Structure of Rotations
Design of the Program
The principal goal of residency training is provide an opportunity to learn clinical judgment. Residents have an opportunity to care for a large number of patients who are suffering from a very broad range of neurological disorders, and are expected to take responsibility for clinical assessment and decisions. Special emphasis is placed on the ethics of personal responsibility for patient care.
During the first (PGY2) year of residency training, the principal rotations involve primary patient responsibility on the four inpatient services. During the second year (PGY3) there is substantial elective time, so that residents can choose educational experiences of particular importance for their individual goals. In the final year (PGY4), senior residents supervise consultation and inpatient care at the four hospitals, and participate in the care of pediatric inpatients.
The First Year
The first year of our program (PGY-2) is designed to teach the fundamentals of caring for neurology patients. During this year, residents rotate through the three adult neurology hospitals, usually in two-month blocks of time. First year residents evaluate clinic, consult, and emergency room patients, take in-house call, and take primary responsibility for the care of patients they admit. First year residents also follow their patients into our Neurological Intensive Care Units at The Methodist Hospital and the Ben Taub Hospital to expand their experiences in caring for critically ill neurologic patients. During their Methodist Hospital experience, residents spend a month on each of several specialty services including the stroke service, the critical care neurology service, the neuromuscular service, the neurogenerative disorder service and the MS service. The broad diversity of patient populations seen by our Program exposes first year residents to ALL neurologic disorders.
Rotating through each hospital provides a broad exposure to all aspects of neurology: acute emergency neurology, common diseases, and tertiary referral neurology. There are over 3,500 neurology admissions per year to our hospitals, representing a diverse and unique clinical experience. There are also innumerable consults and outpatients seen making ours one of the busiest neurology residency program in the country.
One month in the first year is spent on the service of the Chief of Neurosurgery in order to learn about many disorders that are seen by the practicing neurologist, including neck injury, head trauma, and the management of increased intracranial pressure. It also affords the opportunity to observe the living anatomy during surgeries for herniated disks, aneurysms, tumors, and so forth.
First year residents also attend a myriad of didactic daily Conferences and Outpatient Clinics, as detailed subsequently.
The Second and Third Years
Rotations
During each of the second and third years, residents rotate for two months through each of the three adult neurology services (TMH, VA, and Ben Taub). They supervise and assist first-year house officers on the wards, in seeing consults, and in the outpatient clinics. While on the wards, upper-level residents round with the junior residents, provide clinical support, and teach the lower-level residents and students.
Senior residents often evaluate patients in the emergency room during the day to determine whether they should be admitted to our Neurology Service or another service, or whether they should be discharged home to be followed-up in clinic. In addition to managing the inpatient services, residents also administer a consultation service at the VA hospital.
Through being in charge of all patients at each hospital, the upper-level residents see many patients and sharpen their diagnostic and therapeutic skills.
Call
There is no required in-house call. Senior residents, however, are supervisors responsible for the care of the patients on their service, and therefore do take backup call from home on a regular basis. At times, especially at the beginning of the year, upper-level residents come into the hospital to personally evaluate each admission as is necessary for optimum patient care.
Child Neurology
The second year curriculum includes a three-month Child Neurology experience. This is a wonderful opportunity to see disorders presenting in the younger age group. The Child Neurology rotation includes two months on an inpatient consultation service and one month in an outpatient clinic.
The inpatient service is at Texas Children's hospital, which is acknowledged to be one of the finest Children's hospitals in the country. This facility serves the children of Houston as well as being a referral hospital for the entire Southwest and many international patients. It is located immediately adjacent to The Methodist Hospital in the Texas Medical Center. The Child Neurology Department is one of the largest in the country, and provides excellent inpatient and outpatient teaching.
Residents see patients as part of a consult team consisting of a child neurology fellow, an adult neurology resident, general pediatric residents, and medical students. The team rounds daily on all the service's patients. Adult neurology residents learn about the work-up of developmental delay, developmental regression, epilepsy, neuromuscular disease, altered mental status in the child, and a host of other disorders including the neurologic complications of medical and surgical conditions.
The outpatient Child Neurology experience is one month long. It takes place in a clinic in the Neurosensory Center. Residents see children with a diverse group of illnesses.
Adult neurology residents also see children in the resident run Muscular Dystrophy Association clinic discussed below.
Electives
There are three months of electives in the second year and six months in the third year for a total of nine months. We have maintained a policy of keeping this time "sacred" so that electives can be used as desired. There are no required rotations. Our program is flexible so that residents may emphasize the aspects of neurology that are of interest to them or that are important for their future careers. Residents who wish to pursue an academic career, for example, often use six or even nine months for research time.
Many residents elect to spend time on the traditional services of electroencephalography (EEG), evoked potentials, neuroradiology, and neuropathology. Two to Six month rotations are available in the electromyography and nerve conduction laboratory as an elective. Residents may also choose to study neuro-ophthalmology, neurosurgery, psychiatry, epilepsy, aphasia, neurobehavior and dementia, movement disorders, pain, or neuro-oncology. Indeed, all of the resources of the Texas Medical Center are available to residents.
In addition to their supervisory roles, child neurology experiences, and electives, second and third year residents also attend daily didactic conferences and several additional outpatient clinics outlined below.