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Residency Rotation Schedule

rotation schedule

Duke University Hospital Inpatient Unit Rotation

The hospital serves as both a quaternary/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 Duke University Hospital inpatient neurology consists of three separate teams: Stroke, General Neurology and Consults.

The Stroke team consists of medical students, interns, advanced practice providers (nurse practitioners or physician’s assistants), a PGY-2 neurology resident, a vascular neurology fellow (~six months out of the year) and an attending with vascular neurology subspecialty training. 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.

The Consult team consists of one PGY-2 neurology resident, one PGY-3 neurology resident, one PGY-4 resident, and an attending, as well as residents rotating from neurosurgery, family medicine and internal medicine. This team is responsible for consults within the hospital and the emergency department.

Education is focused on common neurological disorders and the basics of neuroradiology (CT, MRI, PET, angiography, myelography), Doppler ultrasound (extracranial and transcranial), peripheral neurophysiology (nerve conduction studies, electromyography, autonomic testing), and central neurophysiology (electroencephalography, evoked potentials, sleep studies).

Neurointensive Care Rotation

During the neurointensive care rotation (eight weeks, in two four-week blocks), the PGY-2 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 illness.

Clinic Rotations

While on clinic rotations, both at Duke and the VA, the JAR will work with several attendings, seeing patients in both general and specialty 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), Duke Street Clinic (general/community neurology) and the VA medical center (general neurology and subspecialty clinics in TBI, movement disorders, epilepsy, sleep, and neuromuscular disease).

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/Call

This is a two-week rotation with six shifts/week (Sunday night through Saturday morning, 7 p.m. to 7 a.m. + sign out). 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 as their back up (in house).

A PGY-3/4 resident is always on back-up call, in house. In the beginning of the year, they are directly supervising 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 the transfer line.

Saturdays are the only 24 hour shift, starting at 7 a.m. and continuing to 7 a.m. on Sunday. This is covered by a PGY-2 resident with PGY-3/4 as backup. There is always an intern covering the neurology inpatients at night. Sundays are covered similarly except that he shifts ends at 7 p.m., when night float takes over.

In addition to the coverage described above and the interns, weekend days include two day float residents (one PGY-2, one PGY-3/4). They help to cover the emergency department and consult pagers while the remainder of the team takes care of the inpatient services. Day float resident typically are able to go home by early afternoon.

Senior Resident Rotations

Senior resident rotations add further responsibility to the resident's duties and broadens exposure to neurodiagnostic procedures and pediatric neurology.

The Pediatric Neurology rotation joins the neurology resident with a pediatric neurology resident, and pediatric neurology attending in the consultative evaluation of inpatients and outpatients. Six weeks during the PGY-3 year are predominantly inpatient; six weeks during the PGY-4 year are predominantly outpatient. 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. Most residents perform 80-100 studies under supervision of the lab staff, fellows, and attendings.

The EEG/Epilepsy/Sleep rotation is for 12 weeks. During the first eight weeks, the resident learns how to interpret routine EEGs and evoked potential. 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.

Chief Resident Rotations

Each resident functions as either the General Neurology or Consult chief neurology resident at Duke for approximately four months. This affords the resident additional experience in neurological diagnosis and care, as well as teaching and administrative roles. Also, the chief residents will have the opportunity to function as junior attending (with close backup by the attending) for on the General neurology service.

The chief residents also spend approximately seven to eight weeks each as the VA Chief Resident (entirely outpatient) and VA Consult Resident (inpatient consults). In addition to additional experience in neurological diagnosis and care, these rotations provide significant autonomy and graduated responsibilities. This includes e-consults and supervision of junior residents, psychiatry interns and medical students.

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

Electives

There are many elective options available including neuroradiology, neuropathology, neuro-ophthalmology, neurophysiology, and neuromuscular. In addition, since 2014, there are “required electives” in neuroimmunology, neurodegenerative disease, neuro-oncology and headache/pain. These were designed to give residents a concentrated exposure to areas of neurology that do not always receive a coherent/concentrated treatment. Other options include research electives and design-your-own elective (where residents will pick clinics/times in multiple areas).

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.