The objective of our Neurology Residency Program is for residents to be capable of assuming clinical responsibility for the care of patients with neurologic disorders under the supervision of senior neurology residents or faculty. Our goals for our residents are:
- Become familiar with evaluation and management of serious and complex neurologic disorders.
- Learn appropriateness of diagnostic testing modalities and how to interpret data gained from diagnostic studies.
- Learn to interact with consultant staff, patients’ families, nursing staff, and aftercare coordinator.
- Become adept at handling of consultations from the emergency department and other inpatient hospital services.
Patient Care
- Perform detailed neurologic history-taking and examination
- Develop a reasonable differential diagnosis with special regard for emergent neurologic situations and disorders for which treatment is available
- Develop a tentative treatment plan to be reviewed with senior resident and attending neurologist
- Identify problems for which emergent intervention is needed
- Use clinical pathways, e.g., ischemic stroke pathway; brain death determination
Medical Knowledge
- Employ a rational and judicious approach to diagnostic studies
- Come to understanding of pertinence of results of diagnostic tests
- Identify effects of medication which may have potential for neurologic manifestations
- Learn indications for requests for consultations
- Be knowledgeable in the appropriateness of requests for specific treatment modalities, e.g., Physical Therapy, Occupational Therapy, and Speech Therapy
Interpersonal and Communication Skills
- Develop skills at interaction with patients and family members and communicate effectively with them
- Dictate a concise and comprehensive discharge summary
- Teach rotating residents and senior medical students
- Observe and critique neurologic examinations performed by senior medical students
- Learn to be a "team player" with other members of the care team, i.e., nursing staff, case manager, and social worker
Professionalism
- Demonstrate concern for patients, which supersedes self-interest
- Be committed to the highest standards of excellence in the practice of neurology
- Possess the personal attributes, behavior and skills for the successful practice of neurology: honesty, integrity, rational planning, effective communication, and the ability to perform under stress
- Be reliable, neat, clean, conscientious, careful, cooperative, and flexible
- Demonstrate ethical behavior
- Be sensitive to a culturally diverse patient population, including issues of ethnicity, race, and religion
Systems-Based Practice
- Become familiar with patterns of after-hospital care
- Be aware of costs and provide cost-effective care
- Learn use of specialized support and referral avenues, e.g., request for help from Medical Ethics Committee, other consultants, etc.
- Be able to utilize electronic medical records
Practice-Based Learning & Improvement
- Apply research and statistical methods as they relate to patients under the resident’s care
- Utilize information technology
- Facilitate learning of others
Our conference schedule includes dedicated time each week for grand rounds, anatomy, theme-based didactics, case conferences, morbidity and mortality, journal club, and more. In June of each year we run a Boot Camp during noon conference to prepare our rising PGY-2 residents.
| Time | Monday | Tuesday | Wednesday | Thursday | Friday |
|---|---|---|---|---|---|
| 7:30 a.m. | Morning Report | ||||
| 8:30 a.m. | Grand Rounds | ||||
| 12 noon | Anatomy | Theme-Based Didactics | Topic/Case Conferences | Theme-Based Didactics | |
| Localization | M&M/QIT | Professor Rounds | |||
| Journal Club |
Rotations
Residents complete their psychiatry training during the internship year. They also spend four weeks on neurology rotations (two weeks on general neurology and two weeks on stroke).
Our junior residents rotate through the inpatient neurology services including general neurology, stroke, Neuro ICU, Epilepsy Monitoring Unit, and pediatric neurology. We also ensure six to eight weeks of elective time to explore subspecialties.
Senior residents serve as senior on our general neurology and stroke teams. They also have more dedicated elective time to pursue subspecialty training or complete research projects.
Continuity Clinic is divided between weekly clinics on most rotations and an EMG/clinic rotation where residents have four continuity clinics in a week. The remainder of the EMG/clinic rotation is spent in the EMG lab or in procedural clinics (lumbar puncture, Botulinum toxin injections, or skin biopsies).
| PGY-2 | PGY-3 | PGY-4 |
|---|---|---|
| 8 weeks general neurology | 4 weeks general neurology senior | 6 weeks general neurology senior |
| 8 weeks stroke | 4 weeks sundown | 4 weeks sundown |
| 4 weeks neuro ICU | 4 weeks neuro ICU | 4 weeks outpatient pediatric neurology |
| 4 weeks EMU | 4 weeks EMU | 4 weeks night float |
| 4 weeks inpatient pediatric neurology | 4 weeks inpatient pediatric neurology | 4 weeks general neurology consults |
| 8 weeks night float | 6 weeks night float | 2 weeks stroke consults |
| 4 weeks EMG/clinic | 4 weeks general neurology consults | 3 weeks EMG/clinic |
| 8 weeks elective | 6 weeks stroke consult | 20-22 weeks elective |
| 2 weeks EMG/clinic | ||
| 10 weeks elective |
Facilities
Albany Medical Center's full-time neurology faculty staff approximately 11,000 inpatient encounters annually. There are more than 30,000 outpatient visits to the subspecialty adult and pediatric neurology clinics. In addition to the Adult Neurology Continuity Clinic throughout the three-year program, residents will have exposure to specific attending clinics in movement disorders, dementia, epilepsy, MS, pain, and neuromuscular disease, thereby enhancing the outpatient experience.
The modern Clinical Neurophysiology laboratory at Albany Medical Center is staffed by adult epileptologists, neuromuscular and pain management physicians, and registered EEG technologists and EEG technicians with equipment for intensive video monitoring, routine and ambulatory 24-hour recording, evoked potentials, electrocorticography/cortical mapping, and electromyography/nerve conduction. It is fully-accredited by the American EEG Society – one of only 77 accredited labs in the United States and one of only three in New York State. We specialize in neonatal and pediatric EEG. We perform approximately 2,300 routine sleep studies annually in addition to 150 intensive 24-hour ambulatory recordings. Long-term video EEG monitoring is available for more complicated diagnoses and treatments. We have an active program for the surgical treatment of patients with intractable epilepsy, as well as intra-operative corticography (brain mapping).
Albany Medical Center is the only designated neuromuscular center in the area recognized by the Muscular Dystrophy Association. Our subspecialty trained physicians see a wide variety of hereditary adult and pediatric neuromuscular diseases. The peripheral electrodiagnostic laboratory is also very active with state-of-the-art EMG/nerve conduction velocity equipment. Approximately 1,000 of these studies, as well as more than 400 visual, auditory or somatosensory evoked potentials, are performed annually. Our physicians have expertise in the administration of botulinum toxin for patients with dystonia, hemifacial spasm, and other focal movement disorders. There is an ongoing program in collaboration with Neurosurgery for deep brain stimulation in various movement disorders.
Our pediatric neurology providers offer a complete array of consultative, diagnostic, and treatment services for children. In addition to treating children with attention deficit/hyperactivity disorder, headaches, neuromuscular, and other disorders, we see a large number in our Comprehensive Epilepsy Program and Muscular Dystrophy Clinic.
The Neurosciences Unit consists of 18 stroke/stepdown beds and 22 regular beds and is designed to care for stable patients with any neurosurgical or neurological condition. The 15-bed Neurological Intensive Care Unit (Neuro ICU) is also the only such unit in the region designed to care for patients with severe neurological conditions or injuries. The unit utilizes therapeutic hypothermia to care for patients with traumatic brain injury and cardiac arrest. Patients admitted to the Neuro ICU are critically sick and often require ventilatory support, advanced monitoring of neurological status (i.e. intracranial pressure), or have complicated medical/surgical issues. There is a 13-bed Medical ICU and 17-bed Surgical ICU.
The six-bed adult and six-bed pediatric inpatient Epilepsy Monitoring Unit (EMU), part of Albany Medical Center's Comprehensive Epilepsy Program, has been granted membership into the prestigious National Association of Epilepsy Centers (NAEC), becoming one of just six such programs in the state to be so recognized, and one of only three upstate. The program also received a Level 4 designation by the NAEC, the highest it offers, and shared by the best academic centers in the country. A Level 4 rating from the NAEC indicates a center offers the most advanced medical and surgical diagnostic and treatment options for epilepsy. The EMU has been completely renovated and now offers wireless brainwave monitoring technology that uses advanced computer systems and seizure recording equipment enabling patients to move around the unit more freely. The EMU operates around the clock and is staffed by dedicated epilepsy nurses and technologists.
The outpatient clinic space encompasses 37 exam rooms as well as physician and nursing workstations. Computer terminals in each exam room and at the workstations provide access to electronic health record and clinical reference material. The Movement Disorders Section includes 10 exam rooms, a resource/reference room, and research laboratory.
Albany Medical Center is the only hospital in the area that provides pediatric neurology services. A full spectrum of pediatric neurological and neurosurgical disorders are managed at the Bernard & Millie Duker Children's Hospital.
The Department of Radiology maintains an endovascular suite for angiographic procedures and interventions, computerized tomography, and magnetic resonance imaging immediately beneath the neurology clinic and offices. There is a neuro-reading room for reading of CT and MRI scans.
Research in neurodegenerative disorders is being conducted. Active clinical trials in the treatment of Alzheimer’s disease, as well as movement disorders, diabetic neuropathy, multiple sclerosis, and stroke are ongoing.