The mission of the Ambulatory Neurology Continuity Clinic of the residency program is to provide high-quality neurologic care to the members of our community and advance resident education and engagement in ambulatory neurology.
Our residents participate in a weekly continuity clinic where they have the exciting opportunity to build their own practice and develop the necessary outpatient skills in a supervised setting. Residents are exposed to a broad range of both common and rare neurological disorders in a unique patient population. The residents are supervised by the outstanding faculty who practice general and subspecialty neurology. The Neurology clinic itself represents a specialty practice with referrals primarily from Internal Medicine, but from myriad other disciplines as well. Our department has the distinct advantage of representation by faculty who are leaders in general neurology and across the subspecialty disciplines, including epilepsy, neuromuscular medicine, movement disorders, behavioral neurology and headache.
The Neurology Clinic is located on the 10th floor of the Vanderbilt Clinic (VC-10) building at 622 West 168th street. We share the 10th floor space with other subspecialty clinics as part of the New York Presbyterian Hospital.
We have a unique patient population, mostly from Northern Manhattan and the South Bronx, although patients come from afar to seek the expertise of our physicians. Many patients are from the Dominican Republic and speak primarily Spanish. A number of our residents speak Spanish, while others learn the basics quickly but there are always translation services available to provide the best communication possible with our non-native English-speaking patients. The patients are referred from other Columbia NYP ambulatory clinics, community practitioners, and patients discharged from the ER or inpatient services.
At Columbia, we recognize the importance of a strong ambulatory training experience and education as part of the residency training in Neurology. At major academic medical centers there is a significant amount of inpatient services, and most neurology residency programs place emphasis on the inpatient experience. However, it is increasingly recognized that ambulatory training is crucial as most neurology residents will practice in the outpatient setting upon graduating. We therefore strive to incorporate a rigorous outpatient training experience for our residents, with an emphasis on continuity of care, excellence in patient care, and academic achievement. While the clinic setting can at times be challenging, we urge our trainees to ask questions, be curious and creative, work together with the idea that something new can be learned from every patient.
Most learning comes from the direct attending-resident interaction during patient encounters. We have several stellar general neurology attendings with experience who are in the clinic on a weekly basis and work very closely with the residents. The residents therefore have an ongoing relationship and mentorship with these attendings over the course of their residency. In addition, other faculty from the department, often with a subspecialty or research focus, will rotate through the ambulatory clinic, which provides a distinct approach and knowledge base for the residents. As part of the ambulatory neurology clinic, we have integrated some of the subspecialties (with faculty trained in these areas) such that the residents gains this exposure to expertise in particular areas, but maintains continuity with his/her patients. There is a monthly multiple sclerosis/neuroimmunology clinic, bimonthly headache clinic, weekly stroke clinic, and weekly integration with epilepsy clinic. In addition, throughout their training, residents attend subspecialty clinics (Movement Disorders, Neuromuscular/MDA, Epilepsy, Pediatric Neurology) during certain rotations, to provide exposure to subspecialized care.
In addition to on-the-spot learning during patient encounters, we have instituted Clinic Report at the beginning of each clinic session. We have developed a curriculum for ambulatory neurology, which covers important history and exam features essential to proper diagnosis, and the treatment and management of both common and uncommon neurological diseases. Topics covered include both common and less frequently encountered symptoms and disorders such as:
|• Lower back pain
||• Headache-migraine, trigeminal neuralgia, etc
|• Radiculopathies-lumbar and cervical
||• Peripheral vertigo-BPPV, Meniere's, etc
||• Myasthenia gravis
|• Multiple sclerosis
|• Post-stroke care and secondary prevention
||• Movement disorders-PD, ET
Subjects covered in the didactics are available to all residents on the Neurology clinic website, with other useful information regarding clinic logistics, evidence-based neurology, and an ambulatory read of the week. In the increasingly complex world of medical practice which we encounter today, we also emphasize teaching time management during patient encounters, appropriate documentation and communication skills with patients and other physicians, and how to manage clinical questions and medication-related issues via telephone.
By the end of neurology residency, we expect that residents will be able to recognize, diagnose, evaluate and manage the treatment of patients with common and uncommon neurological problems in the outpatient setting. In addition, in the current ever-changing environment of healthcare practices and economic considerations, you will learn to communicate effectively with referring providers (verbally and in writing), how to practice cost-conscious neurology, and when to refer patients for outpatient diagnostic tests. To achieve this goal, residents are expected to meet specific training-level appropriate goals in patient care and medical knowledge as well as the ACGME core competencies (summarized below).
- Take an accurate neurological history
- Perform an accurate neurological exam
- Interpret the results of the history and exam
- Write a clear and concise note of findings, impression and plan
- Develop an understanding of follow-up visits and when to order tests
- July and August: 3 new patients per clinic session
- September-June: 2 new patients, 2 follow-up patients and 1 ER discharge patient
- Complete 2 observed exams for the boards
- Begin teaching medical students
- Generate a differential diagnosis based on history and exam
- Devise a work-up plan and order appropriate and cost-effective tests
- Devise a basic treatment plan
- Per session: 2 new patients, 3-4 follow-ups, and 1 ER discharge patient
- Participate in clinic debriefing
- Actively participate in teaching medical students
- Develop a complete and sophisticated differential diagnosis, including less common possibilities
- Develop a clear management and treatment plan including possible alternatives, with an emphasis on increasing independence
- Per session: 2 new patients, 3-4 follow-ups, 1-2 ER discharge patients
- Active participation in both Clinic Report and Clinic Debriefing
- Active participation in teaching medical students and junior residents