Year By Year Description
PGY-1 General Overview
The UVA Neurology Program includes a preliminary training year. This year will include 9 months of internal medicine (typically 1 month Acute Cardiology or Cardiac Care Unit [CCU]), 1 month of Gastroenterology, 2 months General Medicine, 1 month Heme/Onc, 1 month in MICU, and 2 subspecialty months (for example, pulmonary, renal and infectious disease), 2 months of neurology inpatient service, two weeks of emergency medicine and 1 month of pathology.
Our program has a novel rotation, our “specialty clinics” elective where residents are able to spend time in several subspecialty clinics throughout the week, including neuro-oncology, neuro-ophthalmology, memory disorders, vestibular clinic, LP clinic, neuroendocrine, brain-cutting, multiple sclerosis clinic and Huntington’s clinic.
PGY2 residents will have 1 to 2 half-days of neurology clinic per week. They begin to develop their own outpatient practices by following patients who have been under their care in the hospital, or who have been seen in the Emergency Department or Neurologic Outpatient Unit. New diagnostic patients add to the total.
Residents attend their weekly, half-day outpatient clinics throughout the three years of residency training, with the goal of building their practices and providing continuous follow-up of a group of patients over three years. These clinics involve General Neurology, Neuromuscular, Vascular Neurology, Movement disorders, and Headache clinics.
One attending is always in the outpatient unit solely to provide patient staffing and teaching for residents and medical students.
Adult Neurologic Inpatient Service
On the Adult Neurologic Inpatient Service, residents work closely with interns and medical students and are under the supervision of a senior resident and attending neurologists who are available to the residents at all times. Residents are responsible for evaluation of patients admitted to their care on the service and in the NNICU, with particular reference to history, physical, neurologic examination, and choice of appropriate laboratory/imaging studies. Every patient's case is considered an individual study, which should include a review of the literature when appropriate.
The inpatient services include a general neurology service and a stroke service. Each service is supervised by an attending physician and consists of two teams, each of which has one first year Neurology resident, one intern and a variable number of students. A third year Neurology resident serves as the Ward Senior and is responsible for teaching and guiding team decision-making.
Call alternates between the stroke and general services. On call duties include seeing new consults from the Adult and Pediatric Emergency Departments and inpatient services as well as fielding calls from outside institutions and families. An intern is always on call with the Neurology resident, assisting with new consults and helping care for patients on the Neurology inpatient services.
PGY2 Neurology residents on an inpatient service have the following daily call cycle:
- Day 1 - Short call - admits to own service 7am-4pm Mon-Fri
- Day 2 - Long call - admits to own service 7am-4pm and both services 4pm-approximately 7pm Sun-Thurs. On Friday and Saturday, admit from 7am to 7am the next day. (There is no Night Float on week-end days.)
- Day 3 - Post call - Long call team hands over opposite team patients at Morning Report at 8am. Leave hospital when work is done
- Day 4 - Pre call/clinic day - no admissions. Leave hospital when work is done. Resident has PM clinic and intern may as well.
Due to resident preference, we have enacted a Neurology Night Float system. PGY-2 residents do 2-3 weeks of Night Float during the year and PGY-3 residents do about 5 weeks. The Night Float resident has the following call schedule:
New patient admissions are presented everyday during Morning Report or bedside rounds. The Long call and Night Float teams present new patients in Morning Report, which is attended by the Neurology attendings and serves as an opportunity for the entire group to learn from the expertise of the various members of the inpatient service. It also serves as a forum for transfer of care for some patients admitted the previous day. Following Morning Report, we round in the Neurological Intensive Care Unit. The daily routine, including conferences is summarized as follows:
- Everyday routine: Pre-rounds 7am-8am, Morning report 8am-8:30am, NNICU rounds 8:30 to 9:00, bedside rounds 9:00, noon lecture 12pm-1pm (except Fri)
- Monday and Thursday: Neuroradiology rounds at 10am-10:30
- Friday: Grand rounds 12pm-1pm, followed by, M&M conference, Resident run conference, meeting with the residency director or Neuroanatomy rounds
Epilepsy Monitoring Unit
The resident assigned to the Inpatient Epilepsy Monitoring Unit / Comprehensive Epilepsy Program assists with the diagnostic evaluation, drug therapy, and clinical studies of adult and pediatric patients. The service focuses on complex patients with long-standing, poorly controlled seizures who are admitted for 24 hour video and EEG monitoring, medication adjustments, ictal and interictal SPECT neuroimaging, and/or presurgical evaluation. The team, which consists of a neurology resident, epilepsy/EEG fellow, and attending Epileptologist, rounds daily and reviews laboratory studies and continuous 24 hour video and EEG monitoring together.
Because patients in the Epilepsy Unit, although they have poorly controlled seizures, are ambulatory and not usually critically ill, the resident takes call from home 24 hours a day for 6 days each week throughout this rotation. The resident also attends one to two weekly half day adult and pediatric epilepsy clinics. This rotation provides residents with experience in working with the latest technology and treatment regimens found in a comprehensive program designed to stay at the forefront of research, diagnosis, and management of epilepsy.
Residents learn to manage the care of critically ill patients under the supervision of critical care attendings and senior housestaff while rotating in the NNICU. PGY2 residents take this rotation in the second half of the year, and PGY3 residents take it in the first half. The team is comprised of a critical care attending and fellow, the NNICU resident, and medical students. Neurology, anesthesiology, neurosurgery residents and nurse practiitioners rotate through the unit in 2-4 week blocks, taking in-house call every 3-4 days. While on call, the NNICU resident is responsible for the moment to moment critical care management of all NNICU patients.
While caring for both neurologic and neurosurgical patients in the NNICU, the resident becomes involved with the following treatment regimens (among others):
- Status epilepticus intervention
- Management of patients receiving intra-arterial or systemic thrombolysis for acute ischemic stroke
- Management of subdural or intraparenchymal cerebral hemorrhages.
- Management of acute cord trauma
- Intensive monitoring before epilepsy surgery
- Ventilatory support
- Circulatory support
- Management of hypertension
- Management of elevated intracranial pressure
- Stabilization/monitoring of pre-and post-embolization and surgery
PGY-2 residents are given about 6 weeks of elective time their first year. These are split into two week blocks during which they typically rotate on EEG, EMG, and Psychiatry consults. If desired, other electives can be arranged based on resident preference. For more information on electives and a list of electives offered, see "Electives Program" under PGY-4 Year.
PGY3 residents continue developing their clinical skills on the Adult and Pediatric Neurology Consultation Services, in the Neurologic Outpatient Unit as Assistant Director, in the Nerancy Neuro Intensive Care Unit (NNICU), Epilepsy Monitoring Unit (EMU), and on the elective rotation.
The period during which the resident manages the Neurologic Consultation Service is a very active one since the department receives numerous consultation requests daily within the University of Virginia Health Sciences Center. The resident is responsible for providing neurologic consultation on patients in the hospital and emergency room Monday through Friday (7am - 4pm) and during weekend rounds. Residents on the Adult and Pediatric Consultation Services alternate weekend coverage of those services, including back-up for the PGY-2 resident on call, so each resident has every other weekend free. The team is also responsible for providing follow-up consultation on patients seen in inpatient consultation by the PGY-2 resident on call during the previous night. Patients are often managed through consultation, although certain patients may be transferred from the consulted service to the Neurologic Inpatient Service for specific studies or therapy. Residents learn to manage a broad range of concurrent neurologic illness in medical and surgical patients while on the consultation service.
Training in pediatric neurology is obtained during a total of about 10 weeks split into 2 week rotations. The team includes a PGY-3 adult neurology resident, PGY-4 pediatric neurology resident, pediatric neurology attending, and medical students. The primary responsibilities of the resident on the Pediatric Neurology Service covers the Pediatric Neurology service and provides consultation for the Pediatric Inpatient Services, Newborn ICU, Pediatric ICU, Pediatric Emergency Room, and Kluge Children's Rehabilitation Center Monday through Friday (7am - 4pm) and during weekend rounds. (As mentioned above, weekend coverage of the consultation services alternates between the two residents.) The resident on the Pediatric Neurology Service takes call from home at night as back-up to the PGY-2 resident on call for the neurology services. The resident also attends the weekly pediatric epilepsy and general pediatric neurology clinics three afternoons a week.
When rotating on the Neurologic Outpatient Unit, the resident functions as assistant director of the unit, thereby becoming experienced in the running of an outpatient practice. In assisting with thegeneral administration of the unit, the resident orients rotating residents and medical students, communicates with the patients' primary physicians, and ensures the efficient operation of the unit. One sees patients Monday through Friday in clinic and assists with the supervision and teaching of family medicine and PM&R residents, anesthesia fellows, and medical students. An attending neurologist is always available in the unit for consultation and patient staffing. This rotation as well as the weekly continuity clinics prepares residents for the changing practice patterns of increasing ambulatory care that are being seen nationally. There is no night call and weekends are off.
The experience in the NNICU during the PGY-3 year is similar to what it is during the PGY-2 year, except that the rotation is done during the first half of the year. Residents continue building their expertise in the management of critically ill neurologic and neurosurgical patients.
Residents have about 10 weeks of elective time during the PGY-3 year. We have an outstanding electives program. For more information on electives and a list of electives offered, see "Electives Program" under PGY-4 Year.
The PGY-4 year of training gives residents the opportunity to manage the Adult Neurologic Inpatient Service, thereby gaining valuable administrative and supervisory experience for their future goals in academic or private practice. PGY-4 residents continue their outpatient practice (including a half-day each of diagnostic and follow-up clinics during electives) and attend the field clinics in southwestern Virginia. This field clinic involves 2 three day trips to underserved areas that are located in the rural part of southwestern VA. The majority of the PGY-4 year, however, constitutes elective time, which is described in more detail below.
Adult Neurologic Inpatient Service
The senior resident assigned to the Adult Neurologic Inpatient Service (the ward senior) is responsible for the general administration of both the general and stroke services. This resident is expected to be familiar with all patients on the service, to evaluate patients admitted to the NNICU, and to provide assistance to PGY-2 residents on patients presenting particular diagnostic challenge. He /she is responsible for coordinating admissions to the service, daily morning report, and neuroradiology rounds. The senior resident orients the medical students, interns, and PGY-2 neurology residents, and provides backup for emergent consultations. Senior residents exercise maximum responsibility (with attending back-up) for the care of patients and supervision of students and housestaff, thus meeting program goals and ACGME requirements for increasing responsibility.
Epilepsy Monitoring Unit
Each senior resident spends 2 additional weeks in the EMU.
Residents are now spending two weeks on psychiatry consultation service during their PGY2 year and their PGY4 year. Additional time on psychiatry rotations is available as elective. The electives of neuropsychology and behavioral disorders are also available and very popular.
The flexible electives program makes it possible for residents to discover their preferences for fellowship training or future practice patterns, or to have an intensive period of research in areas of current interest. Residents can hone skills acquired during the first two years with clinical rotations such as EEG, EMG, neurodegenerative diseases, neuro-oncology or neuroradiology; begin to develop a subspecialty; or continue projects in their particular areas of clinical or research expertise. Residents elect rotations in clinical programs, research programs, or a combination of the two and work with faculty within or outside the department, depending on their interests. Attending or participating in conferences related to the elective and making correlations between clinical and investigational neurology are encouraged.
- Neuromuscular Disorders
- Electromyography (EMG)
- Electroencephalogram (EEG)
- Movement Disorders
- Neurodegenerative Movement Disorders
- Fontaine Specialty Clinics
- Neurological Rehabilitation
- Neurological Behavior
- Headaches and Vertigo
- Alternative Therapies for Neurologic Disorders
The resident may spend time in the following:
- Alzheimer's Disease Program (and related disorders)
- F. E. Dreifuss Comprehensive Epilepsy Program
- EEG/EP, EMG, and Neurovascular Laboratories
- Movement Disorders Program
- Nerancy Neuro Intensive Care Unit
- Neuromuscular Disease Program
- Neurologic Outpatient Unit
- Pediatric Neurology Program
- Comprehensive Stroke Program
- Pain Management
- Subspecialty areas of other departments
The resident may get involved with one of the many clinical or basic
research projects within the Department of Neurology or in other
departments within the School of Medicine or University. The University
of Virginia School of Medicine is in the top one-third of 125 medical
schools in the United States in amount of research funding by the
National Institutes of Health.
(Detailed descriptions of ongoing research in the departments of Neurology and Neuroscience are available from the coordinator of the training program or by clicking the link below.)
Residents have taken advantage of international opportunities, including a previous experience in Uganda where our resident did public health research in epilepsy treatment. Two of our residents have gone to our established Glasgow, Scotland rotation, at the Institute of Neurological Science. During this experience residents are mentored by Dr. Maria Farrugia, an international expert in myasthenia gravis. Our newest international opportunity is located in Palmerston North, New Zealand, precepted by U.Va. neurology residency and neurophysiology/epilepsy fellowship graduate, Dr. Annemarei Ranta.