Neurology Residency Program

Residents will care for acute neurological admissions from the emergency department and transfers from other institutions.  They will learn directly from a senior resident and attend rounds for all patients daily using a team approach.  Residents will learn to diagnose and treat common and uncommon neurological diseases in addition to extensive neurological pathology.  Some diseases residents will become comfortable managing include neurological infections, neuro-immunology, refractory epilepsy, peripheral neuropathies, and neuro-oncology.  Residents will develop and enhance their diagnostic acumen skills and integrate anatomy, physiology, and pathology knowledge with the clinical situation, review the current literature to provide the most up-to-date treatment and enact a care plan under their team members' guidance. Senior residents in this service learn additional mastery of the above neurologic issues through the supervision and teaching of junior neurology residents. 

Residents will participate in the outpatient clinics with various Neurology faculty.  The resident will see patients in each of the Neurology subspecialities represented at Jefferson.  These include patients with various cerebrovascular syndromes, movement disorders, neuromuscular diseases, epilepsy, headache disorders, and neuro-oncology among others. This rotation also has a dedicated lumbar puncture clinic which allows PGY-2 residents to quickly learn and master the procedure under the guidance of faculty.

Residents in the 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.

Residents provide care for all the Ward patients overnight at TJUH. They will also be responsible for seeing all inpatient and ER consultations overnight, including acute strokes. 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 calls from home.

Residents care for all the stroke and neurology-service ICU patients overnight at JHN. In addition, they will also be responsible for seeing all inpatient consultations, including the Wills Eye Hospital Ophthalmologic Emergency Department. This senior-resident rotation allows for a great amount of autonomy and self-directed learning. Various subspecialty fellows and a ward service attending are always available, taking calls from home.

Patients with intractable headaches or drug toxicity are scheduled admissions from the outpatient center.  These patients are referred from throughout the country.  The resident will round daily with a Headache attending and develop and implement a comprehensive management plan.  Treatments for primary headaches include DHE, neuroleptics, anti-epileptic drugs, corticosteroids, NSAIDs, nerve blocks, ketamine, and lidocaine.  Residents will be exposed to patients with intracranial hypertension, intracranial hypotension, vasculitis, sinus thrombosis, as well as primary headaches such as episodic migraine, transformed migraine, cluster headache, hemiplegic migraine, and hemicrania continua.  Residents will also become familiar with interventional procedures such as nerve blocks and applications of non-pharmacologic devices for headaches.

The eight-bed Epilepsy Monitoring Unit is generally elective admission to objectively clarify patient's seizures for maximizing potential anti-epileptic management, assist in diagnosing and managing non-epileptic seizures, or provide surgical management for refractory seizures.  The resident will round daily with 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 manage anticonvulsant medications effectively.  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 be able to observe electrocorticography and neurosurgical management in the operating room as part of one of the largest epilepsy surgery centers in the United States.

Residents will participate primarily in the outpatient clinical practice of a neuro-oncologist with limited inpatient clinical consultation exposure. They will participate in obtaining histories and physical examinations from the patients as well as discussing the plan of care with the attending physician within a multi-specialty setting involving neurology, medical oncology, neurosurgery, and radiation oncology.

Residents will participate in the outpatient clinical practice of a neuro-immunologist and receive instruction on the diagnosis and treatment of neuro-immunological disorders, including multiple sclerosis, neuromyelitis Optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody disease, sarcoidosis, and many others. 

Residents will participate in the review of CT, MRI, MRA, MRV, CTA, and perfusion CTs to gain an 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.  

Residents will participate in the daily care of neuromuscular out-patients and observe/assist in the performance of EMG/NCS studies as needed in the out-patient and in-patient care areas. Residents will receive instruction across the breadth of neuromuscular diseases and receive supplemental exposure to educational materials to help achieve competency of peripheral nerve neurophysiologic testing interpretation.

As a senior resident, responsibilities are extended to include evaluation of all daytime consultations at TJUH and JHN. Residents will see emergency room and inpatient consultations for neurological illnesses, including acute stroke evaluation and management. 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.

This dedicated 4-week block in the PGY-3 year is designed to instruct residents on the foundations and application of electroencephalography as well as ambulatory epilepsy care. Residents will work through this 4-week rotation with exposure to reading and interpreting outpatient EEG studies with the instruction of an attending epileptologist. Supplemental asynchronous EEG learning materials are also provided. To supplement this experience, residents will also rotate through the epilepsy subspecialty clinic, engaging with and managing patients with a breadth of epilepsy syndromes and disorders.

Residents will rotate a total of 3 months at Nemours Children’s Hospital during the PGY3 and PGY4 years.   During this time, residents will rotate through both inpatient consultation services and 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.

Residents will rotate with this specialized psychiatric consult team to complete their ABPN-required psychiatry education.  Our consultation-liaison service sees a diverse panel of patients, including patients with exacerbations of primary psychiatric disorders, psychiatric complications of medical disorders, patients requiring pre- and post-operative transplant assessment, psychiatric needs in the context of a cancer diagnosis, women’s mental health, substance abuse and psychopharmacologic management in the setting of polypharmacy.

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

This PGY-4 ambulatory rotation allows senior residents to serve in a more autonomous role in providing ambulatory urgent neurologic consultations for patients who have urgent needs but not to the level requiring inpatient evaluation or admission. The resident will be responsible for the history, examination, and neurologic assessment of new outpatient consultations across the breadth of neurology. The clinic is staffed by an attending faculty neurologist.

Residents can use elective weeks to gain additional clinical and educational experiences within the department. Departmental electives include neuromuscular/EMG, movement disorders, neuro-immunology, neuro-ophthalmology, epilepsy, stroke/critical care, headache, cognitive/behavioral neurology, neuro-oncology, neuro-ophthalmology, sleep, general neurology, medical teaching, and research. Residents may also use elective time to seek clinical education in departments other than neurology, such as internal medicine, neurosurgery, or physiatry. Elective time is also used to facilitate time for residents seeking international rotations.