Stroke Service
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 4 Neuro IR physicians on staff in addition to other stroke faculty. 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 One of the more unique aspects of our services is the first hand acuity our residents get as the hospital does not have a neurocritical care consult service so our residents are the first call for neurocritical care emergencies in the hospital and continue to manage critical ill patients in the ICU even when on stroke or ward service!
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, and Western Psychiatric Institute and Clinic, The PGY2 resident will always be with a PGY3 or PGY4 resident, who serves as the senior resident on the service. 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 can 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. We have a wide variety of subspeciality attendings who are involved in resident education. The experience at the VA gives a more bread and butter experience mimicking community neurology.
Child Neurology
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. 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.
Night Float
All neurology residents spend one month each year on night float. A senior and junior neurology resident work together however covering different services giving the junior tremendous autonomy. 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. The residents are also in charge of overseeing all of the active patients on continuous EEG overnight to provide some of the best EEG training in the country!
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 2 weeks, is extremely popular with our residents, and intensively reviews functional neuroanatomy and the principles of neurological localization through the study of multiple cases. 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.
Neurocritical Care
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. Attention is directed to neuromuscular emergencies, such as myasthenia or acute demyelinating neuropathies as well as central nervous system conditions however depending on the interests of the resident, additional responsibilities and more directed learning experiences are available in critical care EEG, trauma, and many others. Our faculty is heavily involved in our residency program and love to teach in one of the top critical care programs in the country with many world renown faculty members!
Psychiatry
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.
Ward+
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. This is a unique opportunity for residents interested in honing in teaching skills to prepare for a career in academics.
Women’s Neurology
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.