First Year (PGY-2)
The goals of the PGY-2 experience are focused on the acquisition of medical knowledge and clinical skills, including electroencephalography interpretation. The emphasis in PGY-2 is on clinical localization in neurology, hospital and ambulatory-based practice, and the evaluation and management of neurological emergencies. During this time, residents also have the opportunity to begin exploring future research and scholarly interests.
Second Year (PGY-3)
The PGY-3 training builds upon the foundation of knowledge and clinical skills acquired during the PGY-2 rotations. The goals of the PGY-3 experience include an expansion of clinical responsibility for the care of patients, and increased independence in the assessment of neurological emergencies. The PGY-3 resident increasingly explores the subspecialties of neurology, becomes a mentor and role model for PGY-2 residents and medical students, and begins to develop research, educational, and leadership initiatives.
Third Year: PGY-4
The PGY-4 experience allows residents to consolidate their large body of neurological knowledge and subspecialty depth, in preparation for the board certification examination and the independent practice of neurology. The PGY-4 resident is expected to participate in research, education, and leadership initiatives, while developing a professional identity and career plan for fellowship training or clinical practice.
Admitting Night Float Rotation (ANF) is done in both late PGY-2 year and early PGY-3 year. The ANF resident works closely with the Senior Night Float resident, admitting patients to both the Merritt Neurology Ward Service, as well as the Neurovascular Service, from various places including the Emergency Room, outside hospitals, the NICU, and other Medical Center services. The ANF rotation is often the first opportunity residents have to learn how to run acute stroke activation and how to do a neurological consultation.
Ambulatory Rotation is designed to provide residents with experience in the everyday practice of neurology. Residents will experience general and subspecialty neurological manifestations that are not routinely encountered in the hospital setting. For PGY2s this is a six-week rotation split between the faculty practice and Vanderbilt clinic. For PGY4s this is a two-week rotation predominantly in Vanderbilt Clinic.
Child Neurology Rotation is based at the Morgan Stanley Children's Hospital of NewYork-Presbyterian (CHONY). The clinical activities of our Division of Child Neurology are headquartered at CHONY, within a state-of-the-art, inpatient unit that can accommodate up to 28 patients. The clinical responsibilities of this service are dependent on the residents' PGY level. As a PGY-2, residents are responsible for admitting and providing neurological and medical care for child neurology inpatients, under the close supervision of child neurology residents and attendings. PGY-3 residents admit patients to the EMU, and consolidate their knowledge of reading EEG's by expanding into the pediatric population. PGY-4 residents are members of the Child Neurology Consult Team, which is responsible for new consultations and follow-ups from the pediatric ER, ICU's, and floors, and which works in parallel with our child neurology residents and attendings.
Epilepsy/EEG Rotation is an educational experience for PGY-2 and PGY-3 residents. During this rotation, residents become a member of the Epilepsy Division and care for patients in the adult EMU, which includes learning how to read routine outpatient EEG's, and reviewing EEG's with faculty.
Junior Night Float (JNF) Rotation is a six-night per week rotation, during which a PGY-2 resident is responsible for cross coverage of all patients on the inpatient services, with the exception of the NICU. The JNF resident is also responsible for admissions one night per week.
Memorial Sloan Kettering Cancer Center Rotation gives PGY-3 residents the opportunity to rotate through the Neuro-Oncology Consult Service at this world-renowned cancer hospital. Residents are exposed to a broad range of patients with both primary and metastatic brain tumors, as well as various neurological complications of cancer and its therapies. While on this rotation, residents typically have one night in four on 24 hour call.
Merritt Ward Service Rotation provides PGY-2 residents with their main opportunity to care for patients with general neurological diseases. These patients have been admitted to the Medical Center's Milstein Hospital from the Emergency Room, the Neurological Intensive Care Unit, the faculty practice doctors at the Neurological Institute, and outside hospitals. Typical diagnoses on this general neurology service include epilepsy, migraine, encephalopathy and dementia, and neuromuscular disease, among others. Overnight call is required once per month on this rotation. 24 hour coverage is provided by a day team, as well as two night floats – one responsible for admitting new patients, the other for cross-covering patients already admitted.
Neurological Care Unit (NICU) Rotation exposes residents to the dynamic environment of our 18-bed, state-of-the-art NICU. Here, residents learn to effectively evaluate and manage patients with severe and acute neurological emergencies, many of whom require advanced monitoring, mechanical ventilation, cardiovascular support, invasive procedures, and neurosurgical interventions.
Neurology Consult Service Rotation involves residents in the PGY-3 and PGY-4 years providing neurological expertise throughout NewYork-Presbyterian/Columbia University Medical Center, including the ICU's, the Emergency Room, and the general medical and surgical floors. All patients admitted to a neurology service at the Medical Center must first be seen by the Neurology Consult Service. The consult team consists of one PGY-4 resident, two PGY-3's, psychiatry and medical rotators, and sub interns. This educational experience most closely resembles the work of a practicing consultant neurologist in the acute hospital setting. The service makes daily rounds, seven days a week, providing over 2000 neurological consultations annually to every service in the Medical Center.
Neuro-Oncology Rotation enables PGY-3 and PGY-4 residents to experience the complexities of both outpatient and inpatient management of patients with brain cancer through our outstanding Division of Neuro-Oncology. While on this rotation, residents are able to see patients on their own in the outpatient setting, as well as in consultation in Milstein Hospital. Residents also attend Tumor Board every week with our neuro-oncology faculty. There is no call requirement on this rotation.
Neuropathology Rotation introduces PGY-4 residents to the Department of Pathology and Cell Biology's remarkable Division of Neuropathology. Here, residents are exposed to a broad range of pathology, both grossly and under the microscope, and attend brain cutting sessions each Friday morning. Working alongside the neuropathology faculty and fellows, residents are able to gain a deeper understanding of both neuroanatomy and neuropathology, often going to the OR to look at frozen sections.
Neurovascular ("Stroke Service") Rotation teaches residents to care for patients with neurovascular conditions of all types, including ischemic stroke, hemorrhagic stroke, vasculitis, arteriovenous malformations, and others. Like the Merritt Neurology Ward Rotation, patients are admitted to the Neurovascular Unit at Milstein Hospital from a variety of sources.
Psychiatry Rotation for PGY-4 residents is an inpatient experience on the Psychiatry Consult Liaison Service. As required by the Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Psychiatry and Neurology (ABPN), all neurology residents must participate in this four-week clinical experience. This rotation exposes neurology residents to the principles of psychiatric evaluation, interviewing techniques, the multi-axial psychiatric diagnostic framework, psychotherapy, pharmacotherapy, and a systems-based approach to patient care and disposition.
Senior Night Float (SNF) Rotation residents have the highest level of responsibility and independence in medical decision making in the Neurology Residency Program. The SNF is responsible for evaluating and recommending a plan of diagnosis and management for patients with acute and emergent neurological problems who present to the ER, or who are already hospitalized on other services at the Medical Center. The ability to fill this role represents an important milestone in the development of an independent neurological consultant.
Senior Outpatient Faculty Practice Rotation allows PGY-4 residents to gain more exposure to the outpatient setting, spending half a month with neurologists in our general neurology practice, seeing patients independently.
Neuromuscular/EMG Rotation allows PGY-3 and PGY-4 residents to interact and learn from our clinical neurophysiology fellows and faculty. Clinical testing sessions are supplemented with didactic lectures and patient care rounds, including one session of nerve and muscle histopathology, daily case review, weekly EMG didactic lectures, weekly combined clinical neurophysiology lectures, the weekly Muscle Rounds Conference, MDA Clinic participation, and impromptu lectures based on clinical studies.