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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.