The overall structure of our program is designed to develop, nurture and monitor the development of the residents from juniors in need of additional supervision, to graduating chiefs capable of practicing independently. As such, the levels of responsibility across training years are clearly delineated and progressive. The increase in skills and level of responsibility is reflected in the on-call system of our program. During the first 3 months of the year, junior residents take buddy-call with senior or chief residents.
In addition to inpatient responsibilities, all residents have a continuity clinic at either Jacobi Medical Center (JMC) or the Moses Division for all three years of the residency program.
Junior (PG-2) year:
As juniors (PG-2), the neurology residents experience all of the inpatient services, with some lesser exposure to consultative services. While attendings continue to supervise each patient's care and write daily progress notes, the expectation of some early independence develops during the course of the PGY2 neurology resident year. Specific patient management issues become the major focus of junior resident interactions with both neurology attendings and senior (PG-3) and chief (PG-4) residents. As their own skills develop, junior neurology residents also begin to supervise medical students and other trainees to a limited degree. Juniors are expected to become certified in lumbar puncture and the NIH stroke scale by the conclusion of the year.
The PG-2 year breaks down as follows:
2 blocks consult Neurology at Jacobi
2-3 blocks inpatient Neurology at Weiler Division (Einstein)
1 block inpatient Neurology at Moses Division
1-2 block inpatient Stroke Service at Moses
1-2 blocks inpatient Epilepsy Service at Moses
1 block consult Neurology at Weiler
½ block Stroke Service at Jacobi
½ block consult Neurology at Moses
1.5 blocks Night Float (split between Moses and Weiler)
1 block vacation
Senior (PG-3) year:
The level of resident independence escalates significantly with the transition to the senior (PG-3) year. This year is largely a consultative year, with senior residents taking primary responsibility for both the MMC-Moses and MMC-Weiler consult services. Senior residents develop team-building skills by running the neurology consultant team and organizing simultaneous delivery of patient care and teaching. The senior residents develop their teaching skills by presenting patients and didactic topics in a variety of settings, particularly to junior residents and medical students. Seniors participate in buddy-call, during which time they supervise junior residents in the acute evaluation and care of patients with emergent neurological issues.
Seniors are also expected to begin certification for brain death examinations during this training period.
The PG-3 year breaks down as follows:
1 block consult Neurology at Moses
2-3 blocks consult Neurology at Jacobi
2 blocks consult Neurology at Weiler
2-3 blocks elective time
2 blocks Pediatric Neurology
½ block Neuroradiology selective at Jacobi
1.5 blocks night float (split between Weiler and Moses)
1 block vacation
Chief (PG-4) year:
By the beginning of the PGY4 year, chief neurology residents are functioning as soon-to-be experts, in this largely supervisory year. The Chief resident year consists of time spent as chief of the MMC-Moses Neurology and Stroke service, the JMC Consult Neurology service, the Weiler Neurology service and the MMC-Moses clinic. Chiefs provide peer mentoring on the inpatient ward services to junior residents, particularly early in the year. Chief neurology residents are first in line to take calls from junior neurology residents regarding real-time discussions of patients during night call. All PGY4 neurology residents, but particularly the administrative chief residents, play an increasing role in organizing resident education by participating regularly on the Post Graduate Education Committee, institutional committees, and in the planning of the lecture series, as well as grand rounds schedule and visiting neurology professorship rounds.
The PG-4 Year breaks down as follows:
1-2 blocks Moses Chief (split between Neurology and Stroke Service)
1-2 blocks Jacobi Chief
1-2 blocks Clinic Chief
1-2 blocks Weiler Chief
1 block Pediatric Neurology
1 block Psychiatry
5 blocks Elective
1 block vacation