Neurology Rotations

All Years

Continuity Clinic

During all three years of training, every resident will maintain a half-day outpatient clinic once a week. This will provide an opportunity to experience a typical outpatient practice, as patients seen will follow one resident throughout the entire residency.  This experience will help gain skills and understanding about managing patients in an outpatient setting and provide for continuity of care over time.  Various faculty preceptors will be assigned to provide supervision and teaching throughout the year.

Vacation

Residents will be provided four weeks of vacation yearly.

PGY-2

Multispecialty Clinic – at JHN

Residents will participate in the outpatient clinics of various Neurology and select Neurosurgery faculty.  The resident will see patients in each of the Neurology subspecialities represented at Jefferson.  These include patients with various cerebrovascular syndromes; movement disorders including Tourette's syndrome, Parkinson's disease, and dystonia; neuromuscular diseases including myasthenia gravis, inclusion body myositis, and peripheral neuropathy; epileptics with acquired and idiopathic epilepsy syndromes; headache disorders including new daily persistent headache, chronic migraine, hemicrania continua, and trigeminal autonomic cephalgias; and neuro-oncology patients with primary CNS neoplasms.

Ward Service – at TJUH

Residents will care for generally emergent admissions from the emergency department and transfers from other institutions.  They will learn directly from a senior resident and daily attending rounds for all patients in a team approach.  Residents will learn to diagnose and treat common neurological diseases in addition to an extensive amount of neurological pathology.  Some of the diseases residents will become comfortable managing include neurological infections, neuro-immunology, peripheral neuropathies, and neuro-oncology.  Residents will develop and enhance their skills in diagnostic acumen and integrate knowledge of anatomy, physiology, and pathology with the clinical situation, review the current literature to provide the most up-to-date treatment, and enact a plan of care under guidance by their team members.

Stroke Service – at JHN

The stroke service requires immediate availability to evaluate and diagnose patients with vascular disease.  Residents will develop skills of acute management, use of anticoagulants, antithrombotic agents, and lipid management.  Knowledge of coagulation abnormalities and secondary prevention of stroke will be emphasized.  Residents will round daily with a stroke attending and apply their knowledge of anatomy, physiology, and pathology to localize patients’ lesion(s) and apply acute management of patients with vascular disease.  The resident will also develop extensive proficiency in imaging modalities as the team will evaluate all neurological imaging on all patients.

Inpatient Headache Service – at Methodist (transportation provided)

Patients with intractable headaches or drug toxicity are scheduled admissions from the outpatient center.  These patients are referred from throughout the region.  The resident will round daily with an Headache attending and develop and implement a comprehensive plan to determine if the headache is primary or secondary.  Treatments for primary headache include DHE, neuroleptics, anti-epileptic drugs, steroids, NSAIDs, nerve blocks, and lidocaine.  Residents will be exposed to patients with pseudotumor cerebri, intracranial hypotension, vasculitis, sinus thrombosis, as well as primary headaches such as episodic migraine, transformed migraine, cluster headache, hemiplegic migraine, and hemicrania continua. The resident will meet weekly with the headache team including psychiatry, psychology, pharmacy and nursing to maximize a plan of care.  Additionally, residents will work in the outpatient setting to gain exposure to outpatient headache disorders and learn additional skills such as injecting botox for headache and nerve blocks.

NICU – at TJUH

Residents in the Gibbon Building NICU will care for all neurological and neurosurgical patients in the ICU.  The resident will round daily with the intensive care attending and be responsible for management of all intensive care and emergency situations that occur while the patient is in the ICU.  Diseases likely to be encountered include neuromuscular respiratory failure, increased intracranial pressure, hemodynamic instability, coma and encephalopathy, post-operative neurosurgical management, status epilepticus, traumatic brain injury, spinal cord injury, sepsis, Guillain-Barre syndrome, and medical complications of neurological diseases.  The resident will learn skills and procedures that may be life saving in case of neurological emergencies.

Night Float – at TJUH

Residents provide care for all the Ward, Epilepsy, and NICU patients overnight at TJUH. In addition, they will also be responsible for seeing all inpatient and ER consultations overnight, including acute strokes admitted to the TJUH ER. This rotation allows for a great amount of autonomy and self-directed learning, but the junior resident is always under the guidance of an on-site senior resident at JHN.Various subspecialty fellows and a ward service attending are also always available, taking call from home.

Neuroradiology – at TJUH

Residents will participate in the review of CT, MRI, MRA, MRV, CTA, and perfusion CTs to gain understanding of the physics, anatomic, and pathologic knowledge and cognitive skills required to interpret studies in a tertiary care neuroradiology practice.  Additional opportunities include observation of cerebral angiography, WADA testing, and myelography.  

PGY-3

Inpatient and Emergency Room/Stroke Consultation Service – at TJUH

As a senior resident, responsibilities are extended to include evaluation of all daytime consultations at TJUH. Residents will see emergency room consultations for neurological illnesses, including acute stroke consultations within the hospital. A wide assortment of pathology will be seen, building upon the previous year’s education. Diseases encountered by residents include peripheral neuropathies, seizure management, spinal cord lesions, vasculitis, auto-immune diseases, and paraneoplastic syndromes, and residents will also be exposed to a vast array of neurological manifestations of systemic illnesses. In the emergency room, residents will be exposed to a wide assortment of neurological problems from common neurological diseases to complex problems of initial presentations of rare diseases.  With attending supervision, the resident will evaluate the consult, determine an appropriate differential diagnosis, develop a treatment plan, and communicate necessary diagnostic and treatment measures to the requesting physician. Additionally, one consult resident will carry the Acute Stroke Code pager and will be the first line for in-house acute stroke management at TJUH. With attending guidance, they will administer antithrombolytics for acute infarctions, thrombotic agents to reduce intracerebral bleeds, or recognize and incorporate neurosurgical consultation for additional acute interventions.

Epilepsy Service – at TJUH

The eight bed Epilepsy Monitoring Unit is generally elective admissions to objectively clarify patient's seizures for maximizing potential anti-epileptic management, assist in diagnosis and management of non-epileptic seizures, or provide surgical management for refractory seizures.  The resident will round daily with an epilepsy attending and epilepsy fellow, review their patient's video EEG from the previous day utilizing external lead placement or depth electrodes, and learn to effectively manage anticonvulsant medications.  The resident will also attend a weekly multidisciplinary meeting including neurosurgery, neurology, neuroradiology and neuropsychology to evaluate refractory epilepsy patients for neurosurgical management.  If interested, the resident will also have the opportunity to observe electrocorticography and neurosurgical management in the operating room.

Neuro-ophthalmology – at Wills Eye

Residents will have the opportunity to work at Wills Eye Hospital, one of the top ophthalmology centers in the United States, within the Neuro-opththalmology division.  Among other skills, residents will gain proficiency in checking vision, acuity, peripheral fields, and fundoscopic examination.  Residents will help to manage patients with ocular manifestations of various conditions, such as autoimmune diseases, optic neuropathy, myasthenia gravis, and the ocular disorders that may occur with brain tumors, AIDS and stroke.

Shared PGY-3 and PGY-4

Electives

Elective blocks may be spent doing research, additional months of EEG, EMG, or specialty clinics such as Neuro-ophthalmology, Movement Disorders, Multiple Sclerosis, Pain, Headache, Oncology, Neuroradiology, or Sleep Medicine.  Residents may also design elective rotations to match their areas of interest pending department approval.

Pediatric Neurology – at AI duPont

Residents will rotate a total of 3 months at Alfred I. duPont Hospital for Children during the second and third years.   During this time, residents will serve either on the inpatient consultation service and attend outpatient specialty clinics.  The resident will be exposed to genetic, congenital, postnatal, and developmental neurologic diseases.  The resident will round with an attending daily and help direct care of pediatric neurological patient illnesses.  The resident will also have the opportunity to spend time in outpatient general and specialty clinics such as neuromuscular and mitochondrial diseases, headache, epilepsy, auto-immune, and developmental delay.

Senior Night Float – at JHN

As a senior resident, PGY-3s and PGY-4s will supervise the PGY-2 night float at TJUH while providing overnight care for all stroke and NICU patients at JHN. They will also be responsible for determining the appropriateness of any overnight transfers from other hospitals, and will see any emergent consults in JHN. It is a excellent opportunity to prepare for taking call from home in the future. The senior night float also works closely with the stroke or neurocritical care fellow and ward attending taking call from home.

NICU – at JHN

The resident will expand and enhance their intensive care training beyond the Gibbon NICU Service to manage more complicated patient issues such as subarachnoid hemorrhages, aneurysm coils or clippings, intracranial to extracranial bypass operations, and cavernous sinus fistulas.  In addition to the critical care issues outlined above, the resident will become more comfortable with Swan management, advanced ventilation management, hypothermia protocols, and many cutting edge treatments and technology available within this unit.  Jefferson neurosurgery and endovascular neuroradiology program treats the highest volume of patients with aneurysms, brain AVMs, and angioplasty and stenting occlusive carotids and intracranial disease in the nation. Residents will become leaders in the in the academic field of stroke and neurocritical care and will develop the necessary insight into the disease process, pathology, pathophysiology and management of critical neurological patients either inpatient or working with patients in the outpatient settings who have undergone such experiences.

PGY-4

Senior Resident, Ward and Stroke – at TJUH and JHN

PGY-4 residents will spend two months in graduated responsibilities, working in a leadership role on both the Ward and Stroke services.  The resident will directly supervise the junior resident on the service, serving as the team leader and provide additional reading materials to enhance the education of the team members and provide the most up-to-date patient care.  The senior resident will organize didactic lectures for both residents and students.  While on Ward Senior, they will also triage all general neurology transfers from other institutions.  This rotation will allow the resident to function as an attending in both clinical and academic roles.  Attending oversight and guidance will continue to be provided.

Inpatient Geriatric Psychiatry – at TJUH

Residents will rotate in a specialized psychiatric unit for the required ACGME rotation at Jefferson Hospital for Neurosciences.  The resident will take care of geriatric patients suffering from various cognitive, behavioral, and movement disorders.  Residents will also have the opportunity to gain exposure to ECT for depression.  During this month, the resident will also work to develop a stronger appreciation for acute and chronic pharmacologic effects.  Residents may also choose to spend their months in other available psychiatric services including the inpatient psychiatric unit at Gibbon Hospital or inpatient consultation services.

Neuropathology – at TJUH

Residents will review slides on a one to one basis with a neuropathology attending on a daily basis and will attend weekly neuropathology conferences and weekly brain cutting sessions.