Curriculum

Neurology Residency Curriculum
The Houston Methodist neurology residency program is a four-year categorical program. The PGY-1 year is made up of 13 four-week block rotations. The resident rotates in general inpatient and outpatient internal medicine and related specialty services, including an elective block of rotations for rheumatology, geriatrics, endocrinology and pulmonology. PGY-1 residents will also spend two months on neurology services during this year to allow exposure and orientation to neurology prior to the PGY-2 year.

The neurology curriculum has been designed to assure professional maturation of residents. The PGY-2 year has more months of inpatient rotations than the PGY-3 or PGY-4 resident. With each year of training, the resident has fewer general neurology rotations and more specialty and elective rotations. This schedule assures that residents gain increased specialty training with one-on-one faculty teaching and that they are able to design a schedule of electives that broadens their educational experience or focuses on areas of evolving interest.

The inpatient teams at Houston Methodist include at least one junior and one senior neurology resident. This design provides the junior resident with supervision and, at the same time, offers the senior resident increased responsibility and opportunity for mentoring and teaching. The night-call schedule provides increased patient responsibility, as residents progress in their training. Senior residents provide back-up call for the junior night-call resident. Again, the junior resident has supervision, while the senior resident is able to supervise and instruct the junior resident. Third, one senior (PGY-4) resident will be elected to serve as administrative chief resident each year. The administrative chief resident will assist directly in program development and work as a liaison between staff and residents. This experience will provide the resident the opportunity to gain additional supervisory and administrative skills. Duty hour requirements and restrictions are enforced at institution and departmental levels.


Block Rotations - PG-1


BLOCK 1

BLOCK 2

BLOCK 3

BLOCK 4

BLOCK 5

BLOCK 6

ID 

INPATIENT

MICU

NEURO

INPATIENT

HEM

BLOCK 7

BLOCK 8

BLOCK 9

BLOCK 10

BLOCK 11

BLOCK 12

ENDO

HEPAT

NEPHR

CARDS

NEURO

INPATIENT

BLOCK 13

 

 

 

 

 

INPATIENT

 

 

 

 

 


Block Rotations - PG-2


JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

Neurodegen/
Neuromuscular
60% outpatient 

Neurodegen/
Neuromuscular
60% outpatient 

Neurodegen/
Neuromuscular
60% outpatient 

General 
Neurology/Stroke
100% inpatient

General
Neurology/Stroke
100% inpatient

General 
Neurology/Stroke
100% inpatient

JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE

General 
Neurology/Stroke
100% inpatient

Psychiatry-
Consult-Liaison
100% inpatient

Movement Disorder
90% outpatient 

Headache/Pain
Gen. Neurology 
80% outpatient

Epilepsy/Sleep
90% outpatient 

Neuro-surgery
100% inpatient


block Rotations - PG-3


JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

Neurodegen/
Neuromuscular
60% outpatient

Neurodegen/
Neuromuscular
60% outpatient

Headache/Pain
Gen. Neurology 
80% outpatient

Neuro-Intensive Care
100% inpatient

Pediatric 
Neurology
50% outpatient

Pediatric 
Neurology
50% outpatient

JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE

General
Neurology/Stroke 
100% outpatient

Neuro-rehab/Pain
50% outpatient

Elective

Elective

Elective

Elective


Block Rotations - PG-4


JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

General 
Neurology/Stroke
100% inpatient 

General 
Neurology/Stroke
100% inpatient 

Pediatric 
Neurology
50% inpatient 

General 
Neurology/Stroke
100% inpatient

Neurodegen/
Neuromuscular
60% outpatient

Neurodegen/
Neuromuscular
60% outpatient

JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE

Research

Research

Elective*

Elective

Elective

Elective

* Electives include:  EEG/Epilepsy, Neuropathology/Ophthalmic Pathology, Neuroradiology, Research Electives, EMG/NCV, Neuro-ophthalmology, Neuromuscular, Sleep, and Pain.


PGY-1 Year
Houston Methodist’s PGY-1 year consists of 13 four week blocks of training, (13 four-week blocks) in conjunction with rules and regulations outlined by the Accreditation Council for Graduate Medical Education (ACGME) and Neurology RRC. During this year, there is a coordinated curriculum with didactic lectures, journal club and morning report through the Internal Medicine, Transitional, Neurology and Graduate Medical Education departments. The PGY-1 must successfully complete all 12 months of training before beginning their PGY-2 year of training. Resident performance and eligibility for promotion will be evaluated by rotation faculty and, ultimately, the neurology program director.

PGY-2 Year
The first year of residency training includes twelve months of required rotations that includes four months on the stroke/vascular neurology service and combination inpatient/outpatient rotations on general neurology, neuromuscular and ALS, pain/headache, and movement disorder services. The PGY-2 resident will also rotate on the consult-liaison psychiatry service for one month and evaluate a variety of patients with primary and secondary psychiatric conditions, including major depressive disorders, disorders of psychosis, personality disorders, management of dementia and delirium, and disorders of anxiety and adjustment disorders. Residents will be expected to take a history and perform a physical examination of the psychiatric patient and assess the patient according to the DSM IV Axis category of disease. Residents will round with the attending physician on all teaching inpatient/consult cases.

The neurology residents will also rotate on neurosurgery for one month. They will be supervised by the residents and the neurosurgery attending for inpatient and consult services. The residents will also assist with surgery and evaluate neurosurgical cases, including brain tumors/malignancies, intracerebral hemorrhage, leptomeningeal biopsy, ventroperitoneal shunt placement and management, spine cases, and vascular malformations. The residents will follow inpatients daily, write notes and present cases to the attending during rounds. The assessment and management of all cases assigned to the teaching inpatient service will be supervised and finalized by the attending neurosurgical attending.

PGY-3 Year
In the second year of training, the resident will have two months of pediatric neurology at the Childrens’ Memorial Hermann Hospital, which is one-half mile from the Houston Methodist Hospital. The inpatient consult service team is made up of the attending physician, pediatric neurology or neurology residents, pediatric or medicine-pediatric resident, and students. The other two weeks a month, the neurology residents will rotate on the outpatient service at the Hermann Professional Building, Suite 1010, covering the breadth of pediatric neurology, including movement disorders, spasticity, epilepsy, headache, developmental delay disorders and metabolic disorders. Twice monthly, the resident will attend a half-day pediatric neuromuscular neurology clinic, a once monthly half-day clinic at the Shriner’s Hospital and a twice monthly pediatric neuro-oncology and neurofibromatosis clinic at the University of Texas M.D. Anderson Cancer Center.

The PGY-3 resident will also have one month of required rotations in neurointensive care and neurorehabilitation-pain. During the neurorehabiliation rotation, residents will gain two weeks of experience in managing inpatients with stroke, movement disorders, spinal cord disorders, brain trauma and neuromuscular disorders. The latter two weeks, the resident will see both inpatient and outpatient chronic pain patients and learn how to manage pain. During the neurointensive care rotation, residents will evaluate and manage a variety of neurocritical cases, including acute stroke and hemorrhage, encephalopathies, status epilepticus, respiratory failure, and spinal cord trauma and compression. Residents will be expected to assess circulation, airway management, cardiovascular support, electrolyte and fluid balance, and CNS functional assessment and monitoring. Residents will be taught and supervised in performing a number of procedures, including intubation and management of ventilation, arterial and central line placement, and emergent cardioconversion during cardiopulmonary resuscitation.

During this year and/or the PGY-4 year of training, the resident will be required to complete two months of basic science or clinical research. The PGY-3 resident will participate in new or ongoing clinical or basic science research projects under the supervision and guidance of physician-scientists within the department and approved researchers from within and outside the institution. Residents also have the option to extend their research training during their elective rotations.

The PGY-3 year has four months for elective rotations, including EMG/NCV, EEG/epilepsy, neurophthalmology, neuroradiology, neuropathology/ ophthalmic pathology, neuro-oncology and a research elective.

PGY-4 Year
The senior year of residency allows for more specialty training, clinical responsibility, and teaching. PGY4’s will often lead inpatient clinical teams under the supervision of an attending physician by distributing patients among team members, supervision of junior residents and medical students, administrative responsibilities and teaching.

During this year of training, the resident will be required to complete the two months of basic science or clinical research, if not done in the PGY-3 year. The PGY-4 resident will participate in new or ongoing clinical or basic science research projects under the supervision and guidance of physician-scientists within the department and approved researchers from within and outside the institution. Residents also have the option to extend their research training during their elective rotations.
The PGY-4 resident will also complete the third month of pediatric neurology at Hermann’s Childrens’ Hospital. During the final year, the resident will have four months of elective training for additional subspeciality training and exposure. A six-month elective block for EMG/NCV or research electives is possible, pending approval by the program director, specific rotation directors and the number of elective rotations already completed.

Electives
Electives are designed to provide a framework for fellowship training and clinical practice with exposure to subspecialty areas in neurology. The training program provides ten months for elective training in a number of areas:


  • EMG/NCV
  • Epilepsy/EEG
  • Neuropathology/ophthalmic pathology
  • Neuroradiology
  • Neuro-oncology
  • Neuro-ophthalmology
  • Pain
  • Neuromuscular
  • Sleep
  • Research
  • Other (Residents can create a subspecialty experience that combines different clinics or experiences based on their interest and career goals. Program director and specialty faculty approval is required.)


Continuity Clinics

Residents will gain experience in evaluating and managing the adult neurology outpatient over time and become knowledgeable in providing continuity of care for non-acute neurological disorders.

Residents will see an average of four to six patients a week and are expected to provide full assessment, evaluation and management of the ambulatory patient, including history and examination, review of medical records, review and interpretation of diagnostic tests and consultations, and implementing pharmacologic and non-pharmacologic therapy. The resident will review every new and follow up patient with the faculty assigned to the clinic. The faculty will provide supervision and guidance to the resident in the management of all patients evaluated in the clinic. The ratio of faculty to resident in the clinic is 1:1, with no more than two residents assigned to a one half-day longitudinal clinic.

There are two resident continuity clinics that trainees are required to attend during training: the Resident Continuity Clinic (including San Jose Clinic) and the Muscular Dystrophy Association Resident Clinic.

Resident Continuity Clinic
The resident continuity clinic is intended to provide training in the long-term management of the ambulatory adult neurology patient, similar to private practice neurology. Residents are assigned to a half-day clinic weekly in which new patients and follow-up patients will be scheduled for evaluation and treatment of various neurological conditions.

This longitudinal clinic is dynamic and flexible by allowing the resident to organize the clinic according to his/her clinical interests. Patients will be randomly scheduled to the residents’ clinic. However, residents will be able to place patients in their clinic, often as a follow-up from inpatient care. Due to the number of subspecialties represented within the department, residents spend a year in one continuity clinic and then rotate to another. This allows exposure and training in the longitudinal care of ambulatory patients with a variety of conditions under the guidance of faculty with expertise in the management and treatment of those conditions. One of these longitudinal clinics is located at the San José Clinic in downtown Houston.

San José Clinic
Upper-level residents will rotate weekly monthly at this clinic. The clinic serves underserved and indigent patients by providing general and specialty specific care by a staff of volunteer health care providers. Residents will see new patients and established patients for a variety of conditions, including epilepsy, headache, Parkinson’s disease, myasthenia, dementia, neuropathy and back pain.

Patients are referred from both pediatric and adult general medicine clinics. Houston Methodist faculty will be responsible for providing supervision and instruction to residents. However, the experience provides an opportunity for autonomy in a clinical setting with limited resources.

The Resident Muscular Dystrophy Association (MDA) Clinic
The resident will become knowledgeable and gain experience in evaluating and managing the adult neuromuscular and muscular dystrophy patient and providing ongoing care for patients with diseases of the peripheral nervous system, including motor neuron disorders, Duchenne/Becker’s dystrophies, Charcot-Marie-Toothe disease, acquired and congenital myasthenic syndromes, and ataxia syndromes.

Patients are referred to the resident clinic from departmental faculty, local private practitioners and self-referred patients screened through the MDA. The MDA faculty will be responsible for providing supervision and teaching the resident, including case teaching and formal lectures within the clinic setting. The faculty will evaluate every patient seen by the resident and provide instruction and guidance regarding evaluation and management of each case. The clinic occurs monthly either the second or fourth Friday morning of the month.