Rotation Descriptions - MED - Neurology Department, University of Minnesota

The inpatient neurology team administers care to the neurology ward patients and provides consultative service to the hospital. The inpatient team consists of one neurology senior resident (G-3 or 4), 2 neurology junior residents (G-2), 3 medical students and often one or more medicine G-2 residents. The neurology residents at UMMC manage all aspects of patient care and perform all procedures, under faculty supervision, for all patients admitted to the neurology inpatient service. Neurology residents are given progressive responsibility for patient care in cooperation and close communication with attending neurologists.

Morning report: During this rotation an educational morning report conference is held on Monday, Wednesday, and Thursday (11:00 am to 12:00 pm) for the inpatient neurology service residents, which is directed by either Dr. Anderson or Dr. Moriarty. The format is similar to that of Parry rounds, with the directing attending teaching clinical method skills as the resident presents and reasons through a case.

Junior Resident: Junior residents divide their time between the stroke service and the general service, alternating every two weeks. They are mostly responsible for the care of neurology inpatients which include patients with vascular disease (e.g. ischemic stroke, minor hemorrhages, vascular malformations, intravascular procedure candidates), myasthenia gravis exacerbations, CIDP exacerbations, rapidly progressive dementias, and video EEG patients among others. Each junior resident on the team will take two overnight calls on two non-consecutive Saturdays during this rotation. A dedicated night float resident takes call six days of the week other than Saturday.

Senior Resident: Ward senior responsibilities include supervision of the junior residents and medical students on the inpatient service and teaching as well as patient care. The ward senior assigns admissions and consults, supervises sign-in and sign-out rounds, and arranges neuroradiology rounds.

Nightfloat Resident: There is a dedicated night-float resident at night who is responsible for new admissions, cross cover of inpatients, and new overnight consults. A vascular/neurointerventional fellow, and an attending for each of the teams are available 24 hours a day to provide supervision at all times.

Sunday covering resident: When the senior resident is not the covering person for the UMMC on Sundays, a covering resident from the Riverside Consult Service will be on service.

The general neurology consult service is headed by a neurology senior resident (G-3 or G-4) and staffed by a general neurologist, while the stroke/critical care team consists of a neurology G-2 resident, plus a vascular neurology fellow and a staff physician with special expertise in vascular neurology, neuro-critical care, and oftentimes interventional neurology. Medical students and rotating residents from other services, including a neurology G-1 resident, 2-3 transitional residents, and often neurosurgery or psychiatry G-1 residents divide their time between the general neurology consult service and the stroke/neuro-critical care service.

G-1 Neurology Resident: Time is spent between the two services in two week blocks. Residents act as juniors in both services and either carry their own stroke patients while on the stroke team or consult on other services while on the general team. They are under the supervision of more senior residents (G-2 under stroke service and G-3 or 4 under general service) while there is direct and daily interaction and feedback with attending staff.

G-2 Neurology Resident: Time is spent on the stroke service for two weeks, where the resident has more senior roles in supervising and organizing transitional year residents and medical students, and as a night float for two weeks, during which the resident is responsible for new admissions to the stroke service, cross-cover on stroke inpatients and new consults.

G-3 and G- 4 Neurology Residents: Ward senior responsibilities include supervision of the junior residents and medical students on the inpatient service and teaching as well as patient care. The ward senior assigns admission and consults, supervises sign-in and sign-out rounds, and arranges neuroradiology rounds.

The inpatient team consists of one neurology senior resident (G-3 or 4), one G-1 psychiatry resident, and 2-3 medical students. The inpatient team predominantly sees consultations on other services while neurology inpatients are predominantly admitted for VEEG evaluation. There is no night float system instituted at VAMC due to the lower inpatient responsibilities for the neurology service compared to other facilities, but there is home call in place. All residents on the team are responsible for home call and discuss each case, whether they end up going in the hospital or not, with the attending physician on duty.

G-2 residents spend 1 block rotating through a neuro-rehabilitation unit at North Memorial Hospital. This block offers residents the opportunity to acquire skills and knowledge in rehabilitation medicine as it pertains to the care of chronic neurology patients. The neurorehabilitation unit is staffed by a neurologist and a nurse practitioner. This rotation emphasizes a team approach to patient management through interaction with occupational therapy, physical therapy, speech therapy, and other support services. The neurology resident has the opportunity to learn the effect of rehabilitation on patients after a neurologic event (e.g. stroke, myasthenia exacerbation).

This rotation is designed to merge clinical epilepsy (Epilepsy Clinic and Epilepsy Monitoring Unit) with EEG reading. Residents admit monitoring patients, but then turn their care over to the University inpatient team, to allow for dedicated time for reading of EEGs. Daily EEG reading sessions are part of this rotation during which residents note their impressions on the computerized file and subsequently trained epileptologists go over residents’ impressions, allowing for interactive learning. Residents are also exposed to one half-day epilepsy clinic per week, while epilepsy rounds every Thursday enrich the experience.

Residents rotate through the busy subspecialty clinics across all three sites (HCMC, UMMC, VA), including Neuromuscular Diseases/MDA, ALS, Ataxia, Movement Disorders, Huntington Disease, Epilepsy, Multiple Sclerosis, Dementia, Stroke, Sleep Disorders and Neuro-ophthalmology. This rotation offers exposure to a wide range of neurological diseases. Each clinic is staffed by full-time faculty with subspecialty and research interests in the given area. There is some flexibility for residents to design their own program.

This is one of our most popular rotations, largely due to the superb teaching and excellent clinical material provided by Dr Brent Clark. Residents gain experience in the evaluation of gross and microscopic specimens, and participate in brain cutting at UMMC and HCMC. Approximately 90 specimens are reviewed monthly by our university neuropathologists, while there is a large slide database containing almost all neurological diseases (common and rare) to allow for in depth study of neurological pathology.

The busy Pediatric Neurology service at the new Amplatz Children’s Hospital oversees a variety of inpatient and outpatient activities. The pediatric service at UMMC supports 207 pediatric beds, 54 pediatric ICU beds, and 33 neonatal ICU beds. Approximately 212 inpatient consults are requested annually, and roughly 303 outpatients are seen in the general and subspecialty pediatric neurology clinics each year. Neurology residents are exposed to a broad spectrum of disease, with acute and chronic as well as routine and esoteric problems represented. The teaching is superb, with supervision provided by pediatric neurology faculty. Two of three Pediatric Neurology blocks are spent at Amplatz and one with the Minnesota Epilepsy Group. This third block, new in 2011-2012, includes subspecialty epilepsy care seen by a busy private practice group. There is no pediatric neurology night call.

During this rotation, G-3 and G-4 residents rotate through the active EEG, epilepsy monitoring unit, and EMG facilities at the VAMC. Residents develop skills in the interpretation of routine and video EEGs, and in the care of chronic epilepsy patients. The residents also gain experience in the performance and interpretation of EMG and nerve conduction studies, as well as in the care of neuromuscular patients. Supervision is provided by several full-time subspecialty faculty. Residents are able to go to the University for waveform conferences.

Fairview Riverside Hospital is part of the University hospital system, located on the west bank of the University campus, housing the Psychiatry, Family Medicine, Rehabilitation, Obstetrics services, and an Emergency Room. G-3 and 4 residents are assigned to this hospital during regular business hours, with responsibility for inpatient and ER consults. The rotation is highly rated, providing a working environment and high degree of autonomy that preview what working as a neurologist in private practice might offer. The consulting resident covers the inpatient service on two non-consecutive Sundays.

This rotation, introduced in 2010-11, includes an experience in the competency area known as systems-based practice. The Neurology group at Regions Hospital continues to design treatment algorithms and guidelines incorporating evidence-based medicine. Teaching at this hospital, a site also for medical students on Neurology clerkship, is very strong with an expanding neurology faculty and research activities ranging from epilepsy to dementia.

This rotation, introduced in 2010, includes an experience with critically ill patients with neurologic and neurosurgical conditions. Neurologic conditions to be encountered during this rotation include subarachnoid hemorrhage, malignant MCA infarctions, intracerebral hemorrhage, myasthenic crisis, and status epilepticus.

Elective schedules, including the choice and duration of particular electives, are arranged by each resident in accordance with their interests and career plans. A wide range of clinical electives is available, including neuroradiology, neuropathology, psychiatry, EEG, EMG, neuro-otology, neuro-ophthalmology, and sleep disorders. In addition, numerous opportunities are available for residents to participate in clinical or basic neurological research. Total elective time presently is five 4-week blocks.