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Residency Rotation Schedule

residents

Duke University Hospital Inpatient Rotations

Duke University Hospital (DUH) serves as both a tertiary referral center and a community hospital for Durham and the surrounding areas. This provides for an excellent mix of routine and unusual cases.

The DUH inpatient neurology service consists of four teams: Stroke, General Neurology, Consults, and Neuro-ICU.

The Stroke team consists of medical students, interns, advanced practice providers, a PGY-2 neurology resident, a vascular neurology fellow, and an attending vascular neurologist. The intern, APP and PGY-2 resident provide direct patient care, with the PGY-2 resident taking a greater role in leading discussions and formulating plans for all patients. The General Neurology team consists of medical students, interns, a PGY-2 neurology resident, a PGY-4 neurology resident (who leads the team), and an attending neurologist.

The Consult team consists of one PGY-2 neurology resident, one PGY-3 neurology resident, one PGY-4 resident, and an attending neurologist, as well as residents rotating from Neurosurgery, Family Medicine and Internal Medicine. This team is responsible for inpatient and emergency department consults.

The Neuro-ICU team consists of PGY-2 or PGY-3 residents, advanced practice providers, and attending critical care specialists. During the neurointensive care rotation, the PGY-2 or PGY-3 resident works with critical care fellows and attendings as well as a group of advanced practice providers to care for patients in our 24-bed unit. The unit provides care to both post-operative patients and critically ill patients, many of whom are sent from around the state and surrounding region. They have the opportunity to participate in procedures, go to the operating room, and become comfortable with management of critical neurological illnesses. Traditional overnight call is part of the Neuro-ICU rotation.

PGY-4 residents participate on the General Neurology and Consult services at DUH. This affords these residents additional experience in neurological diagnosis and care, as well as teaching and administrative roles. Also, the PGY-4 residents will have the opportunity to function as junior attending (with close backup by the attending) on the General neurology service.

The PGY-4 residents also function as the VA Consult Resident (inpatient consults). This rotation provides additional experience in neurological diagnosis and care, as well as significant autonomy and graduated responsibilities, including e-consults and supervision of junior residents, psychiatry interns and medical students.

Outpatient Rotations

All residents have a continuity clinic throughout their 3 years. Residents follow a panel of their own patients, staffing each with the attending covering the clinic. All fields of general and subspecialty neurology are seen in resident clinic.

While on outpatient rotations, PGY-2 residents work in both general and subspecialty neurology. This includes time at the Duke South Clinic (general neurology, vascular neurology, neuroimmunology, epilepsy, sleep, neuromuscular, MDA clinic), Morreene Road Clinic (headache/pain, movement disorders, behavioral neurology, and ALS clinic), North Duke Street Clinic (general/community neurology, epilepsy, neuromuscular) and the VA medical center (general neurology and subspecialty clinics in traumatic brain injury, movement disorders, epilepsy, sleep, and neuromuscular disease). The VA outpatient clinics also include PGY-4 residents. Specific rotations in EEG (4 weeks), neuro-immunology (2 weeks), headache (2 weeks), and neuro-degenerative disease (4 weeks) are completed during the PGY-2 year.

PGY-3 and PGY-4 rotations add further responsibility to the resident's duties and broadens exposure to neurodiagnostic procedures and pediatric neurology.

The Pediatric Neurology rotation allows the neurology resident to work with a pediatric neurology resident and pediatric neurology attending in the consultative evaluation of inpatients (PGY-3s) and outpatients (PGY-4s). All calls are from home.

The EMG/Neuromuscular rotation is for 12 weeks and includes resident participation in performing and interpreting nerve conduction studies and electromyography as well as evaluating patients with neuromuscular disorders.

The EEG/Epilepsy/Sleep rotation is for 8 weeks and is a continuation of the 4 weeks completed during the PGY-2 year. During the first four weeks, residents improve skills in interpreting EEGs and evoked potential studies. They also provide care for the patients admitted to the Epilepsy Monitoring Unit and work with the clinical neurophysiology fellows and attending in interpreting long-term monitoring and ICU monitoring studies. During the last four weeks of the rotation, the resident functions in the capacity of junior fellow – they have primary responsibility for interpreting long-term monitoring and ICU monitoring EEG studies for the adult service. They are backed up by a fellow at all times. Participation in a weekly Epilepsy and Sleep Disorder Clinic is included.

All residents complete a one-month rotation in psychiatry to gain exposure to diagnostic psychiatry and psychopharmacology. Options include outpatient psychiatry at the VA or the inpatient consult service at DUH or the VA.

PGY-3 or PGY-4 residents complete a 2-week rotation in the world-renowned Preston Robert Tisch Brain Tumor Center.

All residents have continuity clinic throughout their 3 years. For PGY-2 and PGY-3 residents, this is held on either Wednesday or Friday afternoon. Each resident follows a panel of their own patients, staffing each with the attending covering the clinic. PGY-4 residents have their continuity clinic in conjunction with a single attending (two attendings/residents, six months each). These clinics are only cancelled during nigh float and neurointensive care rotation.

Night Float and Weekend Call

Night float is a two-week rotation with six shifts per week, starting Sunday at 7 p.m. and finishing Saturday at 7 a.m. For the first 8 weeks of the year, night float is covered by PGY-3 residents to insure that PGY-2 residents can attend Intro to Neurology lectures. For the rest of the year, night float is covered by a PGY-2 resident with an in house PGY-3/4 resident for supervision and support. In the beginning of the year, the back-up resident directly supervises the PGY-2 resident (seeing and/or discussing all patients with them); in the second half they are still in-house but now only see patients if the PGY-2 is very busy or if they have questions/concerns. In addition to backing up the PGY-2 resident, they are also responsible for the VA and outside transfer phone calls.

Saturdays are 24-hour shifts, starting at 7 a.m. This is covered by a PGY-2 resident with PGY-3/4 as backup. Sundays are covered similarly except that the shifts ends at 7 p.m., when night float takes over. Throughout the week, an intern is responsible for primary care of admitted patients while the overnight resident sees new consults.

During weekends, two day float residents (one PGY-2, one PGY-3/4) help cover the emergency department and consult pagers while the remainder of the team takes care of the inpatient services. Day float residents typically are able to go home by early afternoon.

Electives

There are many elective options available including neuroradiology, neuropathology, neuro-ophthalmology, and any of the other areas of subspecialty neurology listed above. Residents can also choose research electives or design their own electives.

In 2015, Duke Neurology offered its first Global Health elective. Two PGY-4 residents spent four weeks in Kenya with Carmen Graffagnino, MD providing clinical services and teaching/research. Read their story here. This opportunity will be available to one or two PGY-4 residents every year.