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 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 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 rotation includes a strong emphasis on outpatient care. Residents attend an average of 5-6 outpatient clinics per week, including epilepsy, behavioral neurology, multiple sclerosis, stroke, sleep, 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 Yale Consult team gains 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 junior resident (PGY-2 or 3) assists the senior resident with evaluating consults. Together, the two residents see all inpatient consults except pediatric patients, including inpatient stroke alerts. Rounds are held daily on weekdays with the consult attending and the team usually has 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.
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.
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 1-2 advanced practice providers (APPs). The junior resident and APRN on the stroke service are responsible for all aspects of patient care under the guidance of the senior resident, neurovascular 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.
This rotation is designed to give PGY-2 and PGY-3 residents intensive exposure to acute neurology. There are two residents (PGY-2 or PGY-3) on the rotation at any one time: one resident who works from 7:30 am to 7 pm, and a "Swing" resident working from 12 noon until 10 pm, to optimize patient care during the busiest times of the day. Residents act as consultant to the ED, evaluating all patients with primary neurological issues. Residents are responsible for admissions, discharges, and arranging follow-up from the ED. 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 primary ED block is 2-4 weeks long with all weekends off as this is often a challenging rotation.
This rotation is designed for residents to develop basic knowledge, skills and experience in EEG interpretation and evaluation and management of patients with epilepsy and related disorders. Residents spend their time rotating through the Epilepsy Monitoring Unit (CAVE) during each 2-4 week rotation. They are responsible for reviewing routine and extended video-EEG recordings, and following patients who are admitted for pre-surgical evaluation or characterization of spells. Learning objectives include gaining knowledge about seizure semiology, pharmacology of AEDs, and basic EEG interpretation
An advanced elective or rotation in ICU-EEG is available to residents who have already completed their core Epilepsy rotation.
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 department. In addition to the ward responsibilities, residents also attend several pediatric neurology clinics during the week.
The Department of Neurology maintains a consultative service at Gaylord Specialty Healthcare, 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) resident 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.
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, behavioral neurology, 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.
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. 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.
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.
Cornell Scott Hill Health Center
Residents also attend a clinic at Hill Health Center, a community health center with a long history of serving New Haven neighborhoods. Patients in this clinic are among the most disadvantaged in the state, and residents have the opportunity to provide much-needed neurological care to this community.
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).
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.
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.
Each resident typically spends 3 months on electives during each of their final two years of residency. Residents are provided guidance by the Program Director, Chairman, and other faculty members in selecting these electives. These electives can be focused in any area that will help further the residents goals for his/her career development.
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:
- Neuroimmunology / Multiple Sclerosis
- Neuromuscular Disease
- Neuromuscular Medicine/EMG
- Headache / Chronic Pain / Botox Clinic
- Sleep Medicine
- Movement Disorders
- Neuro-Infectious Diseases
- Behavioral Neurology
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.
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.
Teaching Senior Elective
PGY-4 residents can complete a 2-4 week elective as the teaching senior. This is a structured elective that is a component of the Neurology Education Certificate track, and during this elective, residents get multiple opportunities for teaching with observed feedback, work on their scholarly project, complete guided readings in learning theory, and supervise medical students in simulations of neurological emergencies and LP simulation.
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.
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 provided with 4 weeks of “Golden Electives”. During this 4 week block the residents do not have any Continuity Clinic or on-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. We have ongoing training agreements at centers throughout the world, and residents have traveled to many countries to pursue away electives.
During elective months, residents continue to attend their Continuity Clinics an average of once every week.