Neurology residents at Yale obtain exposure to a broad range of neurological diseases. The Department of Neurology maintains active services at two major teaching hospitals, an in-patient rehabilitation center, and three outpatient clinic sites. Residents also have the option of rotating at several international sites, including England, Prague, and Puerto Rico.
Yale-New Haven Hospital
Yale-New Haven Hospital (YNHH) has been the primary teaching hospital for the Yale University School of Medicine since 1826, when the hospital was incorporated. YNHH is a 900-bed facility with a staff of 4,500. There are 700 residents and fellows, and approximately 1,500 senior physicians affiliated with Yale-New Haven Hospital as attendings, ambulatory, clinical or non-resident M.D.’s.
YNHH contains separate Intensive Care Units for newborn, pediatric, surgical, cardio-thoracic, medical, cardiac, neurosurgical and neurological patients. YNHH also functions as a community hospital for the city of New Haven. Approximately 42% of the patients discharged reside in New Haven, and the majority of New Haven residents who are hospitalized receive their ongoing care at Yale-New Haven Hospital. The Department of Emergency Services, one of New England's busiest, cares for over 80,000 people a year.
The Yale Primary Care Center, opened in 1976, serves an inner city population and provides continuing care health education to more than 30,000 patients each year. YNHH also serves as a secondary treatment center, assisting area physicians with specialty consultations, diagnostic testing, and therapeutic procedures. Each year there are 190,000 outpatient visits in 142 outpatient clinics, over 2.5 million tests conducted in the Department of Laboratory Medicine and over 200,000 examinations in Diagnostic Imaging.
As a tertiary care center, Yale-New Haven Hospital carries out complex procedures and highly specialized consultations. Over 55% of hospital discharges are from outside the city of New Haven. For example, the Department of Radiology has established a nationally recognized program in Interventional Neuroradiology. The Hospital has one of the few programs in its region to treat spinal cord injuries. The Stroke Service receives referrals from throughout New England and is involved with clinical trials of new types of stroke treatments, as well as testing the efficacy of new imaging modalities in cerebrovascular disease. The Epilepsy Unit provides care for patients referred from throughout the world.
In October 2009, the Smilow Cancer Center opened to become the most comprehensive cancer care facility between Boston and New York City, offering patients state-of-the-art care and treatment. It includes 112 inpatient beds, outpatient treatment rooms, expanded operating rooms, infusion suites, diagnostic imaging services, therapeutic radiology, a specialized Women's Cancer Center and the Yale-New Haven Breast Center/GYN Oncology Center. From a neurologic standpoint it will allow further expansion of our Neuro-Oncology division and increase exposure not just to tumors of the nervous system but also neurologic manifestations of other types of cancers.
West Haven VA Medical Center
The West Haven VA Medical Center is a 259 bed acute care facility with an active outpatient clinic. The VAMC is located 5 miles from Yale and is connected by a shuttle bus system. Residents now spend most of their time during their VA rotations focusing on the many neurological disorders that present in an outpatient setting, and less of their time caring for patients on the inpatient ward service. The clinical service is a model of efficiency, with one of the most comprehensive and user-friendly electronic medical record system in the world, and exceptional integration of other clinical services with the neurology service.
In addition to its clinical services, the West Haven VA research program is among the largest and most active in the VA system. In 1996 the West Haven VA program ranked 2nd in the number of investigators, 2nd in VA research funding, and 1st in total research funds. There are major research programs in cardiology, pulmonary, renal, and digestive diseases; endocrinology, dermatology, neurology, and psychiatry. Thirty-seven research programs occupy 10 buildings on the VA campus.
The West Haven VA Medical Center is respected for one of the best neurology units in the VA system. Yale faculty serve as attendings and provide state-of-the-art supervision for housestaff. Here, residents admit and follow patients who often have "classical" neurological problems such as multiple sclerosis, Parkinson's disease, dementia, and stroke. The WHVAMC stroke program served as the prototype special care unit for the entire VA system, and has also served as the coordinating center for major clinical trials in stroke prevention for patients with atrial fibrillation and left ventricular hypertrophy. The West Haven VAMC is unique in housing the region's only Positron Emission Tomography (PET) Center. This state of the art facility is available to patients at WHVAMC and Yale-New Haven Hospital. It includes an on-site cyclotron. PET protocols include applications in cerebrovascular disease, epilepsy, brain neoplasms, dementia, and trauma.
Opportunities exist for the residents to become involved in ongoing research projects as time and interest are presented. The recently established VA Neurosciences Research Center, which is an integral part of the Department of Neurology, houses a major research program which focuses on cellular and molecular mechanisms in neurological disease, and on neural regeneration.
Gaylord Rehabilitation Center
Outpatient VA Clinics
Outpatient Yale Clinics
The home of the Department of Neurology's outpatient clinic is at the garden level of the Yale Physician's Building at 800 Howard Avenue. Residents spend half a day there each week seeing patients in follow-up after discharge from the hospital or new referrals. To ensure continuity, a system is in place so that residents who take care of a patient in the hospital also see that patient in their own clinic. Residents book their patients in either a dedicated stroke continuity clinic on Monday afternoons or a general neurology clinic on Tuesday aftenoons. There is also a Neurology Urgent Access Clinic (NUAC) on Thursday afternoons for new patients needing urgent evaluations referred by primary care physicians or the Emergency Room. Patients seen in the NUAC clinic are then followed by the resident in his or her Monday or Tuesday afternoon continuity clinic. The clinic is equipped with an electronic record system, and all clinic notes are entered electronically. Both inpatient and outpatient imaging are available for review through an electronic database.