Residency Program

Curriculum

First Year (PGY-2)

During the first year of neurology training, our residents learn to obtain complete and reliable histories, do a thorough and accurate neurological examination, and learn how to manage common neurological problems, including stroke, seizure disorders, headache, and disorders of similar prevalence. In addition, residents will learn how to respond to neurological emergencies, such as status epilepticus, acute stroke, respiratory compromise in neuromuscular disorders, acute encephalopathy, meningitis and encephalitis, spinal cord compression, raised intracranial pressure and space-occupying lesions.

The bulk of this training is as a junior resident on the Neurology services at Shands Hospital and the Malcom Randall Veterans Administration Medical Center. Residents take primary responsibility in the evaluation and management of patients on the Neurology service and share in covering the inpatient consultation service. They are under the supervision of a senior (PGY-3 or 4) neurology resident and the neurology attending physician. The team is complemented by residents rotating from Neurosurgery, Anesthesiology, Psychiatry, and Family Medicine. During a two month epilepsy/EEG rotation early in training, PGY-2 neurology residents learn how to read electroencephalograms and manage patients with epilepsy. In January of each PGY-2 year, residents participate in the Neuroscience course given to first year medical students. This is an ideal time to solidify knowledge of neuroanatomy and the basic neurosciences. Neuroimaging education is integral to all patient care activities and is complemented by bimonthly neuroradiology resident teaching conferences, as well as weekly Friday morning Neuroradiology-Neuropathology conferences. PGY-2 residents will also have their first of four Out-patient Clinic month rotations, during which they rotate in general and specialty neurology clinics at the UF and VA clinics. The specialty clinics include epilepsy, neuromuscular, movement disorders, gait and balance, and dementia/behavioral neurology. In the general neurology clinics, residents will encounter a wide variety of patients including prevalent disorders, such as headache, back pain, multiple sclerosis, and sleep disorders.

The first year schedule includes the following rotations:

By the end of the PGY-2 year, residents should have the ability to recognize and manage "new" clinical problems, understand neurological localization, develop core differential diagnosis, execute proper workup and evaluation, lead and teach rotating residents and medical students, and interact professionally with patients, staff, and colleagues. To advance to the next year of training, residents are expected to demonstrate an appropriate level of competency in each of the six core competencies of patient care, medical knowledge, practice-based learning, communication skills, professionalism, and systems-based practice, in addition to meeting all of the specified requirements for advancement.

Second Year (PGY-3)

Second and third year residents function as senior residents on the ward, responsible for managing the work flow of the service and supervising junior neurology residents and rotating residents and students. When not on the ward services, residents will rotate between required and elective rotations. The required rotations, which are usually taken in the second year, but may also be taken in the third year, include pediatric neurology (3 months), neuropathology (2 months), psychiatry (1 month), EMG (1-2 months), and outpatient neurology (3 months in addition to the 1 month in the first year). By the end of the PGY-3 year, residents should demonstrate mastery of a large set of skills in neurological subspecialty areas, demonstrate efficiency of clinical triage and decision-making, mastery of handling neurological emergencies, and continued professional interactions with patients, staff and colleagues. To advance to the next year of training, residents are expected to demonstrate an appropriate level of competency in each of the six core competencies and to meet all of the specified requirements for advancement.

The PGY-3 year schedule includes the following rotations:

Third Year (PGY-4)

In the third year of training, residents assume greater responsibility for the program, including planning the resident lecture series, journal club, and quality assurance. One resident is selected as the Administrative Chief Resident and serves on the Neurology Residency Oversight Committee. During the third year of residency, residents will complete remaining required rotations and will have the opportunity to take more elective rotations. A block of 3 to 5 months of elective can be scheduled for research or mini-fellowship. There are plans to expand the resident complement to four residents per year, which will allow for increased elective, research, and mini-fellowship opportunities. The expansion, which has ACGME approval, will occur as soon as funding is available.

The PGY-4 year schedule includes the following rotations:

By the end of the PGY-4 year, residents should demonstrate leadership skills to head a neurology consult team or ward team, and be fully prepared to practice the specialty of neurology independently.

Specific Rotations:

Continuity Clinic

All residents (PGY-2, 3 and 4) participate in a continuity clinic one half-day per week, which alternates at Shands and at the VA. First-year residents will pick up patients from the continuity clinic of a former third-year resident. All inpatients requiring outpatient follow-up are followed by the discharging resident in their own continuity clinic. Continuity clinics are supervised by attending neurologists.

EEG PGY-2 selective

Each PGY-2 resident, during the first six months of residency, will spend two months on the Epilepsy/EEG service. Residents will learn the techniques and interpretation of EEG. They will care for patients on the epilepsy monitoring unit and gain experience in video-EEG, in reviewing and interpreting 24-hour EEG monitoring of critically ill patients, and in learning the evaluation and management of patients with epilepsy in the outpatient and inpatient settings.

Psychiatry

The resident is assigned to the psychiatry ward at the Veterans Administration Hospital, participates in rounds and conferences, and attends the Memory Disorder Clinic.

Neuropathology

The resident works with two neuropathology faculty (Drs. Eskin and Yachnis) and neuropathology fellows in reviewing current pathological material (surgical and post-mortem) and attends neuropathological conferences and brain-cutting. In addition to learning basic neuropathology, this rotation provides residents with the opportunity to review and consolidate their knowledge of the pathogenesis of neurological diseases.

Outpatient Clinic Subspecialties Rotation

The resident submits a schedule one month in advance of each clinic rotation to select the clinics to be attended. These must include one half-day clinic from each of the following each week: general neurology, neuromuscular, epilepsy, movement disorders, and memory/Alzheimer's. At least two of these clinics will be at the VA. In addition, the resident will attend the weekly VA multidisciplinary Gait and Balance clinic. The resident is expected to research the most interesting patients and dictate well-referenced letters.

Pediatric Neurology

Three months are spent on the pediatric neurology service. During this time, residents will maintain their continuity clinics (1/2 day per week) and will continue to take night call on the adult service, but will be excused from all other obligations on the adult service to devote themselves to pediatric neurology. They will admit and follow patients on the child neurology service, attend pediatric neurology clinics (general pediatric neurology, epilepsy, developmental/behavioral), and attend pediatric neurology conferences. They will present a pediatric patient at Neurology Grand Rounds once a month.

Elective Rotations

EMG/Neuromuscular Disease: Residents on the EMG elective will learn how to perform nerve conduction and needle EMG studies. They will learn the indications for the neurophysiological investigation of neuromuscular disorder, and they will learn how to evaluate patients with neuromuscular problems. They will attend the clinical neurophysiology conferences. The objective is that every neurology resident has the ability to interpret EMG. Most residents elect at least one additional EMG month in their residency to become proficient in performing NCS/EMG by the time of graduation.

Epilepsy/EEG: Residents may elect to take an additional month or more of epilepsy/EEG.

Neuroradiology: When on the Neurology service, residents are expected to review all images obtained on their patients and review them with the service attending. All current imaging studies are available for review on an excellent web-based system. During the neuroradiology elective, residents will have access to extensive teaching files, attend neuroradiology conferences, and read studies with attending neuroradiologists.

Neuro-ophthalmology: Residents will attend neuro-opthalmology clinics and conferences with Dr. John Guy.

Movement Disorders: Residents will attend Movement Disorders clinics, conferences, and will have the opportunity to observe deep brain stimulation placement surgery. The clinics include new and return clinics, DBS stimulator clinics, and Botox clinics. Residents attend a yearly Botox-workshop set up for all UF Neurology residents and practice Botox-injections during the Botox-clinic.

Behavioral Neurology: Residents will attend behavioral neurology conferences and work with behavioral neurologist attendings and fellows on various research projects. They will be responsible for reading and discussing classical and current behavioral neurology literature. Interested residents may also participate in Alzheimer's Disease clinics.

Neurosurgery: Residents may rotate for one month on the Neurosurgery service, where they may participate in neurointensive care, neurosurgery outpatient clinics, neurosurgery consultations, and in-patient management. They may observe neurosurgical operative procedures.

Research: Residents who wish to have protected time to complete a research project may spend one month of elective time in research.

University of Florida Location: http://www.neurology.ufl.edu/residency/curriculum.shtml
Updated: Mar 11, 2008, © 2007 University of Florida