Virtual Open House - September 7, 2023
October 06, 2023ID10830
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- 00:00All right. Well,
- 00:01I'm going to introduce other people.
- 00:02Maybe you can briefly tell me raisins
- 00:05versus olives for a warm up short
- 00:08and then maybe tell me one thing
- 00:12that is most exciting about this
- 00:15residency that you really appreciate.
- 00:17So I'm going to go to Jeff
- 00:20Dewey who is a graduate of a
- 00:22residency and fellowship programs,
- 00:23associate clerkship associate
- 00:25program director,
- 00:26Wellness director for the program for the
- 00:30department and clerkship director many,
- 00:32many titles and educator extraordinary.
- 00:34So Jeff any thoughts versus
- 00:36olives what you like.
- 00:38But yeah so I'm pro Raisin anti Olive
- 00:42that's me in a nutshell.
- 00:45Thank you for the kind introduction. I'm
- 00:46excited to be here. Excited
- 00:48to see all of you here. My,
- 00:52let's see, one of the things I mean,
- 00:53the thing I
- 00:54love about the residency is,
- 00:55of course, the residence.
- 00:56It's what keeps me young.
- 00:58And it's one of the reasons I
- 00:59get out of bed in the morning
- 01:00is to support our residents
- 01:01and everything that they do.
- 01:02So I'll take that one before anyone
- 01:06else takes it.
- 01:09All right. JP McHale, you can go next.
- 01:15So I'm JP. I'm a P GY4.
- 01:17I'm one of the recruitment
- 01:18chiefs this year with is Hawk.
- 01:19See, you guys will be seeing
- 01:21us a lot if you apply.
- 01:23I like both raisins and olives,
- 01:24but if I had to pick,
- 01:25I'd probably say raisins.
- 01:27But I agree that it's not as
- 01:29good in dishes because sometimes,
- 01:30I don't know, I feel like sweet
- 01:32is a little weird in most dishes.
- 01:34And then my favorite thing
- 01:37about the residency,
- 01:39I everyone says the people
- 01:40and I love the people.
- 01:41But I will say something else.
- 01:43Also I I I think we get
- 01:46really good training here.
- 01:48You know I think when I was looking
- 01:50for a place where I feel like I
- 01:51was going to see a high volume of
- 01:53patients and and be introduced to a
- 01:54lot of diversity in many different
- 01:55ways and and I do feel like I've
- 01:57gotten that experience thus far.
- 01:58So I really appreciated
- 01:59that part of my training
- 02:01outstanding. Issac, where do you go next? So
- 02:06everyone on Issac, as JP just
- 02:09mentioned, also recruitment Chief.
- 02:15I'm from Atlanta, GA Also,
- 02:18I love raisins and olives.
- 02:20I don't know if I would pick
- 02:23one more than the other.
- 02:24I feel like I grew up on raisins and
- 02:26painted dolls as a child and then
- 02:29developed my appreciation later on.
- 02:30So, but I definitely still
- 02:33eat my kids raisins. You know,
- 02:35sneak one or two from them occasionally.
- 02:38And I have to disagree.
- 02:39I think raisins are definitely
- 02:42excellent and dishes particularly.
- 02:45I'm surprised.
- 02:45JP also could like Mediterranean
- 02:47dishes and like,
- 02:48I don't know if you guys
- 02:50would have some Afghani rice
- 02:52and some water reasons. All
- 02:53right, all right, I'll move on.
- 02:55But my favorite thing or a
- 02:59good thing about the program,
- 03:00I probably would say because people have
- 03:03already taken the low hanging fruit.
- 03:05But really about like how supportive
- 03:08I think the bunch that we've had,
- 03:10there've been a lot of good times
- 03:12and a lot of tough times through our
- 03:15residency and the people that have,
- 03:17which you grow and develop relationships.
- 03:20But then there's residency.
- 03:21Like, I really we stick together
- 03:23and help each other through
- 03:25definitely those tough times.
- 03:27So it's a good bunch. I love everyone here.
- 03:31So that's me.
- 03:34So I've got Diad of PGY ones who are there.
- 03:40So I we have Yang and Laura,
- 03:42we have 3 PGY ones.
- 03:43You'll need another one in a second.
- 03:46So you've just gotten to know the program,
- 03:47but you were excited enough
- 03:49to match with us last year.
- 03:50So you can give us your raisins,
- 03:52olives thoughts and then some thoughts
- 03:53about early on about the program.
- 03:57Well, on raisins versus olives,
- 03:59I have to say both are great.
- 04:02I happen to prefer olives.
- 04:03I think combining them would be a pretty
- 04:06versatile and interesting experiment.
- 04:07So I'll have to try that when I go home,
- 04:11but in in terms of what
- 04:13I love about the program,
- 04:15I would echo you know what we've already
- 04:18heard about the people being just phenomenal.
- 04:20I've actually been on this is my 4th
- 04:23week of neuro electives right now.
- 04:25I'm in my first year and I've just loved
- 04:27working with every single resident and
- 04:29attending who I've been on service with
- 04:31and it's been phenomenal to make those
- 04:33connections early on in the residency.
- 04:35And I think the flexibility is really
- 04:37a great thing that if you want to
- 04:39pursue those electives earlier on,
- 04:41you know during your first year,
- 04:42you're absolutely able to.
- 04:43There's actually 62 week elective
- 04:45slots that we have during our
- 04:47PG by one year here at Yale.
- 04:49And so if you wanted to do 6 neuro ones,
- 04:51I think that's that's actually
- 04:53possible and that's in addition to
- 04:54the four weeks of stroke in the the
- 04:56two weeks of neuro ICU that we get.
- 04:58So we get a lot of great integration
- 05:00early on with our program.
- 05:06Hi, I'm young. I'm another P
- 05:09GY1 and raisins versus olives.
- 05:12I would actually also say, you know, olives.
- 05:17I think olives over raisins because my,
- 05:20my mom actually traveled to an
- 05:23area in China called Xinjiang.
- 05:26It's a province that produces
- 05:28a lot of grapes.
- 05:29So whenever she comes back
- 05:31from her business trip,
- 05:32she would raise my bags and bags of braces,
- 05:36which is why, yeah,
- 05:38I just have too much in my childhood.
- 05:40But yeah, you know,
- 05:43olives is actually not part of a
- 05:46regular diet that I grew up with.
- 05:48But you know I've acquired a tight such,
- 05:52you know, it's it's it's nice.
- 05:56So apparently I also only had,
- 06:01you know a little bit of
- 06:06especially to the program so far,
- 06:08but I would echo that the electives is
- 06:12one of my favorite experiences so far.
- 06:14I'm currently on a education focused
- 06:19elective, the epilepsy and EG elective.
- 06:22It's I'm totally loving it.
- 06:26You don't carry any patients doing
- 06:28this elective and you just focus
- 06:30on learning and yeah, you get to
- 06:33work with the EMU and go to clinic.
- 06:36I went to clinic this after this.
- 06:38So yeah, I'm looking forward to obviously
- 06:42discovering new things as my years.
- 06:47You know, a handful of years ago we
- 06:49expanded our program and then expanded
- 06:51the prelim program commensurately.
- 06:53And one of the goals and doing so
- 06:56and Jeff you probably remember this,
- 06:58we were really deliberate about it.
- 07:00It's nice to see it pay off,
- 07:02was integrating our PGY ones much more into
- 07:06the the the residency family and being
- 07:09thoughtful how about how we did that,
- 07:11which was bringing them in for a stroke
- 07:14and neurosite ICU and expanding electives,
- 07:17but doing so without having to make our
- 07:19prelims work night or nights or weekends.
- 07:21So all of these electives are with
- 07:24nights and weekends free and I
- 07:26think that was very thoughtful.
- 07:28We we really got a lot of clear sort
- 07:30of planning and feedback about how
- 07:32to do that negotiated that and it's
- 07:34I think worked spectacularly well
- 07:36and it's just really nice.
- 07:37It's really gratifying to me to hear
- 07:39you say that we didn't plan this,
- 07:41but it's gratifying to because these
- 07:44things take years to bear fruit
- 07:47sometimes Speaking of raisins and olives.
- 07:50So, Izzy, you're next.
- 07:56Hi everyone. I'm I'm Izzy.
- 07:57I'm a teacher.
- 07:58Wife are reading the program.
- 07:59I am a Raisin nay Sayer and olive yay Sayer.
- 08:05But I agree that the raisins are
- 08:08great in like, certain rice dishes.
- 08:13And the one thing that I've really
- 08:16appreciated about the program is just
- 08:19how approachable everybody is from
- 08:22the other residents to of course
- 08:24faculty and that it's been really
- 08:27nice to have kind of both formal
- 08:29mentorship relationships but also
- 08:31informal mentorship relationships.
- 08:33And and you know, we work with them very,
- 08:37very closely.
- 08:38It really doesn't feel like too much of
- 08:42A hierarchy as you know you might have
- 08:44seen in Med school or anything like that.
- 08:46And they really do value you know
- 08:51our input in terms of patient care
- 08:55and sort of you know planning for
- 08:58the next steps for a diagnostic
- 09:00or treatment considerations.
- 09:02And it it's nice to be treated
- 09:05like a colleague and really having
- 09:08our opinions matter and that's
- 09:10really been great for independence
- 09:12and sort of learning as I grow,
- 09:15especially this year becoming a senior
- 09:18and taking the next steps in managing
- 09:20patients and learning neurology.
- 09:25Sam think last but not least
- 09:27another one of our PGY ones.
- 09:30Hi.
- 09:31I was late to join on, but it
- 09:34sounds like there is a debate about
- 09:36raisins versus olives and I took the
- 09:39liberty of going into my country
- 09:41just to kind of show
- 09:43you all the stuff
- 09:44that we have here.
- 09:46With that said, I also like dollars.
- 09:49It's like I just don't keep them around.
- 09:52But yeah, it's nice to be here.
- 09:54I was just here.
- 09:56It feels like, I don't know,
- 09:58a couple of months ago,
- 09:59but it's been a whole year.
- 10:01So it's very nice to to be able to do this.
- 10:05Neurology at Yale.
- 10:06I have had my stroke elective
- 10:10so far and I loved it.
- 10:13It was too short, busy,
- 10:16but I learned a lot and I I thought
- 10:21our seniors were fantastic.
- 10:23They were they gave us grace and you
- 10:26know let us out when the work was done.
- 10:29They one of my, you know,
- 10:33one of the the seniors that was on my,
- 10:36I guess, in the area that that
- 10:38we were working in one time,
- 10:39who was not my direct senior,
- 10:41actually overheard me having a
- 10:43conversation about how I just witnessed,
- 10:46you know,
- 10:47a sad situation with the patient and,
- 10:50you know, checked in with me like
- 10:51hours later towards the end of the day.
- 10:53And I really appreciated the humanity
- 10:56of just like the mindfulness.
- 10:58So it's a great program.
- 11:00Please come.
- 11:03That's awesome. Sam and Nick,
- 11:05now you can feel less alone.
- 11:07Clearly you have somebody who's similarly
- 11:11enthusiastic about raisins. The
- 11:16I'll go last. So I'm going to
- 11:19be a typical middle child and
- 11:20Canadian and say I like them all,
- 11:21they're great and and be completely
- 11:23noncommittal and conflict diverse
- 11:25and and all that sort of thing.
- 11:26But you know, I really do like
- 11:30raisins better and baked goods.
- 11:32I actually am a big fan and it's a
- 11:34delight to bite into some banana bread
- 11:36or something and get a soft Raisin.
- 11:39I really enjoy that.
- 11:40But for example, so I'm going to,
- 11:45I'm going to say something different
- 11:46about what I like about the program
- 11:48and what I like about the job.
- 11:50And I was thinking about this a lot.
- 11:52So my children are in grade school
- 11:57and they do something called
- 12:00social and emotional learning.
- 12:02I think this was something I don't
- 12:03remember having in grade school.
- 12:04It sounds fantastic.
- 12:05And they learn about how to
- 12:08manage their emotions and how
- 12:10to manage developing a growth
- 12:11mindset and all that sort of thing.
- 12:12In my 8 year old who just started 3rd
- 12:15grade told me about something they
- 12:18learned recently which was the 2nd valley.
- 12:20You know and they said when you're
- 12:22sort of climbing a mountain,
- 12:24you know you sort of make that ascent.
- 12:26And then often there's a little
- 12:28dip and you go into this valley,
- 12:30this sort of second valley from
- 12:32the from the first valley and all
- 12:34you can see is yourself going down.
- 12:37And you can either think of that as
- 12:40sort of an ongoing descent or you can
- 12:42think of that as a dip that's going
- 12:44to set you up for the 2nd ascent.
- 12:46You know, and it really depends
- 12:47on what you do about that,
- 12:49you know, so they're,
- 12:50this is what they're teaching
- 12:518 year olds in Connecticut,
- 12:52or at least my 8 year olds in Connecticut.
- 12:54And Jeff,
- 12:55who has taught me a lot about
- 12:57Wellness over the years,
- 12:59has shown me similar diagrams.
- 13:00And it's really nice to think.
- 13:02And you know,
- 13:03I really like that second valley.
- 13:06I really like what makes it interesting
- 13:08for me at this stage 10 years later
- 13:11is that challenge that's going to
- 13:14be for the next period of growth.
- 13:17And you know,
- 13:17for example,
- 13:18we had a challenge of PGY twos coming
- 13:21and not feeling really part of the team,
- 13:23you know,
- 13:23and not as integrating as well after
- 13:25their PGY one year and feeling
- 13:26separated and not doing much neurology,
- 13:28you know,
- 13:29that's just one of many examples
- 13:30And it looked like a task that
- 13:32would be difficult to overcome.
- 13:34But we did and it took a long
- 13:36time and it took longer than it
- 13:38would have wanted or expected to,
- 13:39but it happened.
- 13:40And you know,
- 13:41the longer you do something like that,
- 13:43the more you get used to and more
- 13:45comfortable with those second
- 13:46valleys and you'll have many of
- 13:47them in your residency.
- 13:48Asak talked about,
- 13:49you know,
- 13:50depending on the support of his
- 13:52peers during those times.
- 13:54And we, you know, if you're interested,
- 13:56Jeff wrote a really nice paper
- 13:59about thriving in residency.
- 14:00And one of the things that he found
- 14:04in his interviews and in our analysis
- 14:06of interviewing residents was just
- 14:10how that growth happens through
- 14:12challenge with the appropriate support.
- 14:14And it can always be perceived at the time.
- 14:16And all of you will have second or third
- 14:19valleys as you go through the airas process,
- 14:21as you go through your interviews,
- 14:23everything will seem extremely high
- 14:25stakes and but you'll get through them.
- 14:27That's just what they are.
- 14:28They'll be an ongoing nether ascent
- 14:30after that and there always is.
- 14:33So that's that's that's my
- 14:35moment of philosophy.
- 14:37No, I'm no, I'm going to go from
- 14:40that to PowerPoint as we do.
- 14:42So let me just pull it up.
- 14:43I'm not going to belabor this presentation
- 14:45because I did it at our first day and
- 14:47I'm sure many people had it there.
- 14:48And it's also on Zoom or on.
- 14:50We're going to put these up videos up,
- 14:53but here's our residency.
- 14:55We're very proud of it.
- 14:56This is my backyard.
- 14:57Here's our chair,
- 14:58Doctor Haffler,
- 14:59who has never missed one of our opening
- 15:01picnic and the rest of our team.
- 15:03And we work in a highly supportive
- 15:06environment that's very focused on education.
- 15:09We're all over the web in every way,
- 15:12Twitter and Instagram and our websites,
- 15:14which we carefully update and look at.
- 15:17Or we have a couple of podcasts and
- 15:19you can always e-mail us and most of us
- 15:21are emails are ourfirst.last.yale.edu.
- 15:26We are an advanced program.
- 15:27Currently we will have 10 positions starting
- 15:30at P GY2 with 10 guaranteed prelim spots.
- 15:35Stay tuned as to whether that changed.
- 15:36No one, no big announcement right now.
- 15:39We are a highly academic program.
- 15:42You heard from our PGY ones.
- 15:44They get six weeks of neurology and
- 15:46six weeks of electives that they
- 15:47can spend any way they like and many
- 15:49choose neurology or other things.
- 15:51In that way 95% of our residents
- 15:54pursue fellowships.
- 15:55Really good mix of inpatient
- 15:57and outpatient specialties,
- 15:58really good mix,
- 15:59something I'm also very proud of.
- 16:00Lots of people do movement disorders
- 16:03and neuro immunology and neuromuscular
- 16:05medicine and headache and R2 for example.
- 16:09R2 recruitment chiefs are both
- 16:11pursuing outpatient specialties,
- 16:13out focus specialties and many do.
- 16:16So a lot of residents have anxiety
- 16:19about getting that experience.
- 16:21And then on a side note,
- 16:23one of our,
- 16:25one of our former residents is very
- 16:27interested in doing a study on
- 16:30developing some standardized curricula.
- 16:32I just met with him this afternoon
- 16:34for outpatient neurology.
- 16:34So we care about that and
- 16:36we're thinking about
- 16:40that. You will all need a minimum of three
- 16:41reference letters, a maximum of four.
- 16:43At least one should focus on clinical
- 16:46neurology for international graduates,
- 16:48ideally something from the United States.
- 16:50But we realize that there are
- 16:53challenges with that and we can
- 16:54understand that that's difficult to get.
- 16:56You know, electives and observerships and
- 16:57all those sorts of things are much harder.
- 16:59Since the onset of the pandemic,
- 17:01we will interview about 100
- 17:03and 32140 applicants,
- 17:05which is a relatively small
- 17:07fraction of the applications we get.
- 17:09So it's very competitive and it'll
- 17:12be 12 applicants per interview day.
- 17:14And we do pretty brisk interviews.
- 17:16So we do half day sessions,
- 17:18either 9:00 to 1:00 or 12:00 to 4:00 and
- 17:21there's an overlap in the middle for a
- 17:23case discussion and and clinical stuff.
- 17:26We reviewed all applications.
- 17:27We've been doing holistic review forever.
- 17:29I'm reading about this all the
- 17:30time now and I'm like, yeah,
- 17:31we've kind of always been doing
- 17:33this by at least two reviewers.
- 17:36All of our reviewers will be
- 17:37educated on sources of bias.
- 17:38Most are very experienced reviewers will.
- 17:40If we have new reviewers,
- 17:41we always them with with
- 17:43some education about that.
- 17:44We don't have cut off scores or
- 17:46filters or anything like that.
- 17:47We do interview and match
- 17:50international medical graduates.
- 17:52I always get a lot of questions about
- 17:53that during these sessions and I was
- 17:55just want to be very transparent about that,
- 17:57right?
- 17:59We do interview and match
- 18:02international graduates.
- 18:03US experience is preferred.
- 18:04We realize that we review everything
- 18:06holistically and in context,
- 18:08but it is preferred.
- 18:10It is highly,
- 18:12highly preferred that graduation
- 18:14from medical school would have
- 18:15been the in the past five years.
- 18:17There are rare exceptions to this that
- 18:20relate to additional training and
- 18:21personal circumstances or things like that.
- 18:24But I always want to be very,
- 18:25very open about that and and this
- 18:27is as you heard from our residents,
- 18:30an extremely clinically busy
- 18:32and intense program.
- 18:33It's very hard to reintegrate
- 18:35into residency after a long gap.
- 18:37And so I I always want to just be very
- 18:40clear about that and that the reasons for it.
- 18:43And we do offer both J1 and H1B visas
- 18:45depending on the circumstances.
- 18:47Those typically are discussions
- 18:49that I have with applicants at the
- 18:51time they interview or afterwards.
- 18:56This is how we review.
- 18:57So for the application,
- 18:58we look at your grades and MSPE,
- 19:00your research and scholarly work,
- 19:01your leadership engagement.
- 19:02And we like to look at resilience,
- 19:05evidence of resilience,
- 19:06which we could see throughout the
- 19:08application during the interview.
- 19:09We look at a lot of the same things
- 19:11and these are really carefully
- 19:13aligned with the objectives of
- 19:14our program because our residents
- 19:16are what make our program work.
- 19:18And so we want to recruit our residents
- 19:20on the basis of what our mission is.
- 19:22And and we've been enormously successful
- 19:24when we've stuck to this process.
- 19:28We've had lots of innovations
- 19:30that I think have helped.
- 19:32We have an X + Y clinic format.
- 19:34We were one of the first.
- 19:35We've caught a lot of
- 19:36other people how to do it.
- 19:38We we don't have any 28 hour in house call.
- 19:41We have overnight call at the VA,
- 19:43but that's phone call and like I said before,
- 19:46very early exposure to outpatient
- 19:48subspecialties which has not been an
- 19:50issue with our fellowship matching.
- 19:52We have lots of leadership opportunities.
- 19:55We can talk about that more.
- 19:56One of our residents will be going to Kapala,
- 19:58Uganda next week,
- 20:00I think this weekend as part
- 20:02of our Global Health program.
- 20:04We've had a very successful
- 20:06clinician educator track.
- 20:07One of our former residents,
- 20:09recent graduates was just invited
- 20:10to be a member of the editorial
- 20:13board of the neurology education
- 20:14journal Harry Sutherland.
- 20:16So just really excited for him about that.
- 20:19He just learned that Monday or Tuesday
- 20:22we've had a great success with our 25
- 20:25program with healthcare management,
- 20:27lots of people on editorial
- 20:29boards in different places.
- 20:31We had a resident who was on the
- 20:34board of the match and remains
- 20:36involved with that organization
- 20:38since starting on the board.
- 20:40Jeff as a resident was the
- 20:42resident member of the residency
- 20:44Review Committee of the A/C GME.
- 20:46And so we really look to train leaders
- 20:48and scholars and I and I feel very,
- 20:50very proud of our track record of of
- 20:54offering and being successful with
- 20:57leadership opportunities for residents.
- 20:59We have a strong commitment to diversity,
- 21:01equity, inclusion.
- 21:02We have Vanessa Cooper's actually
- 21:04doing another open house tonight,
- 21:06but she's our Associate Director
- 21:08of Diversity Education,
- 21:09so she sends her regrets.
- 21:11Reshmaud Arula is our departmental
- 21:12Director of Diversity, Equity Inclusion.
- 21:14We really,
- 21:15I think got on board with
- 21:17best practices very early on.
- 21:19We do do critical grand rounds with
- 21:22the health disparities focus and
- 21:24we're very interested in developing
- 21:26novel educational tools and taking
- 21:28our usual approach to education to
- 21:32to DEI topics what's our vision.
- 21:35So increased diversity in the
- 21:37faculty neuro hospitalist service.
- 21:39We have ongoing discussions and
- 21:41planning for this and ensuring that
- 21:42the residents size is commensurate
- 21:44with the educational opportunities.
- 21:46We will be expanding to a new
- 21:48tower opening in 2027 which is
- 21:50an enormous opportunity.
- 21:52It's been very exciting.
- 21:53I've been part of some of the processes
- 21:57of recruiting faculty leaders,
- 21:59you know, as part of this expansion,
- 22:00which has been really fun.
- 22:01So I think this is really going to be
- 22:03some growth and we want to continue
- 22:05to do what I've talked about before,
- 22:07right?
- 22:07We want to continue to nourish,
- 22:10nurture, grow leaders and scholars.
- 22:12And I think what you've heard from
- 22:14residents to empower our residents
- 22:16to make meaningful changes within
- 22:18the system and to innovate.
- 22:19I think we have an amazing track
- 22:21record of innovating educationally.
- 22:23I think it's one of our strengths
- 22:25and the expertise.
- 22:26The depth of our bench in
- 22:28terms of educational experts
- 22:30I think is second to none in the nation.
- 22:33I'm, I'm really proud to say
- 22:34that we've really built out in
- 22:36terms of educational expertise.
- 22:37So we're really proud of that.
- 22:41I was interviewing A faculty applicant
- 22:44who was talking about sort of the
- 22:46future of education and neurology
- 22:49education and sort of being scholarly
- 22:51and sort of asked my view on this.
- 22:53And I said it's most important to
- 22:56me that my home is in order first,
- 22:59you know, before I go out into the world
- 23:00and talk about innovations elsewhere.
- 23:02So for us, for all of us,
- 23:05education starts with our residency
- 23:07and with our educational programs here
- 23:09at Yale and doing a good job of that.
- 23:11And we can innovate and share
- 23:13and grow and build.
- 23:14But our focus is on these residents,
- 23:17is on this program and is on the
- 23:19experiences that we can get here.
- 23:21So we're really proud of it,
- 23:23really proud of our residents.
- 23:26We're going to leave it open to questions.
- 23:28You can raise your hand and ask
- 23:30a question in person or you can
- 23:33take something into the chat.
- 23:35JP and Isak have been expert.
- 23:38We had a very, very active chat.
- 23:40I'm going to pause for a moment,
- 23:42but if there's a longer pause,
- 23:44I'll just start asking questions.
- 23:46But as as I might have anticipated,
- 23:49there hasn't been a longer pause.
- 23:50So,
- 23:50Mohammed Mansour,
- 23:51you can go ahead and ask a question.
- 23:56Yeah. Hello, everyone.
- 23:57Thank you so much for hosting this.
- 24:00I'm Mohammed Mansour and Egyptian IMG,
- 24:03and I'm currently an Epilepsy research
- 24:05fellow at George Washington University.
- 24:08Well, actually I think you have like the
- 24:12perfect program as as far as it can be.
- 24:15But I just want to to get more
- 24:18information about the about your epilepsy
- 24:20center like for instance the number
- 24:23of beds and the volume of epilepsy
- 24:26surgical cases that you that you do.
- 24:29Oh man, you're getting into the weeds,
- 24:31Mohammed. So well one of the many
- 24:33hats I'm wearing right now is the
- 24:35interim clinical chief for epilepsy.
- 24:36So I have looked at my fingertips.
- 24:40We're actively recruiting the clinical
- 24:42chief which is very exciting.
- 24:45So, so we have an 8 bed Atlas minor unit.
- 24:49We will be expanding to 10
- 24:51once we go to the new tower.
- 24:52Our surgical volume fluctuates but we
- 24:54have an extensive surgical program.
- 24:56We do a combination of stereo,
- 24:58EEG, grids and strips resections,
- 25:02Ecog, we have a very active
- 25:05neuro stimulation program.
- 25:07Izzy is is very active actually in
- 25:09doing some work on one of our clinical
- 25:12trials in in status epilepticus.
- 25:14We have one of the most active
- 25:18ICU EEG programs in the country.
- 25:21We are expanding broadly across the
- 25:24system in terms of from New York to
- 25:27Rhode Island in terms of the outpatient
- 25:29epilepsy care that we provide.
- 25:32It's a very,
- 25:33very exciting time to be interested
- 25:35in epilepsy in the world and I think
- 25:37it's extremely exciting time at Yale.
- 25:39I think there would be amazing opportunities.
- 25:41Thank you. Brenda, you're next.
- 25:48Hello. Thank you so much
- 25:50for this wonderful session.
- 25:51Clearly, Yale is a dream program.
- 25:54And one of the most interesting
- 25:56thing I want to ask no more
- 25:58about is the leadership program
- 26:00that you are talking about.
- 26:01I'm personally very much interested in the
- 26:03academics and the teaching opportunities.
- 26:05So what are the teaching
- 26:06opportunities that are that the
- 26:08residents can participate in?
- 26:10Maybe I'll hand that off to the
- 26:12residents, maybe they can talk about
- 26:13some of the teaching they've done.
- 26:16Okay. Thank you.
- 26:18Yeah, I can start. I mean I think
- 26:21I would say one of the many strong
- 26:23points for Yale is there is a very
- 26:25strong educator clinical track.
- 26:27I think you'll see here most of a
- 26:30decent number of our faculty actually
- 26:32have advanced degrees in education,
- 26:34which I would not say is ubiquitous
- 26:36amongst a lot of programs and it shows.
- 26:39I think that you know, people are
- 26:41interested in everything from education,
- 26:42Wellness, sorry, resident,
- 26:44Wellness and well-being to actual like
- 26:48education and pedagogical methods.
- 26:51And so all of that from the flat faculty I
- 26:53think bleeds into what we get as residents.
- 26:57So there is pretty ample
- 26:59opportunities to teach.
- 27:00You can do morning reports.
- 27:01As a resident,
- 27:02I had the opportunity to give a lecture
- 27:05to like the Neuro Psych program about
- 27:08neuroanatomy of attention last year.
- 27:10You could do a lot of work
- 27:12with the medical students,
- 27:13clinical handson teaching
- 27:14as well as lectures.
- 27:16And then there's a lot of research
- 27:19that people do as well in terms of
- 27:21education and education pedagogy.
- 27:22Harry Sutherland,
- 27:24who Doctor Mueller was just mentioning,
- 27:26has you know,
- 27:27like a whole EE G game that he
- 27:30set up regarding education and
- 27:32how we learn about Eegs.
- 27:35And people do things like that
- 27:37pretty routinely, I would say.
- 27:38So I think that's very just a strong
- 27:39point of the program, certainly.
- 27:42Thank you so much.
- 27:43Another another big component that
- 27:46some people have gotten involved in
- 27:49as residents is one of the podcasts
- 27:51that we do with the neurology
- 27:53board that Dr. Mueller and Dr.
- 27:55Dooley are very much involved in.
- 27:57But if there are some residents that are
- 27:59particularly interested in being involved
- 28:01in hosting some of those episodes as well.
- 28:03So that's another opportunity that
- 28:06many people have taken advantage of.
- 28:07And you can teach a lot of people on
- 28:09a broad scale through those podcasts.
- 28:13I'm Invisible. I'm Chris.
- 28:17Vacation chief. Yeah, this
- 28:20is who This is who we needed.
- 28:22So I'm below the street side
- 28:24to the top of your head. Yes, hi,
- 28:27there we go. Everybody
- 28:29has already mentioned
- 28:30a lot of of teaching opportunities
- 28:32that they're. So like,
- 28:34if you can imagine it,
- 28:35there's probably a way to do it.
- 28:37Doctor Dewey and I have been
- 28:38working on an enrichment program
- 28:40for students who are interested in
- 28:42applying into neurology as well and have
- 28:44been doing some individualized teaching
- 28:47in that around sort of to augment
- 28:50clerkship experiences and the things
- 28:52that we've have in a more set structures.
- 28:54There are lots of opportunities if
- 28:56that's something you're interested in.
- 28:57And I certainly feel like I've
- 28:59personally grown throughout residency
- 29:01and I'm continuing to grow as a would
- 29:05be want to be somebody educators.
- 29:07So if you're interested in that we
- 29:11have lots of opportunities and I
- 29:12think there's both like
- 29:14informal and formal ways.
- 29:15I think the more informal ways would
- 29:18be you know you will get assigned
- 29:20medical students on your teams to
- 29:23to kind of nurture but then also
- 29:28more formal teaching opportunities.
- 29:30I know that how Blumenfeld runs
- 29:33a clinical neuroanatomy and case
- 29:34based teaching series that he does
- 29:37with the medical students and
- 29:39he invites the residents to come
- 29:41present and faculty as well to help
- 29:43with the case based discussions.
- 29:44And then I I think there's also a
- 29:47lot of community outreach education
- 29:49that I'm aware of.
- 29:51There is the like local high school
- 29:54programs that I believe Doctor Foreman
- 29:56and then on the stroke service.
- 29:59And then Dr.
- 30:00Schaefer is also involved in for
- 30:02sort of community education outreach
- 30:04programs from like the K to 12 piece
- 30:07of it and then sort of like maybe
- 30:10teaching for stroke care as well.
- 30:12So that it's not just like within
- 30:13the hospital system itself,
- 30:14it's also within a broader
- 30:17sense of community.
- 30:23Thank you. Thank you. So
- 30:24one thing to add,
- 30:25I just got an e-mail about this today.
- 30:28You know, there's lots of hospital
- 30:30wide opportunities for leadership
- 30:31and and career development as well.
- 30:34For example, there's a quality care,
- 30:37quality improvement and quality care,
- 30:40I can't remember the name of it,
- 30:42track with specific training on
- 30:44quality improvement through the
- 30:47hospital and one of our residents
- 30:48is going to be enrolling in that.
- 30:49So that's formal training
- 30:51and high quality care,
- 30:53quality improvement program evaluation.
- 30:55It's something that we I think
- 30:57can continue to grow with.
- 30:58It's an exciting field.
- 31:00I think that neurologists are getting
- 31:01better about and we have resources
- 31:03to provide formal training in that,
- 31:05which is really exciting.
- 31:06So one of our PGY threes is
- 31:07going to join that track.
- 31:11All right. Thank you, Bittor.
- 31:13I think you're next.
- 31:16Hi, everyone. Thank you all for this.
- 31:19I would like to know a little bit
- 31:22more about the research track and
- 31:25specifically is it feasible for
- 31:28residents without the PhD to join the
- 31:31clinical neurosciences research program.
- 31:35It's possible it's been
- 31:37done it's much harder.
- 31:38The reason is that the focus of the
- 31:41R 25 grant that's that funds that
- 31:44tends to be on mechanisms of disease.
- 31:48So so that is clinical and sorry
- 31:53translational and basic research.
- 31:55It's so much harder to learn and develop
- 31:58those techniques during residency.
- 32:00It's possible so that this has to be
- 32:02discussed on a case by case basis.
- 32:04That said, the vast majority of our
- 32:07residents do scholarly work and that can
- 32:10range anywhere from case reports or series,
- 32:13chart reviews, clinical trials,
- 32:16other clinical studies.
- 32:19I really think there's tremendous value
- 32:20in doing a chart review for anyone
- 32:22whether or not you're going to do,
- 32:24you know,
- 32:25do a ton of clinical research in your career.
- 32:28We have, we had our third annual
- 32:31resident research blast,
- 32:32which is during Grand Grand onslaught
- 32:34where our residents just give
- 32:36a very short 5 minute overview
- 32:37of their research projects.
- 32:39And that's always been enormously successful.
- 32:41And actually I'm always embarrassed
- 32:43to learn that there's stuff that
- 32:44residents are doing that I wasn't
- 32:46totally aware of when I see that,
- 32:48which is really nice.
- 32:49So there's just so much support for
- 32:51research and there's elective time to do it.
- 32:53Whether or not you choose to do the research,
- 32:55check
- 32:58Abaji. Abaji, I think you're next.
- 33:02Hi. Thank you so much for organizing this.
- 33:07I'm a graduate student at Mayo
- 33:09Clinic studying neuro immune
- 33:10mechanisms and epilepsy.
- 33:12For the prayer program,
- 33:13I was wondering how do residents receive
- 33:15feedback on their clinical performance,
- 33:17especially if they make a mistake or say,
- 33:19take a suboptimal decision?
- 33:22How, how are they given a feedback
- 33:26on those situations? Yeah,
- 33:28it's a great question.
- 33:31Anybody want to speak to that?
- 33:33Any of our residents do a little
- 33:34bit through it. So there are
- 33:37a wide breadth of opportunities for
- 33:39feedback that we take advantage of and
- 33:41it kind of falls in line in regards
- 33:43to the strong emphasis of education
- 33:45that we have within that program.
- 33:48So just from the general standpoint,
- 33:52we have the standard Met Hub
- 33:54evaluations that we often do which
- 33:56we do take a lot of emphasis on and
- 33:59many people do follow those and then
- 34:01we do emphasize in person feedback.
- 34:04So we have feedback Fridays where
- 34:07it is stressed that the particularly
- 34:09the attendings make sure it's pull
- 34:12everyone aside and give a little
- 34:14bit of feedback in person.
- 34:15But that's not just the attendings
- 34:17but also us as residents giving
- 34:19feedback to like as you said earlier
- 34:21we have medical school students,
- 34:23PA students as well as like off
- 34:27service rotators through internal
- 34:29medicine or even different campuses
- 34:32or different hospital systems
- 34:34that come in and rotate with us.
- 34:36So we try to do that as well
- 34:38and we provide evaluations.
- 34:40We even have inter kind of resident
- 34:44evaluations to some extent where
- 34:46maybe someone's doing a night
- 34:48rotation is starting off early on.
- 34:50We may give feedback to the the
- 34:53junior resident on kind of how
- 34:54they did throughout the night,
- 34:56their night shifts etcetera.
- 34:59In particular about like a situation
- 35:02of where there may be a decision
- 35:04that may have happened or something
- 35:06that may have gone wrong.
- 35:08There's always a stress that
- 35:10you know we work as a team.
- 35:12I've never been in a situation
- 35:15where in people do make mistakes.
- 35:17There are mistakes that are made.
- 35:19There are systems in place where if
- 35:22you may make a mistake that you should
- 35:26always have some sort of mechanism
- 35:28where that's there's someone else
- 35:30that may catch that sometimes things
- 35:32may not go as fully as planned.
- 35:35I've never been in myself in a situation
- 35:38where I truly felt like I've been
- 35:40reprimanded for any sort of mistake.
- 35:43I felt like it's always been
- 35:44a supportive environment.
- 35:45I personally really do like and
- 35:47I've done this myself as a senior
- 35:49where I just kind of we just kind
- 35:52of they fell right after the event
- 35:54or even when everybody's together
- 35:56the following morning before round
- 35:58just take a moment and just have
- 36:01a discussion just stop.
- 36:03Have everyone express how they feel
- 36:06about something that how things
- 36:08went down and kind of just have a
- 36:12conversation and really dedicate
- 36:14time to that before just brushing
- 36:16it under the rug and moving on.
- 36:18And I feel like I've been in that
- 36:20situation several times where we
- 36:22just had that conversation as a team
- 36:24and I've never in my own moments
- 36:26of making mistakes you're seeing
- 36:27someone else making mistake.
- 36:29I've never seen something where
- 36:30we've been particularly felt like
- 36:32they're negatives only positives and
- 36:34constructive criticism of feedback.
- 36:37You know, it's it's such a
- 36:40great question, Abhijit.
- 36:41And we feel very strongly that you can't
- 36:43have a functioning training environment
- 36:45where people can't feel like it's not
- 36:48possible to make a mistake, right.
- 36:50You know, it's going to happen and
- 36:52our approach has to be we take
- 36:54it seriously but not personally.
- 36:55What have we learned?
- 36:56The other thing actually is Jeff
- 36:58as a Director of Wellness develop
- 37:00used some best practices,
- 37:01develop a critical instant
- 37:04debriefing process.
- 37:05So Jeff, did you want to speak to that?
- 37:07I think that's actually been very effective.
- 37:09We could use it more,
- 37:10but it's been effective.
- 37:11Yeah.
- 37:11It's, it's basically
- 37:12a formalized version of what
- 37:14Isak was talking about with,
- 37:15which is an opportunity to get together
- 37:18with anyone involved in a significant event.
- 37:20And that could be a bad patient outcome,
- 37:24a tough family interaction,
- 37:25you know, medical error,
- 37:28anything that really pushes you
- 37:30beyond your coping mechanisms.
- 37:31And so it's an opportunity to get together
- 37:34and formally debrief the experience,
- 37:37unpack some of the emotions around it
- 37:39and normalize what everybody's feeling
- 37:41and make sure people have connections
- 37:43to the support that they need to move
- 37:46on and learn from these experiences.
- 37:49So I agree it's something we
- 37:50can always do more of,
- 37:51but in the instances that I have done it,
- 37:53I found
- 37:53it really effective.
- 37:57And I will also say that
- 37:59Doctor Dooley also helps us out was
- 38:02particularly this is not necessarily
- 38:04fully related to that scenario.
- 38:06But in general with Wellness kind
- 38:08of we've had these brainstorming,
- 38:11brainstorming sessions where this is a
- 38:14confidential safe space where it's just
- 38:17you and your class and Doctor Dillon,
- 38:20it's just a chance to for having events
- 38:24get together as a class
- 38:26and discuss any problems,
- 38:27any good things etcetera.
- 38:28Just have that conversation in that
- 38:31safe space which we've have had
- 38:33many kind of beneficial sessions,
- 38:34I feel like and many people have
- 38:37reported some positive outcomes from that.
- 38:40And then there's always within
- 38:42the hospital itself kind of
- 38:44anonymous kind of mechanism for
- 38:46reporting if there's any sort of
- 38:51any sort of issue that arises,
- 38:53whether that's with any sort
- 38:55of member within the hospital,
- 38:57different teams etcetera,
- 38:58where you wanted to report something
- 39:01that can be done and it will go
- 39:03to the respective programs and
- 39:06their faculty to hopefully produce
- 39:09outcomes following that or at
- 39:11least be reported and recognized.
- 39:12So there are many mechanisms
- 39:15that are in place and I think we
- 39:17kind of do a good job and trying
- 39:19to maintain positive attitudes
- 39:21around and all those. All
- 39:24right, Betty, I hope I'm
- 39:27pronouncing your name right.
- 39:27I'm just going to address a
- 39:29question in the chat and then
- 39:30and then I'll let you go.
- 39:31So Omar asked about the reserved
- 39:37for a physician position at Eras.
- 39:40Feel free to apply for that if you
- 39:41already have preliminary training.
- 39:43So either a transitional year
- 39:45or a prelim year.
- 39:48Currently, we don't have positions open,
- 39:50but that may change.
- 39:51So we are opening that for people
- 39:53who are interested in applying.
- 39:55You can reach out to me directly with
- 39:58questions, but that that would be for
- 40:02somebody starting in P GY2 in 2024.
- 40:05So most people applying for the
- 40:07regular match would be P GY2 in 2025,
- 40:09right And then the prelim
- 40:11year the year before.
- 40:12But if you already have prelim year training,
- 40:15feel free to apply to that.
- 40:16I can't give you more details right now,
- 40:18but we wanted to have that open in Airas.
- 40:20So if you have applied
- 40:21and if you want question.
- 40:22If you have questions,
- 40:23you can reach out an e-mail.
- 40:25So, Etty, go ahead.
- 40:29Yeah,
- 40:30you're spelling that right.
- 40:34So thank you so much for this meeting.
- 40:37I met M and IMG from Albania,
- 40:39currently an Associate Research Scientist
- 40:41here at Columbia University in New York.
- 40:44At the stroke department,
- 40:45as someone interested in
- 40:47vascular, I just wanted to
- 40:48ask, how much exposure do
- 40:51the residents have to DSA or
- 40:53the INR suite during their
- 40:55general Neurology residency here?
- 40:58Oh yeah, barely any.
- 41:00No, I'm just kidding.
- 41:01I'm just kidding.
- 41:01It's quite the opposite.
- 41:03So any thoughts about our exposure
- 41:06to especially in the acute setting
- 41:09to treating patients with advanced
- 41:13treatments for acute stroke,
- 41:14any any questions about that residence
- 41:18as the stroke, as the stroke senior right
- 41:20now I would have to say that we get a lot
- 41:23of exposure to stroke patients both as
- 41:27the stroke code responder to the patients
- 41:30who present with a possible stroke.
- 41:32You know, as you're on consults,
- 41:34you see a lot of that across the board.
- 41:37I think our volume here at Yale sort of
- 41:40is more in comparison than some other
- 41:43centers in the state of Connecticut.
- 41:45And then in terms of shared decision making
- 41:49between us and endovascular neurology,
- 41:52there's a lot of crosstalk back
- 41:54and forth about sort of is this a
- 41:56patient going to be a candidate for
- 41:59thrombectomy or not And then you wheel
- 42:02the patients up to the endovascular
- 42:06suite and if you're not busy,
- 42:09you're welcome to stay And you know take a
- 42:11look at the procedure and all those things.
- 42:14I believe there may be opportunities for
- 42:17elective time specifically dedicated
- 42:19for that as well specifically more
- 42:23like the DSA side of things if you
- 42:27wanted to sort of go and sort of down,
- 42:30up and do those things.
- 42:31And then generally you know we do
- 42:35spend a good amount of time in the
- 42:37neuro ICU working closely with our
- 42:40neurosurgery colleagues on treating
- 42:42patients who need require Dsa's for
- 42:44other indications like aneurysms
- 42:46and repairs and all those things.
- 42:49And so you will also be taking care
- 42:52of those patients as it's a closed
- 42:55ICU unit for neurology run ICU
- 42:58that you will also make codecisions
- 43:01regarding certain patient populations.
- 43:04So there will be ample opportunity
- 43:06for exposure.
- 43:12Our residents respond to approximately
- 43:16220 stroke alerts a month,
- 43:19something like that,
- 43:20that number and of those I think
- 43:24the average that keeps moving,
- 43:27I don't want to be misquoted,
- 43:29but well over a dozen Tier 2
- 43:33activations a month well over.
- 43:36So this is one of the busiest acute
- 43:39stroke centers that you're going to find.
- 43:41Yeah, I was just going
- 43:42to say I think Yale does.
- 43:43It's upwards of 200 throwing
- 43:45back to me a year and I would
- 43:47say like the average like for
- 43:49the for hospital like 20 a year.
- 43:50So it's a very high volume
- 43:51from back to me center.
- 43:57It's more often than not there'll
- 43:58be a thrown back to me case when
- 43:59you're on call basically, right.
- 44:02So and and and balance with
- 44:04that is a lot of support, right.
- 44:05We have stroke nurse navigators
- 44:07who do a lot of the work for that.
- 44:10We're now doing TNK which can be
- 44:13pushed by nurses doesn't require any
- 44:15premixing is given in a single bolus
- 44:18rather than the infusion afterwards.
- 44:21We have a telestroke programs
- 44:23for outlying hospitals.
- 44:24Our residents are not involved in
- 44:25that but could be on an elected basis.
- 44:27Our fellows are our stroke fellows
- 44:29and we have very advanced and
- 44:33thoughtful processes for basically
- 44:34every aspect of vascular neurology.
- 44:36It's a real strength both
- 44:39academically and clinically.
- 44:41And they honestly the challenges is
- 44:42trying to make the most of those
- 44:45educational opportunities right.
- 44:46About 60% of stroke alerts
- 44:50aren't strokes right in the D,
- 44:5295% aren't strokes in the inpatient setting.
- 44:54That's across the nation and
- 44:56it's true at Yale.
- 44:57So we have to make sure that we're
- 44:59creative about how to deal with that
- 45:01volume and still make it educational.
- 45:03We lots of thoughts about that.
- 45:04I could talk about EDLIN,
- 45:08any other questions?
- 45:10Let's see what is the value?
- 45:12Yeah, what is the value of
- 45:14signaling and eras for the Yale
- 45:17Neurology Residency program.
- 45:18So this is so for those who don't know,
- 45:21I guess all the applicants do,
- 45:23but and I see Yang and Laura and
- 45:27Sam smiling there because they went
- 45:30through singling signaling last year.
- 45:32I'll actually tell you,
- 45:34it honestly wasn't on our end.
- 45:38I think we picked the people for
- 45:41interviews that we would have
- 45:43picked just to be entirely honest.
- 45:45I mean it's nice to know,
- 45:46you know around the margins if
- 45:49somebody's from a different geographical
- 45:51error area or if it's unclear if
- 45:54somebody's really serious about
- 45:55the program or things like that,
- 45:57that was helpful.
- 45:58You know,
- 45:59it was that was information we
- 46:02sometimes received other ways and
- 46:03personal statements or or that sort of thing.
- 46:06It's it's not like that we do holistic
- 46:09review, it's not the big thing.
- 46:10So we look at that signaling.
- 46:13There was an option,
- 46:14I don't know if it'll be for this
- 46:15year for people to actually elaborate
- 46:17on their geographical preferences,
- 46:19you know, with a little sentence
- 46:20or two or something like that.
- 46:21Sometimes that was useful,
- 46:23you know to understand.
- 46:24And the goal is we want obviously
- 46:26the best residents we can recruit,
- 46:29which we are very successful with,
- 46:31which I'm very happy about and
- 46:33we want people to be happy here.
- 46:35And so if the signaling indicates
- 46:38that somebody's very enthusiastic,
- 46:40then I suppose it helps,
- 46:41but it's not central.
- 46:43But we're we're still,
- 46:45we're still learning that process and
- 46:47I don't think it's changed this year.
- 46:49The applicants will have to tell
- 46:50me is it 3 signals, is that right?
- 46:52Is it still three?
- 46:54And then you can call it graphical
- 46:56areas and things like that.
- 46:59Yeah, that's right. Yeah.
- 47:01So, you know, don't sweat it.
- 47:03Lots of people who didn't signal
- 47:05got interviewed.
- 47:05You know,
- 47:06like it's lots of,
- 47:08I don't know what the numbers were
- 47:09in terms of people who signaled
- 47:11or not who matched with us.
- 47:12I actually didn't even bother
- 47:13to look at that and go back.
- 47:15I suppose I should.
- 47:20So that's my wishy washy answer.
- 47:22We're still, it's the world of signal.
- 47:24This is a new thing.
- 47:24I still don't totally understand.
- 47:28All right, Victor, you're up next.
- 47:31Hi. Hi. I want to hear from
- 47:34the residents about their
- 47:35experiences with the clinic
- 47:37blocks and what kinds of super
- 47:39specialty clinics are available.
- 47:43Good, good one.
- 47:48I like the X + Y model.
- 47:51You'll see across the board there's like the
- 47:54continuity clinic you can get at each week.
- 47:56But for me it works well because
- 47:58you're just on clinic that week.
- 48:00And I think for about 95% of those
- 48:04weeks you also get the weekend off.
- 48:07And so it's nice to just be in the clinic
- 48:10setting for that week and then you get one,
- 48:14three to four half days to get some
- 48:19specialty clinic during that time along
- 48:22with three afternoons of continuity
- 48:25clinic as well and then another I think
- 48:28morning half day of continuity clinic.
- 48:30So there's a wide range of options.
- 48:33We kind of signal our preferences for which
- 48:37subspecialty clinics we do each clinic block.
- 48:41So you'll you'll do you know two to three
- 48:44different subspecialty clinics each quarter,
- 48:47so like six months, I'm sorry half year,
- 48:50six months and then you will be able to
- 48:55attend those clinics and have some choices
- 48:58in terms of different attendings as well.
- 49:00So for example, right now I'm on neuro opto,
- 49:04neuro immunology and the neuro
- 49:08oncology for my clinic preferences.
- 49:11And so you know we have,
- 49:14I think we have most if not
- 49:18all subspecialty neurology.
- 49:20We have neurotology, neuro ophthalmology,
- 49:23neuro, onc, neuromuscular epilepsy,
- 49:26headache, lumbar puncture clinics,
- 49:28injection clinics,
- 49:30movement and Botox clinics
- 49:32and then stroke obviously.
- 49:34And
- 49:36I don't know if I'm missing some,
- 49:38but you know, lots of different
- 49:40things to choose from.
- 49:41Lots of ways to rotate in them,
- 49:43even outside of your scheduled
- 49:45clinic blocks and the elective time.
- 49:48Also, you can spend it entirely
- 49:50inpatient if you are wanting to do that,
- 49:52or entirely outpatient as well.
- 49:56Thank you so much.
- 49:58They all do. All right.
- 50:01Well, I'm very sensitive of time.
- 50:05I saw the top of Muhammad's had.
- 50:06Everybody should give
- 50:07Muhammad a round of applause.
- 50:09It was his first alone day in the
- 50:12emergency department is a P GY2.
- 50:14So it's a big day in a in a young
- 50:17resident's life and everybody's very happy.
- 50:20He he nailed it.
- 50:21He called me to review one of my agents.
- 50:24So it's
- 50:28good. Graduated responsibility
- 50:29is what that's called.
- 50:34Thank you for that lovely day
- 50:37with my best buddy here, Chris.
- 50:40Plus you gave your first
- 50:42T&K the yesterday too.
- 50:45Oh wow, good for him. action-packed.
- 50:51So couple more questions in the chat.
- 50:54I can do one brief. So one of them is.
- 50:58The first one is, is there an option
- 50:59to do part of one's fellowship
- 51:01and folded with the residency?
- 51:02For example, by utilizing elective
- 51:04time of the 3rd and 4th year?
- 51:07I mean there's no,
- 51:08I mean and you can correct me if I'm wrong,
- 51:09doctor. Well there's no it's it's not
- 51:11wouldn't be a formal unfolding of any
- 51:13sort of fellowship into the residency.
- 51:14You can certainly get the training needed.
- 51:18You know what would be recommended
- 51:19by most of those societies.
- 51:21So for instance you're really focused on it.
- 51:24You could probably try to read 500 E G's,
- 51:25which I think is the recommendation,
- 51:27but you would not have
- 51:28like a formal fellowship.
- 51:28Similarly for EMG and nerve conduction
- 51:31studies, I think it's about 200.
- 51:33If you were really diligent
- 51:34about it and went to clinics,
- 51:35you could probably do 200 EM G's hands on,
- 51:38but again it would not be
- 51:40like a formal fellowship.
- 51:41So I think that's what
- 51:41I would say about that.
- 51:42But I know we have EEG and epilepsy
- 51:44and neuromuscular attendance here.
- 51:46So
- 51:47there is there is fairly generous
- 51:49elective time especially when you
- 51:52consider the the clinic block you
- 51:54know and then sort of half of that.
- 51:56So clinic block is 2 months of every year,
- 51:59elective time is sort of 10
- 52:02to 12 weeks of every year.
- 52:03So that's almost a little less
- 52:05than half the year that sort of
- 52:07outpatient or or sort of focused
- 52:08on what you're interested in,
- 52:10in P GY3 and four.
- 52:13And so there's a lot of opportunities
- 52:15to do that.
- 52:15In terms of unfolding fellowships,
- 52:17I know the neurosurgeons do this
- 52:19really hard to do because of most of
- 52:21our fellowships are accredited, right.
- 52:22They said GME or UCNS accredited.
- 52:24And so there's a certain amount of
- 52:25time that has to be spent after
- 52:27residency doing those things.
- 52:28So you know,
- 52:29I suppose in neuromunology or
- 52:31something like that but but you
- 52:32know most of the other fellowships
- 52:34have a specific accreditation
- 52:36standards which are time based.
- 52:38If I'm nerding out on competency
- 52:40versus time based medical education,
- 52:42there is,
- 52:42there is a difference
- 52:46and I think we're out of time.
- 52:48I really want to be
- 52:50sensitive to people's time.
- 52:52But I think JP answered the question
- 52:54about working with residents and fellows.
- 52:56I'll just mention the fact which is
- 52:58usually approximately half of our stroke
- 53:01fellows are our former residents,
- 53:03which I think helps a lot.
- 53:04So they totally get it.
- 53:06It's something like that typically
- 53:07it is this this year for example.
- 53:09So I think that dynamic tends
- 53:11to work out really well.
- 53:13I do just want to touch base a little
- 53:15bit more specifics for that question.
- 53:17I would say ultimately the
- 53:19relationship between residents
- 53:20and fellows with decision making,
- 53:21I think overall it's pretty
- 53:22large and shared decision
- 53:24making in the sense of you know,
- 53:25discussing the patient's case.
- 53:28As JP mentions,
- 53:30you know you're often the first person
- 53:32see or you're here there overnight,
- 53:34you're waking the fellow up,
- 53:35you're providing,
- 53:36you know the overall assessment and
- 53:38kind of the resident will look over
- 53:41the case and make a final decision
- 53:43on with the discussion for attending,
- 53:45especially interventions required.
- 53:48It depends also on the service or
- 53:50stroke like inpatient services,
- 53:52you're working directly with the resident,
- 53:54the fellow on the attending.
- 53:56Ultimately the decision kind
- 53:57of lands in their hands.
- 53:59But I have had plenty of conversations
- 54:01where I've thought one thing that may
- 54:03have opposed what the fellow has thought,
- 54:05we have a conversation and we make
- 54:08a decision ultimately based on kind
- 54:09of thoughts between the attendees.
- 54:12Also do strongly push to have the
- 54:14fellows often kind of take a lead in
- 54:17kind of as a leadership role of the
- 54:19team and often times they may give
- 54:21them a decision over their own attendees.
- 54:25The decision oftentimes can occur even
- 54:29if they kind of have a disagreement on
- 54:32kind of the the specifics or the details.
- 54:35But I think overall you have a lot
- 54:38of independence that are that's given
- 54:40over time and your opinions are valued
- 54:45amongst the fellows in the attendings,
- 54:47especially given that you're often
- 54:49in the first line or the front
- 54:52front line for your assessments and
- 54:54they depend heavily on your your,
- 54:57your thoughts.
- 55:00Well,
- 55:02Mohammed, I think we're going to
- 55:04have to leave it for maybe you
- 55:06could send an e-mail offline or
- 55:07there'll be other opportunities.
- 55:09I'm sure, sorry that we're.
- 55:10I think we're out of time
- 55:12and we're respectful.
- 55:12People have other good houses
- 55:16and things like that. But
- 55:19I just wanted to say something
- 55:21very important, which is
- 55:22that I really love olives.
- 55:24Oh, gosh. Oh, well, yes.
- 55:26I shouldn't have cut you off
- 55:28for that. So yeah, I don't
- 55:29think we'll need an e-mail.
- 55:32Very good. Thank you for clarifying that.
- 55:34That's excellent. So well,
- 55:36it turns out that's Chris put
- 55:38one more in olives column there.
- 55:41So it's, it's still winning.
- 55:45This was wonderful.
- 55:46Thanks to everyone for attending.
- 55:49As it is for our second group,
- 55:50it's sometimes a smaller group,
- 55:52but I think it was very active.
- 55:54And thanks to all our
- 55:56residents for taking time,
- 55:57especially those in the resident
- 55:59room who are busy and those at home
- 56:01are taking their time afterwards.
- 56:03And it was really wonderful.
- 56:05I'm really proud of this group.
- 56:07So thanks to all of you and good
- 56:09luck to everybody in the next step.