Description of Rotations
- Yale Ward Service
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.
- VA Ward 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.
- Yale Consult 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. The team consists of a senior (PGY-4) resident and a junior (PGY-3 or PGY-2) neurology resident, as well as rotating residents from the Psychiatry and Internal Medicine Programs. There are typically 1-2 medical students on the consultation service.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. This team sees all inpatient consults except pediatric patients, including inpatient stroke alerts. Rounds are held daily on weekdays with the consult attending. 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.
- Neuro-ICU (NICU) Service
The NICU team consists of a neurology resident (PGY-2 or PGY-3), a neurosurgery resident, interns (PGY-1), 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.
- Stroke Service
The stroke team at Yale-New Haven Hospital consists of one senior (PGY-3) neurology resident, one junior (PGY-2) neurology resident, a neurology intern (PGY-1), medical students, a stroke fellow and 1-2 advanced practice providers (APPs). The junior residents and APPs 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.
- Emergency Neurology
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 through Friday, and residents cover a 12-hour shift on either Saturday or Sunday.
- Clinical Neurophysiology
This rotation is designed for residents to develop basic knowledge, skills and experience in EEG and EMG interpretation. In the mornings, residents spend their time rotating through the Epilepsy Monitoring Unit (CAVE) during each 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. In the afternoons, residents attend EMG clinics to obtain an introduction to EMG techniques and interpretation.
An advanced elective or rotation in ICU-EEG is available to residents who have already completed their core Neurophysiology Rotation rotation.
- Pediatric Neurology
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.
- Gaylord Rehabilitation Hospital
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.
- Night Float
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. Night Float works 6 nights per week, with Saturday off. There are 2 night-float residents at YNHH. There is a Inpatient Night-Float (INF) resident that covers all of the inpatient Neurology services, and a Consult Night-Float (CNF) 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 2-week 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. The resident has Saturday off and returns on Sunday night at 7:30 p.m for sign-out. During the time they are on service, the Inpatient Night Float resident attends to all matters pertaining to the Yale Neurology inpatient, stroke and neuro-ICU services (with the help of the APP and fellow team, and under the supervision of the attending neurologists).
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 2-week blocks during the academic year. Consult Night Float works 6 nights per week, and Saturday is off. 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 consult team. Consults and admissions regarding Epilepsy patients are discussed with the Epilepsy Fellow.
- SRC Consultation Service
- The SRC Consult Resident works under the supervision of the SRC Attending, and is responsible for neurological consults at the St. Raphael Campus of YNHH. This rotation provides an opportunity for PGY-2 and PGY-3 residents to gain independence, work in a community hospital environment, network with primary care residents, and work one-on-one with the SRC faculty.
- All PGY-4 residents spend one month on the consult-liaison psychiatry service. The resident is expected to function as a psychiatry resident during this block, under the direct supervision of a psychiatry consult fellow and attending psychiatrist. Residents get broad exposure to psychiatric complications of systemic disease, delirium, drug-induced psychiatric states, and functional neurological disorders. Residents also participate in assessments of capacity. Tailored didactic education occurs during this rotation, provided by the fellow and attending psychiatrist.
- Elective Rotations
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.
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.
- Clinic Block
The clinic blocks are new for the 2018-19 academic year. Every 6 weeks, the same cohort of residents (called a "firm") will spend one week in outpatient clinics. Approximately half of this time will be spent in continuity clinics at the VA and Yale, and the other half is spent in subspecialty clinics chosen by the residents. Residents do not have backup or weekend responsibilities during the clinic block. This rotation will account for 8 weeks of training time every year, and provides a robust exposure to outpatient general neurology and subspecialties.