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.