternoons.

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This rotation is designed to provide residents with direct experience with clinical neurophysiology, particularly EEG and EMG/NCS. Emphasis is placed on the role of these procedures in the diagnosis of patients with epileptic and neuromuscular disorders.  One or two residents rotate through the clinical neurophysiology service at any one time (PGY-2 and/or PGY-3).  Residents are expected to take a “hands-on” approach to learning.

The daily schedule for the clinical neurophysiology rotation is as follows:

Time

Monday

Tuesday

Wednesday

Thursday

Friday

7:30 AM

Morning Report

Morning Report

8:00 AM

EEG Review

Grand Rounds

EEG Review

8:30 AM

EEG Review

10:00 AM

Epilepsy Monitoring Unit Rounds

12:00 PM

Journal Club/M&M

Yale Noon Conference

Neuropathology Conference

Yale Noon Conference

VA Noon Conference 

1:00 PM

Electromyography Lab

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The Pediatric Neurology rotation provides vital exposure to the diagnosis and management of neurological disorders in children. Neurology residents serve as consultants to the Yale-New Haven Hospital Pediatric Ward Service, including the newborn special care units and the pediatric ICU. The residents also provide the initial evaluation of neurological cases in the pediatric emergency room. In addition to the ward responsibilities, the house staff also attend several pediatric neurology clinics during the week.

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The Department of Neurology maintains a consultative service at Gaylord Rehabilitation Hospital, providing residents exposure to the basic principles of neuro-rehabilitation. The patients are divided into four inpatient wards covering rehabilitation in Stroke, Spinal Cord Injury, Traumatic Brain Injury, and Pulmonary Disease.  Neurology residents serve as neurological consultants under the supervision of an attending neurologist from the Yale Neurology Faculty.  Each senior (PGY-4) also completes a 2-week rotation in Physical Medicine and Rehabilitation at Gaylord. This rotation has been designed to maximize exposure to the range of services available to patients rehabilitating from neurological disorders. This includes time on the inpatient service and outpatient clinics, but also exposure to Occupational Therapy, Physical Therapy, Speech Therapy, Sleep Disorders Clinic, Brace Clinic, Post-polio Clinic and Industrial Rehab.  EMG’s, Selective Nerve Blocks, Baclofen Pump refills, and Botox injections are performed on a scheduled basis.

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Some neurological subspecialties care for patients predominantly, or even exclusively, in the outpatient setting. Residents are exposed to these subspecialties during the Subspecialty Clinic Rotation as well as by participating in subspecialty clinics during other rotations. The available subspecialty clinics include MS, movement disorders, neurodegenerative disorders, spinal cord injury/neurorehabilitation, neuromuscular disorders, stroke, neuro-ophthalmology, neuro-oncology, neuro-ID and epilepsy. The clinics are mainly held at the Yale Physicians Building except Neuro-HIV, MS or Neuro-Oncology clinics, which are held at the Nathan Smith Center, Temple Medical Center and Smilow Cancer Hospital, respectively. The weekly schedule during this rotation is as follows:

Time

Monday

Tuesday

Wednesday

Thursday

Friday

7:30 AM

Morning Report

Morning Report

8:00 AM

Grand Rounds

8:30 AM

General Neurology Clinic

Stroke Clinic

Multiple Sclerosis Clinic

Neuro-Oncology Clinic

9:00 AM

Movement Disorders Clinic

12:00 PM

Journal Club/M&M

Yale Noon Conference

Neuropathology Conference

Yale Noon Conference

VA Noon Conference

1:00 PM

Neuro-HIV Clinic or Resident Stroke Continuity Clinic

Resident Continuity Clinic

Neuro-ophthalmology Clinic or VA Continuity Clinic

Neurorehabilitation/
SCI Clinic

VA Continuity Clinic or Hill Health Clinic

4:30 PM

Neuroradiology Conference 

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Longitudinal care is an important component of a physician's treatment of patients. This skill is acquired during the Residency Program through a continuity clinic. Each resident in the Residency Program has a continuity clinic that meets on average ½ day per week. There are continuity clinics at the VA Medical Center and Yale-New Haven Hospital. Patients assigned to the resident in these clinics become the primary responsibility of that resident. The resident, with supervision by the assigned attending, performs all aspects of neurological care for those patients, including follow-up care and problems that arise between visits, other than acute admission to the hospital. Night coverage for these outpatients is generally shared between residents.

Yale Continuity Clinics

The home of the Department of Neurology's outpatient clinic is at the garden level of the Yale Physician's Building at 800 Howard Avenue. Residents spend half a day there each week seeing patients in follow-up after discharge from the hospital or new referrals. To ensure continuity, a system is in place so that residents who take care of a patient in the hospital also see that patient in their own clinic. Residents book their patients in either a dedicated stroke continuity clinic on Monday afternoons or a general neurology clinic on Tuesday aftenoons. There is also a Neurology Urgent Access Clinic (NUAC) on Thursday afternoons for new patients needing urgent evaluations referred by primary care physicians or the Emergency Room. Patients seen in the NUAC clinic are then followed by the resident in his or her Monday or Tuesday afternoon continuity clinic. The clinic is equipped with an electronic record system, and all clinic notes are entered electronically. Both inpatient and outpatient imaging are available for review through an electronic database.

VA Continuity Clinics

The outpatient center at the VA is a recently renovated, spacious clinic, where residents have continuity clinic three times per week - Tuesday morning, Wednesday afternoon, and Friday afternoon. Tuesday morning clinic is a new consult clinic while follow-ups are seen in Wednesday and Friday afternoon clinics. The resident, with supervision by the assigned attending, performs all aspects of neurological care for those patients, including follow-up care and problems that arise between visits, other than acute admission to the hospital. Night coverage for these outpatients is generally shared between residents.

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The Night Float Rotation was designed to increase continuity of care for inpatients during nighttime while meeting the work hour requirements for residency training mandated by the ACGME. PGY-2 and PGY-3 neurology residents participate in the ½ month blocks and spend the other ½ month as Float or Jeopardy resident. Night Float works 6 nights per week, with Saturday off. There are 2 night-float residents at YNHH. There is a Inpatient Night-Float resident that covers all of the inpatient Neurology services, including the Neuro-ICU (Inpatient Night-Float) and a Consult Night-Float resident that evaluates all consults, stroke codes and chill alerts in the hospital (inpatient and ER for adult and pediatrics).

Inpatient Night-Float

The Inpatient Night Float block was designed to increase continuity of care for inpatients during nighttime hours while meeting the residency hour requirements mandated by the ACGME. Both PGY-2 and PGY-3 neurology residents cover as the Inpatient Night Float resident in ½ month blocks during the academic year. Inpatient Night Float works 6 nights per week, and Saturday is off. This duty begins at 5:30 p.m. and ends at 6:30 a.m the next day Monday through Friday nights. On Saturday mornings the Inpatient Night Float resident rounds with the ward team and leaves the hospital by 10:30 a.m. The resident has Saturday night off and returns on Sunday night at 7:30 p.m for sign-out. During the time they are on duty, the Inpatient Night Float resident attends to all matters pertaining to the Yale Neurology inpatient, Epilepsy and neuro-ICU services. Daytime activities such as continuity clinics are not scheduled during this rotation.

Consult Night-Float

The Consult Night Float block was designed to provide coverage for consultation services, including the Emergency Department, inpatient consultations requested from other specialties, and pediatrics. Both PGY-2 and PGY-3 neurology residents cover as the Consult Night Float in ½ month blocks during the academic year. Consult Night Float works 6 nights per week, and Saturday is off. This duty begins at 7:30 p.m. Sunday-Friday and ends no later than 8:00 a.m. Monday-Saturday. At night, the consult night float is the senior resident in-house, and takes responsibility for management and disposition decisions. The Consult Night Float attends to all new consultations in the Emergency Department and Pediatric Emergency Department, as well as provide new consultations to other services in the hospital, provide urgent follow-up for existing consultation patients, and cover the Yale Medical Group-Neurology answering service (except the Epilepsy Service) as needed. The Consult Night Float responds to all stroke alerts and all chill alerts (cardiac arrest cooling protocols). The Consult Night Float is responsible for admitting patients from the ED to the inpatient service and serves as the primary resident physician for these patients until sign-out is given at 6:30 a.m. to the Yale Junior residents. Consults and admissions regarding Epilepsy patients are discussed with the Epilepsy Fellow. Interesting cases are presented during morning report by the Consult Night Float resident, which allows for direct discussion and teaching with a Neurology attending. Daytime activities such as continuity clinics are not scheduled during this rotation.

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The Jeopardy Rotation was created to provide backup support in case of unplanned absences for residents. The half-month block alternates with the Consult Night-Float rotation and the resident is expected to be available 6 days a week with one day off. The Jeopardy resident also occassionaly takes weekend call at Yale.

The Float Rotation was created to provide coverage for residents to attend continuity clinic. The half-month block alternates with the Inpatient Night-Float rotation. The Float resident covers junior residents on the inpatient service and the ER resident during the week for one afternoon so that they may attend their continuity clinic at Yale or the VA. The Float resident also attends their own continuity clinic once a week and occasionally takes weekend call at Yale.

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Each resident typically spends 3 months on electives during each of their last two years. Residents are provided guidance by the Program Director, Chairman, and other faculty members in selecting these electives. These electives can be taken in any area that will help further the residents goals for his/her career development.

Clinical Electives

Many residents spend their elective time enhancing their knowledge and skills in aspects of clinical neurology in which they are particularly interested. The possibilities for this are unlimited, since there is a large number of clinical specialties represented at Yale, and when not available locally residents can spend elective time at other institutions with strengths in specific subspecialties. Many of our residents use their elective time in this way to broaden their experience, or to enhance their competitiveness for clinical practice. Examples of clinical electives available to our residents locally include:

  • Neuroradiology
  • Neuropathology
  • Neuro-oncology
  • Stroke
  • Epilepsy
  • Neuroimmunology / Multiple Sclerosis
  • Neuromuscular Disease
  • Clinical Neurophysiology/EMG/EEG
  • Headache / Chronic Pain
  • Neuro-rehabilitation
  • Sleep
  • Movement Disorders
  • Neuro-AIDS / HIV
  • Neuro-otology
  • Functional MRI / Behavioral Neurology
  • Neuro-informatics

Research Electives

Many residents choose to spend elective time pursuing a clinical or basic science research project in collaboration with one of the many faculty members in Neurology or in other departments at Yale University. Many of these projects culminate in presentations at national meetings. Previous experience in research is not necessary. Click here to learn about research opportunities.

Mini-Fellowships

Elective time during the second or third year of neurology training can be organized into mini-fellowships. This allows residents to address topics in greater detail than usually afforded in a clinical elective. Previous residents have arranged mini-fellowships in clinical neurophysiology, epilepsy, stroke, and basic neuroscience research. These fellowships can be undertaken in conjunction with a clinical research project. In some cases, these mini-fellowships can decrease the time required in a formal fellowship, or offer more flexibility in post-graduate training.

Flexible Training in Neurology

The Yale Neurology Residency Curriculum meets the guidelines of the American Neurological Association, and endorsed by the Accreditation Council for Graduate Medical Education to support education designed to maximize efficient development of neurologist investigators. This goal is achieved through research elective time under the YINP and CNSTP. All residents in a research track will meet all of the requirements for eligibility for the ABPN exam to become board certified in adult neurology. 

Off-Campus Electives

Residents are encouraged to take off-campus electives at other institutions and/or in other countries. To this end both PGY-3 and PGY-4 residents are allowed a “Golden Elective” as one of their three electives. During this 4 week block the residents do not have any Continuity Clinic or call responsibilities. This allows residents to explore off-campus and away electives. These electives are invaluable for those residents seeking exposure to areas of neurology that are not available at Yale University, and can give insight into the approach to clinical care at other institutions or countries.

There are many possibilities available for away electives. One example that has been attractive to our residents is to learn Clinical Neurology at Charles University in Prague, Czech Republic. This successful and popular elective is run by Martin J Stransky, one of our faculty, who is based in Prague for much of the year. Dr. Stransky directs a large clinic and has a number of leadership positions in Prague (http://www.narodni.cz). The Prague elective is open to all residents and is tailored in length and content to the residents' particular interests. Along with a rich historical tradition in neurology (e.g. Purkinje), Prague has several prominent teaching hospitals with a full range of neurological services, including gamma knife surgery and PET scanning. Limited funds are available to defray some of the expenses incurred by travel to Prague.

During elective months, residents continue to attend their Continuity Clinics an average of once every week.

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