PGY1 (13 four-week rotations)

UTS= University Inpatient Medicine teaching service (i.e., wards)
Electives= Endocrinology, Rheumatology, Nephrology, or Geriatrics, Hepatology, Neurology, Palliative care medicine
NCS=Neurology Consult Service/Teaching Service
NMD= Neuromuscular Disorders
MICU=Medical ICU

PGY2 (13 four-week rotations)

PGY3 (13 four-week rotations)

PGY4 (13 four-week rotations)

PGY1 Year

Houston Methodist’s PGY 1 year consists of 13 four-week blocks of training, 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, and Graduate Medical Education departments. The PGY 1 residents 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.

PGY2 Year

The first year of residency training includes twelve months of required rotations that includes three block rotations on the Stroke/Vascular neurology service, three blocks on the inpatient consult service and two block rotations on the Neuromuscular/Neurodegenerative service. Residents will also rotate on three separate outpatient settings in Movement Disorders, Dementia, and Epilepsy. The PGY 2 resident will also rotate on the consult-liaison psychiatry service for one block 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 in the NICU for one block rotation. They will be supervised by Neurocritical Care Faculty and participate in twice daily team rounds and follow inpatients daily, write notes and work in inter-professional teams. 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 cardio conversion during cardiopulmonary resuscitation.

PGY3 Year

In the second year of training, the resident will have two four-week block rotations of pediatric neurology at the Children’s’ 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-pediatrics 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.

The PGY 3 resident will also have an additional block rotation in the NICU.

PGY 3 residents will rotate for two block rotations on Neuro-oncology at MD Anderson Cancer center. Each four-week block is divided into two weeks on the inpatient consult and admission service and two weeks in the outpatient ambulatory Primary Brain Tumor clinic.

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

PGY4 Year

The senior year of residency allows for more specialized training, clinical responsibility, and teaching. PGY 4 residents 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.

The PGY 4 resident will complete the third required block rotation in pediatric neurology at Hermann’s Children's’ Hospital. During the final year, the resident will have five months of elective training for additional subspecialty training and exposure. A six-month elective block for research is possible, pending approval by the program director, specific rotation directors and the number of elective rotations already completed.

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/EEGNeuropathology/ophthalmic pathology
• Neuroradiology
• Neuro-oncology
• Neuro-ophthalmology
• Pain management
• Neuromuscular medicine
• Sleep medicine
• Research
• Others (Residents can create a subspecialty experience that combines different clinics or experiences based on their interest and career goals. A statement of Goals and Objectives is required. Program director and specialty faculty approval is also required.)

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 patients a week and are expected to provide a 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.

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 (option in PGY 4 year only).

San José Clinic
Upper-level residents (PGY 4) will rotate weekly 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.

General Neurology Resident Continuity Clinic
PGY 4 resident who are not assigned to San Jose clinic will participate in this clinic weekly. Residents will evaluate general neurology patients referred from primary care providers, other specialists, or hospital discharges under the supervision of an attending physician. Residents will see new patients and established patients for a variety of conditions. Residents will also have the opportunity to perform common outpatient procedures under supervision, i.e., Botox injection, occipital nerve block, lumbar puncture and others. After evaluation, the patients will be followed longitudinally by the same resident, or to be referred to subspecialty clinics if needed. This clinic provides residents the experience of “real world neurology” outpatient practice, with the goal that the residents are prepared for independent practice after graduation. 
 
The Resident Muscular Dystrophy Association (MDA) Clinic
The MDA clinic occurs twice monthly on the second and fourth Fridays of the month and is supervised by Faculty in Neuromuscular Medicine. 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. 

Teaching conferences series are designed to cover the breadth of neurology, complement bedside teaching, and mature clinical practice. Residents will be required to attend morning report and noon conference daily and grand rounds weekly.

Lectures will be given by departmental faculty and faculty from other departments. Residents will also be required to give lectures, case presentations and journal club throughout the academic year. Junior faculty and residents will present up-to-date advances in neuroscience under the mentorship of selected faculty. PGY 4 residents will be required to give a grand rounds presentation during their senior year of training.

Morning Report is required and occurs at 8:00 a.m. on Wednesdays and Thursdays and will be attended by a faculty member. Residents will present new neurology cases for discussion and teaching.

Resident Lecture Series occurs on Monday-Thursday at noon and covers a large variety of topics relevant to basic sciences of neurology and clinical neurology that fulfill American Board of Psychiatry and Neurology requirements. These topics include neuroanatomy, pathology, genetics, pharmacology, and clinical subspecialties: neurology emergencies, cerebrovascular disease, headache and pain, movement disorders, epilepsy, neuromuscular disorders, neuroimmunology, trauma, neuro-oncology, and behavioral, cognitive neurology. Subspeciality case conferences include neuropathology case conferences, neuroradiology case conferences,  EEG/Epilepsy/IOM case conferences, EMG/NM case conference and sleep medicine case conferences. Residents will also present journal clubs and morbidity and mortality cases under supervision of faculty members. 

 
Professor's Rounds occur on Wednesday from 1:15 to 2:15 p.m. and provides an invaluable opportunity for residents and students to receive hands-on training in the evaluation and examination of the neurology patient. During these rounds, a patient volunteers to be interviewed and examined by a chosen resident. The resident, along with other attendees, must then discuss the site(s) of the lesion, differential diagnosis, evaluation, treatment, and relevant molecular biology. 

Neurology Grand Rounds occur at noon on Fridays at the Houston Methodist Hospital and Pediatric Grand Rounds occur at 8:00 a.m. every Fridays at The Children's Memorial Hermann Hospital. Residents are required to attend all HMH Grand Rounds and Pediatric Neurology Grand Rounds unless rotating on neuro-oncology at MDACC.  Each PGY 4 resident provides a Houston Methodist grand rounds presentation on their topic of choice. Each resident is expected to present a Pediatric Grand Rounds Case Presentation once before completion of three pediatric neurology block rotations.

 
Mandatory MDACC required didactics include Morning Report on Tuesday mornings and the MDACC Friday Lecture Series. Residents are only required to attend these didactics when rotating on Neuro-oncology. 

Resident Basic Science Lectures PGY 3 neurology residents are expected to present advances in neurology/neuroscience under the guidance of a mentor who specializes in the field of research and/or care. The lectures occur throughout the year on Fridays (noon) and are presented to the department and open to the other clinicians and scientists in the medical center.

These lectures provide a superb opportunity for the resident to delve into the pathophysiology of disease as well as understand the direction of current research and the advances in the care, diagnosis, and treatment of neurology diseases. It also provides an unparalleled experience in the critical analysis and critique of research studies and in communication skills, all under the mentorship of experts that are renowned in their field.