The PGY2 neurology resident spends two months on the Stroke Service at Presbyterian University Hospital. The Stroke Service is comprised of three neurology residents (2 juniors and 1 senior) as well as our stroke trained physician assistant, a stroke fellow and stroke attending. The Stroke Service is a very busy clinical service supported strongly by the community, and conventional referrals throughout Western Pennsylvania, Southern New York, Eastern Ohio and Northern West Virginia, as well as increasing numbers of telemedicine referrals from those regions. We continue to be one of the busiest Neuro-interventional centers in the nation and have three Interventional Vascular physicians on staff in addition to other stroke faculty. A typical day on the Stroke Service starts with morning Attending rounds at which time images are reviewed with faculty and discussions of patient care center around evidence-based medicine are conducted. Equal emphasis is given to acute care issues and secondary stroke prevention. The neurology residents work with the Vascular Neurology Fellows in managing new patients as well as emergency room consults and transfers as they come in throughout the day. The resident is given the opportunity to manage many patients who require TNK, intra-arterial thrombolysis, intra-arterial clot retrieval, and stenting of carotid or vertebrobasilar arteries, as well as intracranial hemorrhages. PGY-3 and PGY-4 neurology residents serve as senior residents on the service for 1 month each year. Many patients are evaluated remotely via telemedicine before transfer to the UPMC stroke service. Residents are introduced to this important educational opportunity depending on their individual level of interest.
Neurology Consultation Service
All neurology residents will spend one month per year on the Neurology Consultation Service at Presbyterian Hospital. This includes consultations from Presbyterian Hospital, Montefiore Hospital, Western Psychiatric Institute and Clinic, and Magee Women’s Hospital. The PGY2 resident will always be with a PGY3 or PGY4 resident, who serves as the senior resident on the service. Typically, medical students, as well as Psychiatry and Internal Medicine residents will be on the service as well. All consultations are seen initially by a resident or medical student and then presented to the attending physician. All imaging is reviewed and case discussion centers on the literature and evidence-based medicine. Emergency room consultations are also seen by the consult team during the day. The resident encounters an exceptionally wide variety of cases on this service, many of which demand acute management, including patients from medical and surgical intensive care units, the neurosurgery and trauma services, surgical subspecialty services, transplantation services and the transplant ICU, as well as internal medicine and medical subspecialty services.
Neurology Ward Service
All neurology residents spend one month per year on the neurology ward service at Presbyterian Hospital. The service includes all patients other than stroke admitted to neurology. The PGY2 residents will be with a PGY3 or PGY4 resident during their rotation. Attending rounds are made daily, with a strong emphasis on bedside teaching and evidence-based medicine. Historical and physical findings, localization, differential diagnosis, and management are discussed thoroughly, and imaging is reviewed daily. The PGY2 resident is given progressive responsibility for medical decision making as he/she progresses through the year. The service offers exposure to acute and chronic neurological problems, including complex diagnostic issues. A wide variety of patients with MS, epilepsy, headache, nervous system infections, spinal cord disease, movement disorders, and neuromuscular disorders, are encountered. The residents are able to follow most patients after discharge in resident continuity clinic or subspecialty clinic.
Oakland VA Hospital
All neurology residents also rotate one month per year at the Oakland VA Hospital. This is a very large VA facility serving the needs of Western Pennsylvania, Northern West Virginia as well as some sites in Eastern Ohio. Mornings are spent in the general and subspecialty outpatient clinics. Attending rounds are then conducted in the afternoon seeing general and stroke neurology consults. There is no primary neurology service at the VA. On Thursday mornings, a lumbar puncture clinic is held. As on other services the PGY2 resident is always with a PGY3 or PGY4.
All neurology resident spend one month each year rotating at the Children’s Hospital of Pittsburgh which is a top 10 nationally ranked children’s hospital and again services a very large area encompassing Western Pennsylvania, Northern West Virginia and Eastern Ohio. PGY 2 and PGY 3 residents rotate on the inpatient neurology consult service, where they evaluate a large variety of cases under the supervision of child neurology fellows and attendings. Attending rounds are made daily on all patients. Pediatric EEG interpretation, including stat EEGs, is incorporated into this rotation. The PGY 4 residents spend 1 month each year rotating through the outpatient clinic working directly with a child neurology attending seeing new patients through the rapid access clinic. On this rotation, residents will occasionally see consultations in the emergency room as well. Weekly case conferences and neuroimaging rounds are choice components of this experience. Residents are given progressive responsibility for case management as they proceed through the program. The adult neurology resident on the child neurology rotation can view the daily adult didactic conferences via teleconferencing.
All neurology residents spend one month each year on night float. The night float rotation covers 6 nights of the week, with Saturday night being covered by an off-service resident. A senior and junior neurology resident work together. Duty hours begin at 6 pm and end at 7 am, from Sunday night through Friday night. When the resident departs on Saturday morning, he or she does not return until Sunday at 6 pm. Each rotation is for two weeks. The junior resident covers calls from the neurology inpatient and stroke services and sees new general neurology consults. The senior resident sees new stroke consults as well as new consults from the Oakland VA Hospital. Attendings and fellows are always available overnight to staff any new patients or answer questions if need be.
Intensive Introduction to Clinical Neurology (Boot Camp)
PGY-2 neurology residents begin their training in July in the classroom with this unique activity. This course, lasting three to four weeks, is extremely popular with our residents, and intensively reviews functional neuroanatomy and the principles of neurological localization through the study of multiple cases. The neurological examination is taught as an exercise in functional neuroanatomy. Many introductory lectures on neuroimaging and EEG interpretation are included. The sessions begin daily with lectures on common topics in neurology by the faculty; early-afternoon lectures are given by senior neurology residents covering neurological emergencies. The course prepares new residents for clinical services and is received enthusiastically. Residents generally take one night call shift during boot camp paired with a senior neruology resident in order to familiarize themselves with what to an expect on a night call shift.
Senior neurology residents are required to take a one month block in neurocritical care, though this rotation is also available to junior neurology residents or neurology prelims if there is interest. The team is spearheaded by members of the neurology department who are neurocritical care specialists. Teaching and care rounds are made daily and the residents are able to participate in adult neurology didactics and grand rounds. Emphasis is placed on management of intracranial pressure, blood pressure, and cerebral perfusion. Opportunities for multiple procedures are abundant. A reading list of seminal papers is supplied. This rotation is Monday through Friday with no dedicated night call. Attention is directed to neuromuscular emergencies, such as myasthenia or acute demyelinating neuropathies as well as central nervous system conditions.
This is a required one-month rotation generally taken in the PGY-4 year. The resident rotates at the Western Psychiatric Institute and Clinic (WPIC). Goals are proficiency in basic psychiatric diagnosis, recognition of psychiatric emergencies, and comprehensive knowledge of drugs employed to manage psychiatric disorders, and the side effects of these agents. Emphasis is also placed on addiction and recognition and management of withdrawal syndromes. Basic management of depressive disorders and acute management of delirium are also stressed. Sections from the Handbook of Clinical Psychiatry are required reading.
This is a rotation completed during the PGY-3 and 4 years as well as in the second half of the PGY-2 year. The ward+ resident joins the junior and senior on the neurology ward service, though with the primary objective of teaching medical students and acting interns during their time on the ward service. The ward+ resident will generally observe medical students and acting interns take the H&P as well as given their presentations on rounds in order to give feedback on areas of improvement. The ward+ resident will also generally give short lectures to the medical students during their time on the rotation. The ward+ resident will generally only carry a couple of patients during the week, as the main focus of this rotation is teaching rather than clinical. The ward+ resident has one and a half days off during the week as they also assist the resident covering the ward service on the weekend. The ward+ resident is only required to stay until 2PM on weekend days, though they do have the option to stay on and moonlight if they so choose.
This is a required two week rotation taken at any point during residency wherein the neurology resident rotates at nearby Magee Women’s Hospital. On this rotation, residents have the opportunity to work closely with Dr. Waters, who is a specialist in Women’s Neurology, seeing outpatient, inpatient and emergency room consults pertaining to women during pregnancy or the peripartum period.