Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Department of Neurology

Curriculum

The residency program is a four year categorical program. The PGY 1 year occurs at the Methodist Hospital and is made up 13 four week block rotations. The resident rotates in general inpatient and outpatient internal medicine and related specialty services, including an elective block rotations for rheumatology, geriatrics, endocrinology, and pulmonology. PGY1 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 PGY2 year has more months of inpatient rotations than the PGY3 or PGY4 resident. With each year of training, the resident has fewer general neurology rotations and has more specialty and elective rotations. This schedule assures that residents gain increased specialty training with one-on-one faculty teaching and are able to design a schedule of electives that broadens their educational experience or focuses on areas of evolving interest.

The inpatient teams at 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 for 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 to instruct the junior resident. Third, one senior (PGY4) 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

         

Month Rotations - PG-2

JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
Neurodegen/
Neurmuscular
60% outpatient
Neurodegen/
Neurmuscular
60% outpatient
Neurodegen/
Neurmuscular
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

Month Rotations - PG-3

JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
Neurodegen/
Neurmuscular
60% outpatient
Neurodegen/
Neurmuscular
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

Month 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/
Neurmuscular
60% outpatient
Neurodegen/
Neurmuscular
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 Hospital (Houston) PGY1 year consists of 13 four week blocks of  training, (13, four-week blocks) in conjunction with rules and regulations outlined by the 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, GME department. The PGY 1  must successfully complete all 12 months of training before beginning PGY2 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 which includes four months on the stroke/vascular neurology service and combination inpatient/outpatient rotations on general neurology, neuromuscular & ALS, pain/headache, and movement disorder services. The PGY2 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, 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 MD Anderson Cancer Center.

The PGY3 resident will also have one month required rotations in Neurointensive Care and Neurorehabilitation-Pain. During the neurorehabiliation rotation, residents will  gain two weeks  experience 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 outpt 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 PGY4 year of training, the resident will be required to complete two months of basic science or clinical research. The PGY3 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 PGY3 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 PGY4 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 sub-speciality 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 number of elective rotations already completed.

Electives

Electives are designed to provide a framework for fellowship training and clinical practice with exposure to sub-specialty areas in neurology. The training program provides ten months for elective training.

  • 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 4-6 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 implement 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 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 his 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 number of sub-specialties represented within the department, residents spend a year in one continuity clinic and then rotates 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 San Jose 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. 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 the evaluation and management of the adult neuromuscular and muscular dystrophy adult patient and provide ongoing care for patients with disease 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 in 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 to 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 2nd or 4th Friday morning of the month.