About the Adult Neurology Residency Program

The UNC Adult Neurology Residency Program will transition to a 4-year (PGY-1 to PGY-4), categorical training program, beginning with the entering class of 2010. There will be four adult neurology residents per PGY year, for a total of 16 adult neurology residents in the Program beginning in July 2010.

The major neurology services staffed by residents include the adult neurology ward service, the adult inpatient and ER consult service, and outpatient clinics.  In addition, residents will rotate through subspecialty clinical labs/services within the neurophysiology suite (EEG/epilepsy and EMG/neuromuscular disorders). Residents will also rotate on child neurology, psychiatry, neurosurgery, and neuropathology. A night float system was instituted in July of 2009. Due to flexibility in the curriculum, residents will have the opportunity to schedule over 6 months of elective experiences during their training.

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Rotations

Inpatient rotations

Adult neurology ward service

The neurology ward service is generally comprised of a hospitalist neurology attending, one senior resident, 2 junior residents, 1-3 interns, and 3-4 third year medical students. The service is a “resident-driven” care system, and the senior resident is responsible for supervising the junior members of the team in the evaluation and management of neurology patients admitted to the service.  The attendings provide close supervision and resident/student education, with 3-4 hours of bedside teaching each day.  Because of the night float system, overnight in-house call is kept at a minimum. Short call from 5 - 8:30 PM is shared between junior residents and interns. Junior residents also take in-house weekend call twice a month. Senior residents take senior backup call an average of every fourth night from home.

Neurology inpatient and ER consult service

The consult service is generally comprised of a neurology attending, one senior resident, one junior resident, and 3-4 third year medical students. Residents are responsible for providing neurologic consultation for patient in the hospital and the emergency room (Monday through Friday from 8 AM - 5 PM and during weekend rounds). The senior resident is responsible for taking all consultation requests and supervising the junior members of the team.  Attendings work closely with the residents and provide supervision and teaching throughout the day.  Senior residents take senior backup call an average of every fourth night from home. There is no call requirement for the junior resident on this rotation.

Night float

Residents on the night float service are responsible for the care of neurology inpatients as well as for consultation requests from 8:30 PM to 8 AM Sunday to Thursday. They are supervised by an on-call senior resident and an on-call attending.  The night float resident is responsible for presenting new patients admitted to the neurology service to the ward team each morning at the end of the shift.

Child Neurology

Residents on the child neurology rotation see neurology patients in both inpatient and outpatient settings.  Inpatient opportunities include consultations from the ward teams and direct evaluation of patients admitted to the pediatric neurology service. There are inpatient ward rounds and teaching rounds daily. The outpatient activities include pediatric neurology clinics five days a week.  Residents on the neurology rotation participate in the clinics on most afternoons.

Clinic rotations:

General and subspecialty clinics

Residents rotate through the specialty clinics including the Neuromuscular Clinic, Headache Clinic, Epilepsy Clinic, Sleep Clinic, Movement Disorders Clinic, Multiple Sclerosis Clinic, Neurocognitive Clinic, Stroke Clinic, Pediatric Neurology clinics and Botox Clinic. In addition, the clinic resident is responsible for a twice weekly general neurology clinic (“138”) in which the resident will see new outpatient consultations and assume neurologic care, where indicated, under the direct supervision of the 138 attending.

Urgent triage clinic

Senior residents on the urgent triage service evaluate patients presenting to the general neurology clinic with acute or urgent neurologic problems. The resident will gain experience in the diagnosis and management of various acute neurological disorders under the direct supervision of the attending assigned to the triage service. 

EEG

This rotation is designed to teach the evaluation and management of patients with disorders of consciousness and the indications for clinical neurophysiological studies including EEG, long term monitoring and evoked potentials. Residents will work within the epilepsy team consisting of neurology attendings, fellows, physician assistants and medical students. Residents will attend the adult and pediatric epilepsy clinic and participate in the evaluation and management of patients with paroxysmal events. Residents should gain an understanding of basic management of these patients and integrated the diagnostic evaluation and care of these patients. The resident should gain a basic knowledge of interpretation of clinical neurophysiological studies and develop an understanding of the information these studies can provide as well as their limitations.

EMG

Residents on the Neuromuscular-EMG/NCV rotation see neuromuscular patients in both inpatient and outpatient settings. Their time is apportioned between inpatient and outpatient clinical opportunities and the EMG Section of the Clinical Neurophysiology Laboratory.  Inpatient opportunities include consultations from hospital wide ward teams and direct evaluation of patients admitted to the adult and child neurology services. The outpatient clinical activities include MDA (Muscular Dystrophy Association), peripheral neuropathy, Myasthenia Gravis and autonomic disorder clinics.  Residents on the rotation participate in the clinics on 2 to 3 half-day sessions per week.  Residents electing to spend 3 consecutive months on the rotation will spend a significant time (up to 6-half days per week) performing clinical EMG/NCV tests in the Clinical Neurophysiology Laboratory under the mentorship of a faculty attending.

Electives:

Electives routinely available to residents include:

• Stroke and Vascular Neurology
• Interventional Neuroradiology
• Neurosciences Critical Care Unit
• EMG/Neuromuscular Disorders
• Autonomic Disorders/Autonomic Testing Lab
• EEG/Epilepsy Monitoring Unit
• Sleep Medicine
• Movement Disorders/Deep Brain Stimulation
• Memory and Cognitive Disorders
• Multiple Sclerosis/Neuroimmunology
• Neuropathology
• Physical Medicine and Rehabilitation
• Palliative Care
• Headache/Pain
• Complementary and Alternative Medicine for Neurologic Disorders/Integrative Medicine
• Clinical Research/Trials
• Basic Research 

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Year-by-year schedules (subject to change)

PGY-1

Beginning in 2010, the adult neurology residency program will include a preliminary (intern) year. Rotations during this year include neurology (2 months), psychiatry (one month), emergency medicine (one month), and internal medicine (8 months). Rotations on internal medicine services have been selected to include rotations on subspecialties felt to be most helpful in caring for patients with neurologic diseases: general medicine wards, MICU, CCU, general cardiology, rheumatology, endocrine, infectious diseases, and oncology.

PGY-2 (13 x 4-week blocks)

5 blocks ward junior
2 blocks consult junior
1.5 blocks night float
1 block subspecialty clinic
1 block pediatric neurology
1 block EEG
1 block neurosurgery
0.5 block elective

PGY-3

1 block NSICU (Neurosciences ICU)
1 block consult junior
1 block ward senior
1 block night float
1 block subspecialty clinic
1 block pediatric neurology
1 block pathology
1 block triage
3 blocks EMG or 1 block EMG and 2 blocks elective
2 blocks elective

PGY-4

0.5 block night float
2 blocks ward senior
3 blocks consult senior
1 block pediatric neurology
1 block subspecialty clinic
2 blocks triage
1 block elective or 1 block psychiatry (if psychiatry requirement not fulfilled in previous years)
2.5 blocks elective

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Conferences

Department of Neurology Grand Rounds are held weekly in a state-of-the-art teleconference facility, allowing for recording and webcasts of all presentations.  There are several resident teaching conferences each week that address various topics in clinical neurology and in related basic sciences, which include neuroanatomy, neurochemistry, neurophysiology, neuropathology, and other selected topics in basic neurology.  Clinical conferences in neuropathology, neurophysiology, epilepsy, and child neurology are also held weekly.  Journal Club sessions, when residents review clinical topics in depth, are held monthly.  Resident participation is a major emphasis of all conferences.  The majority of the meetings and teaching conferences are held in a large clinical teaching center in the Clinical Neurophysiology Laboratory.  Other conferences are held in the Department's "small conference room," located within the departmental office suite, or in the "clinic" conference room adjacent to the Neurology Clinics.

 

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Benefits

General benefits (health, dental, life, and AD&D insurance) for residents are provided by the UNC Hospitals GME office. Optional benefits for residents, spouses, and dependents are also available through the GME office.

Additional benefits provided by the department of neurology include:

• The department pays  the registration fee for the ABPN certification exam for all residents who successfully complete the residency training program (beginning with the graduating class of 2010)
• Four weeks of paid vacation each year, one week of which includes either Christmas or New Year's Day
• Paid membership to the American Academy of Neurology
• Annual book and travel allowance for all residents. Senior residents (PGY-4) are provided with additional funds to pay for travel and registration to attend the annual AAN meeting. In addition, supplemental travel funds will be provided to any resident presenting original work at meetings or medical conferences.
• Annual resident retreat
• Meal allowance for each in-house overnight on-call period to be used in the many UNC Hospitals eateries