Rotation Schedule by Year
At least one year of training in an ACGME approved PGY-1 internship year is required before entering the Yale Neurology Residency Program. Two PGY-1 programs are available in the Department of Medicine at Yale. Although many residents do the PGY-1 year in a Yale program, training also may be done at any other ACGME approved institution/program.
Overview and Schedule
The first year of neurology training is designed to provide an intensive clinical experience in a structured teaching setting. In parallel with direct care on the inpatient Neurology Services, PGY-2 residents are assigned to outpatient clinics where they receive one-on-one supervision. A large percentage of time is spent on the Yale-New Haven Hospital adult inpatient service, and the West Haven V. A. Medical Center.
The primary goal of the PGY-2 year is for the resident to achieve a high degree of competence in the clinical assessment, evaluation, and treatment of patients with neurological disease. Residents gain experience in the interpretation of neurodiagnostic techniques including: EEG, EMG, evoked potentials, carotid and transcranial ultrasound, angiograms, computerized tomography, magnetic resonance imaging (MRI), single photon emission tomography (SPECT) and positron emission tomography (PET). As noted below, outpatient as well as inpatient neurology is emphasized. Beginning during this first year of neurology training, residents establish close working relationships with faculty in the Department. Collegiality is emphasized, and feedback is provided throughout the period of residency.
The following represents a typical PGY2 schedule. Each block is 4 weeks.
- Yale Inpatient Wards: 2-3 blocks. Residents work with a team that includes an attending, residents and students. They take primary responsibility for the care of patients on the inpatient ward and the Neuro-ICU. Supervision is by a PGY-4 resident and an attending.
- VAMC Rotation: 1 block. Residents work with a team of attendings, residents and students, and care for neurology patients on the neurology ward, and in the ICUs. Residents also have an average of 4 outpatient subspecialty clinics per week, such as epilepsy, stroke, movement disorder, multiple sclerosis and neuromuscular. In addition, residents help provide consults on inpatients for other services and in the ER. Supervision is by a PGY-4 resident and attending physician.
- Emergency Neurology: 1 block. Residents are stationed full-time in the Yale Department of Emergency Medicine. They function as neurological consultants on all patients with neurological disorders presenting to the Yale Emergency Department. Supervision is by a PGY-4 resident and attending physician.
- Epilepsy: 1 block. Residents work with a team of fellows and attendings, and care for seizure patients on the epilepsy monitoring unit. Residents attend seizure clinic, participate in epilepsy surgery conference, and read EEGs.
- Neuromuscular Medicine: 1 block. Residents receive comprehensive full-time exposure to performance and interpretation of EMGs and NCVs. Supervision is by attendings in the EMG lab – usually providing a ratio of 2 attendings to 1 resident, and is thus a highly educational experience for the residents. Residents also attend neuromuscular clinic as well as MDA clinic.
- Night Float: 2 blocks. Residents cover night-float ½ a month at a time. They are assigned as the Inpatient Night-Float for the first-half of the year and the Consult Night-Float during the second-half. The Inpatient Night-Float resident covers the Yale inpatient neurology services 6 nights per week. The Consult Night-Float resident provides the initial evaluation of all consultations in the hospital (inpatient and ER). The Consult Night-Float resident also presents newly admitted cases and consults seen that night at Morning Report. Daytime activities such as weekly clinic are cancelled. The 1 month Night Float blocks are split into ½ month sections alternating with ½ month blocks of Jeopardy or Float.
- Jeopardy/Float: 2 blocks. The Jeopardy resident provides backup support in case of unplanned absences for residents. The Float resident covers different services (ER, Yale Inpatient, etc.) so that residents may attend their continuity clinics at Yale or the VA. The 1 month block is split up into ½ month sections alternating with ½ month blocks of night float. The Jeopardy and Float residents also occasionally participate in Saturdays and Sundays calls, if needed.
- Subspecialty Clinic Rotation: 1 block. Residents see patients in a variety of ½-day subspecialty clinics. These clinics are selected based on educational value, and the selection is modified periodically based on feedback from the residents and attendings. The clinics currently are movement disorders, multiple sclerosis, neuromuscular, stroke, neuro-ophthalmology, seizure, and neuro-oncology. Supervision is by attendings who are experts in these subspecialty areas, and teaching is one-on-one.
- Second Consult: 1 block: Residents evaluate new inpatient consults at Yale-New Haven Hospital Monday through Friday. They are part of the Neurology Consult Service with supervision by a PGY4 resident and attending. After 4PM, the Second Consult resident also takes sign-out from the Pediatric Neurology service and evaluates any pediatric consults (inpatient and ER) that are requested until 7:30 p.m. The resident signs-out to the Consult Night-Float resident at 7:30 p.m. and helps out if there are numerous consults pending.
- Continuity Clinics: Each resident attends a continuity clinic on average 1 time per week. Continuity clinics are held at the VA ½ day Tuesday, ½ day Wednesday and ½ day Friday and at Yale ½ day Monday, ½ day Tuesday and ½ day Thursday. Each resident follows his/her own cohort of patients for 3 years, assuming all responsibility for outpatient care with supervision by an attending, including covering problems that arise between clinic appointments. Night coverage for these outpatients is generally shared between residents.
Overview and Schedule
The second year of neurology training is directed toward focused training in key areas of neurology. Three months of pediatric neurology are required during all adult neurology residency programs, providing in-depth exposure to this population of patient. A three month block of elective time allows the residents to tailor their training with either specialized clinical or research rotations. Many residents divide time between neuropathology and neuroradiology, or pursue basic science or clinical research projects.
The following represents a typical PGY3 schedule.
- VAMC rotation: 2 blocks. Similar rotation as in the PGY-2 year, but with increased responsibility.
- Pediatric Neurology: 1-2 blocks. Residents are supervised by Pediatric Neurology faculty, and provide consultations for patients on the Pediatrics ward, Newborn Special Care Unit, Pediatric ICU and Pediatric Emergency Room. Residents also attend ½ day clinics an average of 5 times per week
- Emergency Neurology: 1 block. Same rotation as during the PGY-2 year.
- Epilepsy: 1 block. Same rotation as during the PGY-2 year.
- Neuromuscular Medicine: 1 block. Same rotation as during the PGY-2 year.
- Elective: 3 blocks. Residents are provided mentoring by the Program Director, Chairman, and other faculty members to select 3 months of electives in each of their last two years. Residents are encouraged to obtain intensive exposure to neuropathology, neuroradiology, neuroanatomy, neurophysiology, or other fields related to neurology. Many residents spend time pursuing a clinical or basic science research project in collaboration with a faculty member in Neurology or other department at Yale University, and many of these projects culminate in presentations at national meetings. In some cases, PGY-3 electives may be taken off-campus.
- Night Float: 2 block. Same rotation as during the PGY-2 year except PGY-3 residents are Consult Night-Float for the first-half of the year and Inpatient Night-Float for the second-half..
- Jeopardy/Float: 2 block. Same rotation as during the PGY-2 year.
- Subspecialty Clinic Rotation: 1 block. Same rotation as during the PGY-2 year.
- Second Consult: 1 block. Same rotation as during PGY-3 year.
- Continuity Clinics: PGY-3 residents continue to attend continuity clinic at the VA and Yale an average of 1 time per week.
Overview and Schedule
The PGY-4 year of neurology residency training is one of advanced clinical responsibility and in-depth study in elective areas of interest. Each resident rotates through the Consult Service at Yale-New Haven Hospital. During this year, the resident also spends time directing the inpatient Neurology Services at Yale and the West Haven VA Medical Center as Senior Ward Resident. This training in a supervisory role provides a useful transition to clinical practice, fellowship, or academic neuroscience. Three blocks during the year are available for electives.
Residents, at all levels, play an important role in the neurology teaching program. During the PGY-4 year, the senior residents assume a major responsibility for teaching within the residency program, and for the supervision of medical students rotating on the neurology service.
The following represents a typical PGY4 schedule.
- Yale Inpatient Ward: 2-3 blocks. The senior ward resident leads a team of junior residents and students who care for neurology patients on the neurology ward and in the Neuro ICU. This leadership position is closely supervised by attending physicians, but the senior resident plays an active role in management of patients. The Yale Inpatient Ward block is split into 2 week sections alternating with the Yale Inpatient Consult Service block.
- Yale Inpatient Consult Service: 2-3 blocks. Residents provide consultative services to all other departments within the hospital, except Pediatrics. These include Internal Medicine, General Surgery, OB/GYN, Neurosurgery, etc. Together with the Consult Attending, this resident acts as the main liaison between the Neurology Department and other services in the hospital for inpatient care. The same resident also supervises the junior resident who provides consultative services to the Emergency Department. The Yale Inpatient Consult Service block is split into 2 week sections alternating with the Yale Inpatient Ward block.
- VAMC Rotation: 2 blocks. PGY-4 residents, together with an attending physician, supervise a team of residents and students who care for neurology patients on the wards and in the ICUs, and perform consults for other services in the hospital. Residents also attend an average of 3 outpatient clinics per week, usually including stroke, epilepsy, and neuropsychiatry. The PGY-4 resident is responsible for distributing the workload among all team members on the neurology service, which usually includes PGY-3 and PGY-2 neurology residents, a psychiatry intern, and students.
- Psychiatry: 1 block. Residents are part of the psychiatry consult service along with a psychiatry resident and attending. The resident evaluates consults and presents cases to the psychiatry attending on rounds.
- Pediatric Neurology: 1-2 block. Same rotation as during PGY-3 year.
- Elective: 3 blocks. Electives during the PGY-4 year are the same as those during the PGY-3 year, except that they may be taken off campus, since PGY-4 residents on elective do not take call.
- Continuity Clinics: PGY-4 residents continue to attend their continuity clinics at the VA.
- Chief Residents: Two members of the senior resident staff are selected by the faculty to serve as Chief Residents during their PGY-4 year. The selection of the Chief Residents is based on outstanding performance as a clinician, teacher, leader and administrator. The Chief Residents are responsible for coordinating the teaching programs for all residents, approving resident work schedules, inviting visiting faculty, scheduling Grand Rounds, serving as resident advocates at departmental meetings, and participating in the development of policies.