At least one year of training in an ACGME approved PGY-1 internship year is required before entering the Yale Neurology Residency Program. Two PGY-1 programs are available in the Department of Medicine at Yale. Although many residents do the PGY-1 year in a Yale program, training also may be done at any other ACGME approved institution/program.
Overview and Schedule
The first year of neurology training is designed to provide an intensive clinical experience in a structured teaching setting. The primary goal of the PGY-2 year is for the resident to achieve a high degree of competence in the clinical assessment, evaluation, and treatment of patients with neurological disease. Residents will also gain experience in the appropriate use and interpretation of neurodiagnostic tests.
Model PGY-2 Schedule
Yale General Junior: 1-2 blocks. Residents work with a team that includes an attending, residents and medical students. They take primary responsibility for the care of non-vascular/general neurology patients on the inpatient Ward. Supervision is by a PGY-4 resident and attending.
Yale Stroke Junior: 1-2 blocks. Residents work with a team that includes an attending, fellows, residents, APRNs/PAs, and medical students. They take primary responsibility for the care of vascular/stroke neurology patients on the inpatient Ward. Supervision is by a PGY-3 or PGY-4 resident, fellow and attending.
VA Junior: 2 blocks. Residents work with a team of attendings, residents and students, and care for neurology patients on the neurology service. Residents also participate in subspecialty clinics, such as epilepsy, stroke, movement disorders, multiple sclerosis, sleep medicine and neuromuscular. In addition, residents help provide consults on inpatients for other services and in the ER. Supervision is by a VA senior resident (PGY-3 or PGY-4) and attending.
Neuroscience ICU: 1 block. The ICU resident is charged with managing neurology patients admitted to the ICU. They work closely with the attending and fellow to devise and execute a plan of care. It is also expected that residents gain an understanding of neurosurgical ICU patients.
Emergency Neurology: 1 block. Residents are stationed in the Yale Department of Emergency Medicine. They function as neurological consultants on all neurologic cases presenting to the Yale Emergency Department. Supervision is by a PGY-4 resident and attending physician.
Neurophysiology: ½ - 1 block. Residents work with an epilepsy fellow and an attending to learn to read EEGs. They may also gain exposure to clinic patients and patients on the epilepsy monitoring unit. Residents will also work with the neuromuscular attending and fellows to become proficient in EMG/NCS.
Yale Second Consult: ½ - 1 block. Residents provide consultative services to all other departments within the hospital. Under supervision of the Yale Senior Consult Resident and an attending, they are responsible for seeing new consults acting as a liaison between the Neurology Department and other services for inpatient care.
Inpatient Night Float: ½-1 blocks. The night float resident covers the Yale inpatient neurology and neurology ICU 6 nights per week. Daytime activities such as weekly clinic are canceled. The rotation is divided into 2 week blocks. Supervision is by a PGY-3 or PGY-4 resident and attending physician.
Consult Night Float: 1/2 -1 blocks. The consult night float resident provides consultation services to the Yale Emergency Department and the Yale-New Haven Hospital inpatient service 6 nights per week. Daytime activities such as weekly clinic are canceled. The rotation is divided into 2 week blocks. Supervision is by a PGY-3 or PGY-4 resident and attending physician.
Subspecialty Clinics: ½ - 1 block. Residents see patients in a variety of ½-day subspecialty clinics. These clinics are selected based on educational value, and the selection is modified periodically based on feedback from the residents and attendings. The clinics currently are movement disorders, multiple sclerosis, stroke, neuro-ophthalmology, neuromuscular, neuro-infectious diseases, neuro-behavioral and neuro-oncology. Supervision is by attendings who are experts in these subspecialty areas, and teaching is one-on-one.
Continuity Clinics: Each resident attends a continuity clinic on average ½ day per week. Continuity clinics are held at Yale ½ day Monday (hospital discharge follow up for stroke patients), ½ day Tuesday (continuity and hospital discharge follow up for non-stroke patients), at the VAMC ½ day Wednesday and ½ day Friday. Each resident follows his/her own cohort of patients for 3 years, assuming all responsibility for outpatient care with supervision by an attending. In addition, the Yale Neurology Urgent Access Clinic (NUAC), ½ Day on Thursday, provides another avenue for follow up care for patients discharged from the inpatient ward and consult services or the Emergency Room. The VAMC ½ Day Consult Clinic on Tuesday morning provides new consultations, from which patients are then enrolled in the continuity clinic.
Jeopardy: 1 block. The jeopardy resident will serve as the primary back-up resident from Monday to Friday during the rotation unless otherwise listed on the schedule. Other responsibilities include Gaylord consults and cross-coverage for inpatient residents while they are in clinic. The rotation is divided into 2 week blocks.
Overview and Schedule
The second year of neurology training is directed toward focused training in key areas of neurology. Three months of pediatric neurology are required during all adult neurology residency programs, providing in-depth exposure to this population. A three month block of elective time allows residents to tailor their training with either specialized clinical or research rotations. Many residents divide time between neuropathology and neuroradiology, or pursue basic science or clinical research projects.
Model PGY-3 Schedule
Yale Stroke Inpatient Senior: ½ block. The stroke inpatient senior resident leads a team consisting of a junior neurology resident, APRNs/PAs and medical students who care for stroke patients on the neurology ward. Along with the stroke fellow they will fulfill an educational role, provide formal and informal teaching of topics related to stroke neurology. The stroke senior is supervised by the attending and by the fellow but plays an active role in management of patients.
VA Senior: ½ block. The VA senior is a PGY-3 or PGY-4 resident. Together with an attending physician, the senior resident supervises a team of junior residents and medical students who care for neurology patients on the wards and in the ICUs, and perform consults for other services in the hospital. Residents also attend an average of 3 clinics per week. The senior resident is responsible for distributing the work among team members on the neurology service, which usually includes PGY-3 and PGY-2 neurology residents, a psychiatry intern, a medicine resident and medical students.
Neuroscience ICU: ½ block. Same rotation as during PGY-2 year.
Pediatric Neurology: 1 block. Residents are supervised by Pediatric Neurology faculty, and provide consultations for patients on the Pediatrics ward, Newborn Special Care Unit, Pediatric ICU and Pediatric Emergency Room. Residents also attend ½ day clinics an average of 3 times per week
Emergency Neurology: ½ block. Same rotation as during the PGY-2 year.
Neurophysiology: ½ - 1 block. Same rotation as during the PGY-2 year.
VA Junior: 1 block. Same rotation as in the PGY-2 year.
Elective: 3 blocks. Residents are provided mentoring by the Program Director, Chairman, and other faculty members to select 3 months of electives in each of their last two years. Residents are encouraged to obtain intensive exposure to neuropathology, neuroradiology, neuroanatomy, neurophysiology, or other fields related to neurology. Many residents spend time pursuing a clinical or basic science research project in collaboration with a faculty member in Neurology or other departments at Yale University, and many of these projects culminate in presentations at national meetings and publication in peer-reviewed journals. In some cases, PGY-3 electives may be taken off-campus.
Yale Second Consult: 1 block. Same rotation as during the PGY-2 year.
Night Float (INF/CNF): 1-1.5 blocks. Same rotation as during the PGY-2 year.
Subspecialty Clinic Rotation: ½ - 1 block. Same rotation as during PGY-2 year.
Continuity Clinics: PGY-3 residents continue to attend continuity clinic an average of ½ day per week.
Jeopardy: ½ block. Same rotation as during PGY-2 year.
Overview and Schedule
The PGY-4 year of neurology residency training is one of advanced clinical responsibility and in-depth study in elective areas of interest. Each resident rotates through the Consult Service at Yale-New Haven Hospital. During this year, the resident also spends time directing the General and Stroke inpatient Neurology Services at Yale and the West Haven VA Medical Center as Senior Ward Resident. This provides a useful transition to clinical practice, fellowship, or academic neuroscience. Three blocks during the year are available for electives.
Residents, at all levels, play an important role in the neurology teaching program. During the PGY-4 year, the senior residents assume a major responsibility for teaching within the residency program, and for the supervision of medical students rotating on the neurology service. PGY-2 and PGY-3 residents also actively participate in medical student teaching.
Model PGY-4 Schedule
Yale General Inpatient Senior: 3 half-blocks. The general inpatient senior resident leads a team of junior residents and medical students who care for non-vascular/general neurology patients on the neurology ward. This leadership position is closely supervised by an attending physician, but the senior resident plays an active role in management of patients. The senior resident also supervises the ED resident and nightfloat residents.
Yale Stroke Inpatient Senior: ½ block. Same rotation as during PGY-3 year.
Yale Consult Senior: 3 half-blocks. Residents provide consultative services to all other departments within the hospital except Pediatrics. These include Internal Medicine, General Surgery, OB/GYN, Neurosurgery, etc. Together with the Consult Attending, this resident acts as the main liaison between the Neurology Department and other services in the hospital for inpatient care. The Consult Senior also supervises the Second Consult resident and medical students on the consultation service.
VA Senior: 1 block. Same rotation as during PGY-3 year.
Elective: 3 blocks. Electives during the PGY-4 year are the same as those during the PGY-3 year, except PGY-4 residents on elective do not take call.
Pediatric Neurology: 2 blocks. Same rotation as during the PGY-3 year.
Psychiatry: 1 block. Residents work with the Yale inpatient Psychiatry Consult Service providing psychiatric consultative services to the rest of the hospital. A pilot program is being developed to give some residents exposure to acute inpatient psychiatry in place of psychiatry consults.
PGY-4 (Senior) Subspecialty Clinic: 1 block. Residents will rotate through subspecialty clinics and neuropathology lab in order to refine their neurologic skills and prepare for the board examination. Clinics will include movement disorders (DBS, Botox), neuropathology, pediatric neuromuscular clinic, Lumbar puncture clinic, neuro-infectious diseases, and continuity clinics.
Continuity Clinics: PGY-4 residents continue to attend their continuity clinics an average of ½ day per week.
Gaylord: ½ block. PGY-4 residents will rotate for 2 weeks through Gaylord to learn principles in rehabilitation medicine as related to Neurologic patients they often encounter in the acute inpatient setting.