Curriculum

Neurology Residency Curriculum

The Houston Methodist neurology residency program is a four-year categorical program. The PGY1 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. PGY1 residents will also spend three months on neurology services during this year to allow exposure and orientation to neurology prior to the PGY2 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 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 (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 with the opportunity to gain additional supervisory and administrative skills. Duty hour requirements and restrictions are enforced at institution and departmental levels.

 

PGY1 (13 four-week rotations)

BLOCK
1 2 3 4 5 6
INSTITUTION 1 1 1 1 1 1
ROTATION Emergency
Department
Neurology
4(ND/NM)
Hematology 1UTS Infectious
Disease
MICU
% OUTPUT 100 0 20 0% 20 0

 

BLOCK 7 8 9 10 11 12 13
INSTITUTION 1 1 1 1 1 1 1
ROTATION Neurology
45(Stroke)
UTS 3Neurology
(ITS)
UTS Cardiology 2Elective Float
% OUTPUT 60 0 0 0 60 20 0

 

1UTS= University Inpatient Medicine teaching service (i.e., wards)
2Electives= Endocrinology, Rheumatology, Nephrology, or Geriatrics, Hepatology, Neurology, Palliative care medicine
3ITS=Neurology Inpatient Teaching Service
4ND/NM=Neurodegenerative/Neuromuscular Diseases
5Stroke

 

PGY2 (13 four-week rotations)

BLOCK
1 2 3 4 5 6
INSTITUTION 1 1 1 1 1 1
ROTATION 2ITS ITS ITS 1ND/NM ND/NM Stroke
% OUTPUT 0 0 20 60 60 0

 

BLOCK 7 8 9 10 11 12 13
INSTITUTION 1 1 1 1 1 1 1
ROTATION Stroke Stroke Epilepsy
3Dementia Movement  
D/O
NICU Psychiatry
% OUTPUT 0 0 80 90 90 0 0

 

PGY3 (13 four-week rotations)

BLOCK
1 2 3 4 5 6
INSTITUTION 1 1 1 43 1 1
ROTATION 2ITS ITS
1ND/NM Neuro
Oncology
Stroke Elective
% OUTPUT 0 0 60 0 0 50

 

BLOCK 7 8 9 10 11 12 13
INSTITUTION 1 2 2 1 1 1 43
ROTATION NICU Pedi
Neuro
Pedi
Neuro
3Elective Elective Elective Neuro
Oncology
% OUTPUT 60 0 0 0 60 20 0

 

PGY4 (13 four-week rotations)

BLOCK
1 2 3 4 5 6
INSTITUTION 1 1 1 1 1 1
ROTATION 1Inpat. Teach
Service
Inpat. Teach
Service
2ND/NM ND/NM Stroke Stroke
% OUTPUT 0 0 60 60 0 0

 

BLOCK 7 8 9 10 11 12 13
INSTITUTION 2 1 1 1 1 1 1
ROTATION Pedi Neuro Elective Elective Elective Elective Elective 3Outpatient Neurology
% OUTPUT 50 100 100 100 100 100 100

PGY1 Year

Houston Methodist’s PGY1 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, and Graduate Medical Education departments. The PGY1 must successfully complete all 12 months of training before beginning their PGY2 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, two blocks on the inpatient consult service and two blocks rotations on the Neuromuscular/Neurodegenerative service. Residents will also rotate on three separate outpatient settings in Movement Disorders, Dementia, and Epilepsy. The PGY2 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 PGY3 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 PGY3 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. 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.

The PGY4 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 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 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.

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  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 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.