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Sample Rotation Schedule
PGY-2 (Year 1)
PGY-3 (Year 2)
PGY-4 (Year 3)
List of Conferences (All Years)
The VCU Department of Neurology operates on a 13-block rotation schedule, each block is four weeks in duration. .
Neurology Ward Blocks, 7 blocks
MCVH and/or VAMC
4 calls per block in-house at MCVH
9 calls per block from home at VAMC
Neurology residents evaluate patients on request in the emergency departments or they receive admissions from the neurology clinics. Patients with an extensive variety of neurological disorders are managed both on a neurology ward and in the neuroscience intensive care unit. Daily teaching rounds occur and many of the patients are followed after discharge in the resident’s outpatient continuity clinic.
Neurology Consult Blocks, 1 block
MCVH
2 calls per block in-house
Neurology residents are expected to demonstrate competence at obtaining the neurologic history using a variety of sources: the patient, the patient’s caregiver(s), the hospital chart, and other practioners involved in the patient’s care. The resident performs consults requested by other medical and surgical services. All patients are presented to and examined by an attending. As needed these patients may be followed later in the residents’ continuity clinic.
Junior Nightfloat, 2 blocks
MCVH
In-house call shifts, two-week assignments for a total of two full rotation blocks. Resident works two-sets of 4-5 consecutive day 12-hour (9:00 P.M. to 10:00 A.M.) shifts with guaranteed 10-hours out-of-hospital between shifts. PGY-3 or PGY-4 resident available in-house. Resident will discuss new patients and urgent medical issues with the Night Float Sr. Resident , who will assist him/her in formulating the case and developing a care plan.
Neurocritical Care, 1 block
MCVH
2 calls per block in-house
Resident will evaluate and manage, under direct faculty and senior neurosurgery resident supervision, all neurosurgery patients admitted to the neuroscience critical care unit. Participate in daily teaching rounds with the neurosurgery attending, Intensivist, chief resident, and other neurosurgery residents, obtain an orderly and detailed history from the patient and/or family members.
Core Neuroscience Elective (EEG), 1 block
EEG
MCVH and VAMC
Participate in Adult Seizure clinic at MCVH and VAMC. During clinics, residents review the history, examine the patient, and present each to the attending. The resident will review inpatient and outpatient, routine and prolonged, adult and pediatric EEGs and EPs and with guidance of faculty member interprets these studies.
Neuroradiology Elective, 1 block
MCVH
Gain additional experience interpreting imaging studies with a neuroradiologist and observing neuroradiologic procedures. Radiological procedures reviewed in this rotation include: computerized tomography of the head and spine, CT angiography, and spiral CT; magnetic resonance imaging and magnetic resonance angiography; conventional cerebral angiography; endovascular interventional procedures; myelography.
Neurology continuity clinic, 13 blocks
MCVH
Neurology resident exams 2-3 new and 1-2 follow-up patients a week. Presents all patients to attending.
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Child Neurology, 2 blocks
MCVH
7 calls per block from home
The service is comprised of a team which includes a child neurology attending, child neurology fellow, two pediatrics residents, and a neurology resident. As a member of the child neurology team, the resident assesses pediatric neurology patients in the emergency department or in consultation on the wards, and discusses them with the attending. He/she supervises and teaches pediatric interns or residents, and is involved with all neurology/neurosurgery patients in the PICU. All pediatric neurosurgery patients under age 13 are admitted to the pediatric neurology service and the neurology resident discusses management with the neurosurgery residents or attending daily. Also while on the child neurology service the resident attends two outpatient clinics per week.
Neuro-ophthalmology, 1 block
MCVH, VAMC, Stony Point
2 calls per block in-house
Clinical experience is focused on outpatient care supplemented by in-hospital consultations. Residents see patients under the direct supervision of neuro-ophthalmology faculty in the outpatient clinic at Ambulatory Care Center, MCV Physicians Stony Point offices, and at VAMC. Residents perform 15-20 new outpatient consultations each week, obtain history and perform examinations, then discuss with the attending on a one-on-one basis the symptoms, signs, pathophysiology, evaluation and treatment of the patient.
Senior Education Ward Resident, 1 block
MCVH
2 calls per block in-house
On admission, each new patient will be presented by the junior resident to the Ward Senior, who will assist the resident in localizing the lesion, developing the differential diagnosis, and assessment/plan. The junior resident will present the patient to the attending. The Ward Senior will document these items in a brief (one paragraph) note in the chart. Assist junior residents with lumbar punctures, obtaining diagnostic results, and other patient care issues. Handle transfers from outside hospitals and other services. Provide relevant articles from the current literature to the team.
Ambulatory Care Clinic, 1 block
MCVH
2 calls per block in-house
The purpose of this rotation is for the resident to gain experience in the dynamics of a busy outpatient practice, in terms of scheduling, message management, and documentation. Resident expected to participate in specialty clinics, including: headache, seizure, movement disorders, memory disorders, and neuromuscular.
Senior Nightfloat, 1.5 blocks
MCVH
In-house call shifts, two-week assignments for a total of one and a half full rotation blocks. Resident works two-sets of 4-5 consecutive day 12-hour (5:00 P.M. to 8:00 A.M.) shifts with guaranteed 10-hours out-of-hospital between shifts. Senior Resident will review new patients and urgent medical issues with the Night Float Jr. Resident , and will assist him/her in formulating the case and developing a care plan.
Research, 1 block
MCVH or VAMC
2 calls per block in-house
A basic science, clinical, or social research elective is required for each neurology resident. A faculty sponsor is to be selected by the resident during the PGY-2 year to work with during the PGY-3 year.
Neurology Consult, 4 blocks
MCVH and/or VAMC
2 calls per block in-house (MCVH)
6 calls per block from home (VAMC)
Elective, 1.5 blocks
2 calls per 1 block in-house
PGY-3 Neurology residents may select to complete any of the following elective rotations:
EEG
MCVH and VAMC
Neuro-ophthalmology
MCVH, VAMC, Stony Point
Neuroradiology
MCVH or VAMC
Neurocritical Care
MCVH
EMU
MCVH
The resident obtains complete histories containing all relevant details regarding a patient’s seizure disorder and presents all patients to an attending. They review with the EMU attending long-term video monitoring studies of adults and children who are admitted for evaluation of refractory epilepsy and possible epilepsy surgery. Seizure semiology is learned. Acute and chronic anticonvulsant management is extensive as are clinical correlations of neuroimaging studies including CT, MRI, SPECT, and PET.
EMG
MCVH and VAMC
Residents begin in an observational capacity on the EMG rotation and gradually become more hands-on as their level of knowledge and experience increases. Residents who meet the appropriate educational milestones may begin designing and performing their own EMG studies under supervision by about the end of their first month on the rotation. Throughout the rotation, residents will participate in neuromuscular clinic, becoming familiar with the clinical presentations, diagnostic evaluation, treatment options, and social issues associated with neuromuscular disease. Residents will learn peripheral nerve and nerve root innervations of the muscles commonly studied, u nderstand the principles of nerve conduction and synaptic transmission. Residents will learn to perform sensory and motor nerve conduction studies and the basics of needle EMG examination.
Movement Disorders
MCVH and VAMC
The resident will learn to recognize clinical situations (medication failure or side effects) in which deep brain stimulation is a good option. Understand the pros and cons of deep brain stimulation. The resident will f ormulate overall clinical plans to manage movement disorders in a variety of patients, learn appropriate work-up for patients presenting with new onset movement disorder. The resident will be expected to demonstrate competence in performing a detailed examination on the patient with Parkinson’s disease or other movement disorder.
Neurosurgery Outpatient Clinic
MCVH
The intent of this rotation is to provide the neurology resident with a better appreciation of neurosurgical cases. The resident may also spend time in the operating room thereby following a patient seen in clinic through the neurosurgical operation. The residents will participate in various neurosurgical clinics including brain tumor clinic, NPH clinic, spasticity clinic, vascular neurosurgery clinic, peripheral nerve clinic, as well as general neurosurgery clinics. The resident will also attend weekly tumor board clinic on Wednesday afternoon, as well as the Thursday morning lecture series.
Sleep
VCU Sleep Disorders Center or VAMC
Participate in polysomnogram reading sessions reviewing and interpreting with attending physicians. Participate in sleep disorders clinics.
Neurology continuity clinic, 13 blocks
MCVH
Neurology resident exams 2 new and 3 follow-up patients a week. Presents all patients to attending. Residents may overbook their own clinics as their efficiency and proficiency improves.
Consult Liaison Psychiatry, 1 block
MCVH
2 calls per block in-house
While rotating on the consultative liaison services under the direct supervision of the psychiatry attending, neurology residents collect, organize, interpret, summarize and communicate data from multiple sources regarding the patient’s psychiatric illness, premorbid adjustment, family history and psychosocial stressors. He/she evaluates all medical problems and assesses current status of the patient. He/she is expected to utilize medical/neurological and other consultations and laboratory data and integrate with clinical data. He/she must assess extent and severity of psychiatry disorder and evaluate clinical complications, such as disorganized behavior, assaultative, aggressiveness, suicidality, etc. Residents also assess complications of medical disorder, organic failure; hypertensive crisis, metabolic crisis, etc.
Child Neurology, 1 block
MCVH
7 calls per block from home
Senior Education Ward Resident, 1 block
MCVH
2 calls per block in-house
Senior Nightfloat, 1 block
MCVH
In-house call shifts, two-week assignments for a total of one full rotation block. Resident works two-sets of 4-5 consecutive day 12-hour (5:00 P.M. to 8:00 A.M.) shifts with guaranteed 10-hours out-of-hospital between shifts. Senior Resident will review new patients and urgent medical issues with the Night Float Jr. Resident , and will assist him/her in formulating the case and developing a care plan.
Ambulatory Care Clinic, 1 block
MCVH
2 calls per block in-house
Neurology Consults, 2 blocks
MCVH or VAMC
2 calls per block in-house (MCVH)
6 calls per block from home (VAMC)
Neuropathology, 1 block
MCVH
2 calls per block in-house
Resident removes brain, arranges photographs or gross specimen, blocks brain sections for histology, reviews slides. Prepares a clinical case summary, writes a description of gross and histological findings, and reviews diagnosis and report with attending neuropathologist. Works up at least 2 pediatric or adult brains a week and reviews 20-30 biopsy sections of brain, muscle, and peripheral nerve. An excellent in-house prepared neuropathology CD-ROM provides an additional structured learning opportunity including numerous pictures of gross specimens and photomicrographs.
Electives, 6 blocks
2 calls per block in-house
PGY-4 Neurology residents may select to complete any of the following elective rotations:
EEG
MCVH and VAMC
Neuro-ophthalmology
MCVH, VAMC, Stony Point
Neuropathology
MCVH
Neuroradiology
MCVH or VAMC
Neurocritical Care
MCVH
EMU
MCVH
EMG
MCVH and VAMC
Movement Disorders
MCVH and VAMC
Neurosurgery Outpatient Clinic
MCVH
Sleep
VCU Sleep Disorders Center or VAMC
Neurology continuity clinic, 13 blocks
MCVH
Neurology resident exams 1 new and 5 follow-up patients a week. Presents all patients to attending. Residents may overbook their own clinics as their efficiency and proficiency improves.
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Journal Club
There is a monthly general neurology journal club, the resident rotating on the Ambulatory Care Clinic rotation is responsible for selecting an article and faculty preceptor. Dr. Vota moderates this journal club.
There is also a monthly Stroke Journal lub moderated by Dr. Felton. During this time stroke guidelines, current literature, etc., is discussed.
Teaching Rounds
MCVH
Ward teaching rounds are held every morning, including weekends and holidays, overseen by the attending neurologist on service. Resident work up new admissions and present them on morning rounds. Patient care and management are discussed with the on-service attending physician.
There is a separate neurology consultation service and the attending rounds Monday through Friday with the team. The resident presents all consults with the attending who sees each new consult, and discusses the case with the team. On weekends, the ward attending also rounds on consult patients.
VAMC
Teaching rounds are held every morning, including weekends and holidays, overseen by the attending neurologist on service. The same team sees ward patients and consultations.
Conferences
Daily Conference
Daily noon conferences covering the following: neurophysiology, neuro-ophthalmology,
neuropathology, neuroradiology, child neurology, and combined child neurology and pediatrics.
Basic science, board reviews, morbidity and mortality conferences held on Fridays.
Residents are expected to attend weekly brain cutting conferences, neuro-oncology conferences, and epilepsy care conferences when on specific rotations as well.
Crash Course
Neurology basics course held each July through August.
Friday Morning Patient Conference
Weekly conference moderated by Dr. Vota. An interesting patient from the ward, consult, or clinic is invited to the conference room and a resident completes a history and physical examination. The patient leaves the room, and the residents and faculty discuss the case.
Ethics Conference
Quarterly conference moderated by Dr. Vota, reviewing ethics cases developed by the American Academy of Neruology.
Grand Rounds
Held every Thursday from September through June. Visiting and local neurologists give updates on latest developments in the field of neuroscience.
Chairs Rounds
Dr. Towne meets with the residents monthly to attain feedback from residents regarding the program. Also covers various topics such as costs of healthcare, insurance and billing, practice management, quality assurance, and medical ethics.
GME Core Lecture Series
VCU GME sponsored lectures which cover the following topics: medical ethics, quality assurance, healthcare organization, practice management, financing of healthcare, and management information systems.
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