Neurology Residency Program

Bradley Jacobs, M.D., M.S., Director

MRI

Goals and Objectives by Year of Training

PGY1 (Preliminary Year)

The aim of this first year of neurology training involves a comprehensive clinical experience in internal medicine. Residents will have their first exposure to neurology on the general neurology inpatient service and their initiation of the neurology continuity clinic. The experience includes adult inpatient and outpatient diagnosis and management. The core competencies of patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal and communication skills and systems-based practice are fully integrated into the didactic and clinical curriculum of the first year. This year will include 11 blocks of internal medicine with primary responsibility in patient care (with one block in intensive care and two blocks in an outpatient setting), one block in emergency medicine and one block on the general neurology inpatient service. All these rotations will occur at Miami Valley Hospital.

Residents will begin their neurology continuity clinic for one half day per week beginning in this first year of the program and continuing through PGY4. Educational objectives of the resident continuity clinic for the adult neurology resident are to acquire the knowledge, skills and attitudes to perform a thorough neurological exam and to diagnose and manage non-acute neurological illness by providing faculty supervised care to a diverse population of patients representing the broad range of neurological illnesses. The resident follows patients whom they see on the inpatient service as well as other referrals to the clinic. As training progresses the resident is allowed increasing autonomy in management of their patients but always with the input and mentoring of faculty attendings.

PGY2

During the PGY2 year, the first year of full-time neurology residency, trainees obtain a comprehensive clinical experience in adult neurology for both outpatient and inpatient diagnosis and management. The core competencies of patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal and communication skills and systems-based practice are fully integrated into the didactic and clinical curriculum of the PGY2 year. This year of training will consist of 12 blocks of clinical rotations in adult neurology and one block in child neurology. This training will include both inpatient and an integrated outpatient exposure.

Two blocks of exposure on the inpatient general neurology and consultation service at Miami Valley Hospital will include inpatient and emergency department evaluation of patients with a variety of neurological disease under the supervision of PGY3 and PGY4 residents and neurology faculty. During these blocks residents will be exposed to the care of patients in the epilepsy monitoring unit under the supervision of epileptologists. Two blocks of exposure on the inpatient vascular neurology service at Miami Valley Hospital will include evaluation of acute stroke patients via telemedicine and in the emergency room under the supervision of PGY3 residents and the vascular neurology faculty. One block of exposure in the neurocritical care unit at Miami Valley Hospital will involve a focused exposure to the critically ill neurological patient under the supervision of PGY 4 residents and the critical care faculty.

The residents will have three blocks at the Dayton Veterans Affairs Medical Center. During these blocks, residents will evaluate inpatients on the neurology service under the supervision of PGY4 residents and neurology faculty. They will obtain exposure to some of the chronic neurological diseases of this patient population. Additionally, during this rotation they will participate in the outpatient evaluation of patients with an emphasis on neuromuscular disease and sleep disorders. They will also obtain experience in the interpretation of EMG/NCVs and EEGs.

The PGY2 residents will also begin their exposure to child neurology. They will have one month of child neurology annually through their PGY4 year. During this rotation the resident is involved in performing pediatric neurology consultations on the Dayton Children’s Hospital pediatric services. During this time they will supervise pediatric residents and are supervised by pediatric neurology staff. In addition, they will rotate in the outpatient pediatric neurology clinic seeing outpatient consultations under the direction of the pediatric neurology faculty.

The residents will continue their weekly continuity clinic in PGY2. In addition, the PGY2 resident spends 2 blocks rotating in specialty clinics including behavioral neurology, epilepsy, movement disorders, neuroimmunology, neuromuscular disease, neuro-oncology, pain management, sleep disorders and vascular neurology. This clinic exposure will provide a broad overview of neurological disease states, with diagnosis and management being the primary focus. During this subspecialty exposure the resident works with one of several subspecialty trained physicians to gain increasing skills and understanding of these areas of neurology. The resident identifies a career mentor and has protected time for formulating a career path during these subspecialty clinic rotations. In addition, this time may be spent becoming immersed in the literature to define a course of study, develop a clinical or basic science research project or write an application for a research fellowship. This clinical experience will mostly occur at the Neurology Clinic located at Miami Valley Hospital.

During the PGY2 year, the opportunity for more in-depth subspecialty study will begin with three blocks of electives. Elective opportunities will include behavioral neurology, epilepsy, interventional neurology, movement disorders, neurocritical care, neuroradiology, neuroimmunology, neuromuscular disease, neuro-ophthalmology, neuropathology, pain management, research, sleep disorders and vascular neurology. Residents will be required to take at least one block of epilepsy and one block of research elective over the PGY2 and PGY3 years. The research elective will be a one-month block rotation focused on an individual research project with a faculty mentor within the department or a comparable research experience arranged with outside faculty under the direction of a faculty advisor. An initial exposure to research principles will be provided as the resident completes the CITI course and obtains a basic understanding of biostatistics, research design, research implementation and dissemination of study results. The research opportunity is driven by the interest of the resident and will lead to an abstract at a national or regional meeting and/or publication of research results.

PGY3

The PGY3 year offers an opportunity to gain experience in the broad range of neurological practice giving residents insight into future potential career paths. By continually assuming an ascending level of learning and responsibility, residents strive to demonstrate excellence in areas of patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal and communication skills and systems-based practice. During this period of training, residents will experience three months on the Miami Valley Hospital general neurology service, three months on the Miami Valley Hospital vascular neurology service, one month of subspecialty clinic, four months of electives, one month of child neurology and one month of psychiatry.

The PGY3 neurology resident assumes an ascending level of responsibility for patient care, in addition to teaching. During the PGY3 rotations at Miami Valley Hospital PGY3 residents are responsible for providing supervision for PGY 1 and PGY2 residents in the performance of consultations in the emergency room and the hospital on the general neurology service, as well as on the vascular neurology and neurocritical care services. The PGY3 neurology resident provides supervision of these residents at earlier levels of training during the day when needed. The clinical management challenges encountered will serve to reinforce knowledge gained in previous years and solidify their skills necessary for successful clinical neurology practice. In addition, the PGY3 resident prepares with a faculty sponsor two Grand Rounds presentations. They provide clinical backup for the PGY1 and PGY2 residents on their respective rotations and supervise morning report.

Beginning with the PGY3 year, residents will assume overnight call in-hospital at Miami Valley Hospital covering general neurology, vascular neurology and neurocritical care patients. They will take call on average every eighth night. The residents will have supervision from the attending neurologists.

PGY4

During the PGY4 year, residents have an exceptional opportunity to increase their depth of understanding of the field of neurology and to lay the foundation for their future careers and professional development. As a resident matures professionally, the core competencies of patient care, medical knowledge, practice-based learning and improvement, professionalism, interpersonal and communication skills and systems-based practice come into sharper focus. During this year of training residents must demonstrate to their faculty that they are prepared to work independently. The resident assumes and demonstrates to faculty an increasing level of responsibility for patient care and teaching in the context of these core competencies that prepares the resident for independent practice at the end of the PGY4 year. The PGY4 rotation includes the supervision of residents and students at earlier levels of training on the general neurology and neurocritical care services where they supervise PGY 1 and 2 residents from neurology, internal medicine, and psychiatry. While on these rotations, the resident has an increasing level of responsibility for patient care and teaching as they attain supervisory roles for the trainees at earlier levels of training on these inpatient services. The PGY4 neurology resident provides supervision of these residents at earlier levels of training during the day when needed and during rounds. The clinical management challenges encountered will serve to reinforce knowledge gained in previous years and solidify their skills necessary for successful clinical neurology practice

During this period of training, residents will experience three months on the Miami Valley Hospital general neurology service, three months on the Miami Valley Hospital neurocritical care service, three months at the Dayton Veterans Affairs Medical Center, one month of subspecialty clinic, two months of electives, and one month of child neurology.

The Resident Continuity Clinic continues during PGY4. As training progresses the resident is allowed increasing autonomy in management of his or her patients but always with the input of faculty attending.

During the PGY4 year ,the neurology resident will assist in the noon conference series providing case-based teaching for PGY1, PGY 2 and PGY 3 neurology residents as well as for rotating residents from other services and medical students. The PGY4-level resident will contribute to morning report. PGY4 residents will prepare, with a faculty sponsor, two Grand Rounds presentations during the year. The resident will continue his or her involvement with research and will be a co-investigator with a faculty member in completion of one research project.