Neurology Residency Training Program
Clinical Training: Summary of Services
University Hospital Inpatient Service
Two teams work together to provide inpatient neurology care. We have a stroke unit providing specialized care for stroke patients.
Approximately 1,200 patients are hospitalized each year on the Neurology inpatient service. Residents assume the major responsibility for patient care under the supervision of the Neurology faculty. Residents also rotate seeing consults in the early evenings and on weekends.
University Hospital Consultation Service
In addition to the comprehensive inpatient service, the Department of Neurology operates the busiest consultation service in the hospital, providing over 1,200 adult consultations each year for other inpatient services as well as the Emergency Department. Although faculty members supervise the residents, these experiences provide a transition toward independent decision-making as a fully trained neurologist.
The dayfloat resident’s day starts at noon conference every weekday. In the afternoons, this resident helps the inpatient team with procedures and does medical student teaching. The dayfloat resident then takes new consults and cross-covers the inpatients from 5 pm until the nightfloat resident takes over at 8 pm.
Neuro ICU Service
Residents rotate through the neurological intensive care unit for one month during their intern year, and one month during their PGY2 or PGY3 year. Residents learn to admit, diagnose and treat those neurological patients whose acuity level requires intensive care. Aside from a clinical component, the rotation has didactic and Socratic teaching during ICU rounds as well as separate didactic sessions given by the Neurocritical Care physicians.
Neurology Outpatient Services
Our program differs from many other programs in that the Neurology Clinic is a major training site. Our clinic has successfully integrated the efforts of residents and faculty to provide not only a high standard of care but also a quality learning experience. Approximately 27,000 adult patients are seen each year in the General Neurology Clinic and subspecialty clinics. Each resident works full time in the Neurology Outpatient Services for approximately 4 months during the residency. Half of this time is spent in a comprehensive outpatient rotation, during which time residents work in 10 subspecialty clinics, including:
- Epilepsy Clinic
- Neuromuscular Disorders Clinic
- Ataxia Clinic
- Cognitive Disorders Clinic
- Movement Disorders Clinic
- Neuro-Oncology Clinic
- Sleep Clinic
- Stroke Clinic
- Neuro-genetics Clinic
- Multiple Sclerosis/Neuro-immunology Clinic
Half of each resident’s outpatient time is dedicated to a focused outpatient selective, during which time the resident gains exposure to a subspecialty of his or her choice. Options include:
- Multiple sclerosis
- Headache and neuropathic pain
- Neuromuscular disease
- Sleep disorders
- Movement disorders and cognitive disorders
- Neurocritical care
In addition, residents maintain a weekly half-day Continuity Clinic throughout their residency.
The Neurology Service at the VA Ann Arbor Healthcare System is an integral part of the Neurology Program. Two to three neurology residents are assigned to the VA every month, and residents spend 6 months on average on the VA rotation during their residencies. Approximately 60 patients are admitted to the inpatient service annually, and 250 patients are seen in consultation. In recent years, the emphasis has increased on care provided in the Outpatient Clinic, where approximately 2,300 patients are seen each year. The Neurology residents also supervise the inpatient service, see consults and help with EEG interpretation. Residents may also use their time at the VA to explore elective opportunities in rehabilitation and psychiatry. Active involvement by full-time faculty ensures a quality learning experience.
Residents spend an average of 1 month per year on the Pediatric Neurology rotation. The consultation service evaluates approximately 500 children per year in Mott Children's Hospital at the University of Michigan Health System. Four mornings per week are spent in clinic where residents see only new patients. Residents also do inpatient and emergency room consults and advise the inpatient pediatric team. During this rotation, the resident gains a wide experience in the management of children with seizure disorders, developmental abnormalities, metabolic disorders affecting the nervous system and other neurological problems.
The 6-week EEG rotation takes place during the latter half of the first year or the first half of the second year of residency training. During this rotation, the resident learns to perform and interpret both outpatient electroencephalograms and long term EEG monitoring. There is also opportunity to learn more about intraoperative monitoring and surgical treatments for epilepsy.
Electromyography (EMG) / Neuromuscular
The EMG rotation is at least 2 months long, although residents are encouraged to do an additional month immediately afterwards. While on the Neuromuscular service, residents receive didactic and hands-on training in electrodiagnosis of disorders affecting the peripheral nervous system. Over the course of the rotation, the resident becomes increasingly independent and may perform more than 100 EMG studies under supervision. Residents also participate in the clinical evaluation and treatment of patients with neuromuscular diseases and in the examination of nerve and muscle biopsies.
The University of Michigan also is the home of EMG Whiz, a popular Web-based EMG training simulator for residents and fellows.
Night Float Rotation
When on the night float rotation, a resident takes in-house call overnight Sunday-Thursday. This consists of seeing inpatient and Emergency Room consults, and covering the inpatient service. The night float resident presents any admissions to the team in the morning, and leaves most mornings by 9 a.m. Residents do a total of 2 months of night float over 3 years, with 1 month done in the PGY-2 year, and the other month divided between the PGY-3 and PGY-4 years.
Physical Medicine and Rehabilitation Medicine (PM&R)
Several unique opportunities exist for learning within the department of Rehabilitation Medicine. Residents spend 2 weeks rotating through one or more rehabilitation subspecialty clinics, including the Spine Clinic, Medical Rehabilitation, Musculoskeletal Clinic and Traumatic Brain Injury Clinic, Occupational and Physical Medicine Clinic, the Post-Polio Clinic, Pediatric Rehabilitation and the Spinal Cord Clinic. During the rotation, residents learn the basic principles of rehabilitation for neurological disorders and become familiar with the medical treatment approaches of ambulatory patients with a variety of chronic pains. Residents also are exposed to the basic principles of physical and occupational therapy and conditioning exercise, and also become familiar with the elements of a therapeutic treatment plan and with the evaluation, goal setting and rationale of treatment.
This is a 4-week rotation, which consists of rotating with the Psychiatry Consult-Liaison service at University Hospital or through time spent at the Ann Arbor VA Hospital System. Residents will participate in the management of patients with psychiatric disorders. They will learn about the psychological aspects of the patient-physician relationship and the importance of personal, social and cultural factors in disease processes and their clinical expression. Residents are exposed to the principles of psychopathology, psychiatric diagnosis and therapy, and the indications for and complications of drugs used in psychiatry.
In addition to the outpatient selectives detailed above, an average of 4 months of elective time are provided during the 3 years of residency. Many residents choose to work on clinical or basic research during this time. Other popular electives include neuroradiology, neuro-ophthalmology, neuropathology, neurosurgery, neurological education, neuroimmunology, genetics, stroke, sleep, movement disorders and epilepsy. Residents may also use elective time to become more adept at electrodiagnostic tests like EMG, EEG, evoked potentials and intraoperative monitoring. Residents may also choose to do electives in international health care.
There are many opportunities for carrying out fundamental or clinical research with faculty members during elective months. Although the program emphasizes clinical training for resident physicians, extensive research facilities are available in the department's neuroscience laboratories, the Michigan Alzheimer's Disease Research Center, the Positron Emission Tomography (PET) Program, and the VA Health System. Research experiences can be arranged with neurology faculty members who have expertise in neurophysiology, neurochemistry and neuropharmacology. Residents also may pursue advanced training and research in clinical disciplines such as epilepsy, electroencephalography, neuromuscular disorders, electromyography, cerebrovascular disease, cognitive disorders, movement disorders, and neuro-oncology and sleep disorders.
Every resident gets 1 month of vacation per year. This can be taken either as a single calendar month, or as 2 half-month blocks. Vacation is scheduled in "blocks," so it is not taken during other rotations.