Adult Residency Program
The inpatient exposure occurs mainly during the HO-II year. HO-II residents lead the wards team on either the general neurology service or the stroke service. They are responsible for evaluating and managing, under attending physician supervision, all patients on the service. They are expected to put forth differential diagnoses and plans for workup and management.
The neurology residents are encouraged to order tests as they deem necessary for the care of the patients and to do so without direct prior attending approval. Invasive diagnostic testing is typically discussed with the attending, and the attending is always available for complex decision-making.
The HO-II residents spend 6 months on the wards (3 on general neurology and 3 on stroke) and work with an intern from our outstanding Internal Medicine Department. During the 1st month of the HO-IV year, the residents return to the wards to serve as an “acting attending.”
The program provides outstanding outpatient exposure, which we believe is the foundation of clinical neurology. Residents begin working in the outpatient clinics during the HO-II year, and this continues throughout the residency training. All residents have a continuity clinic which meets 1/2 day per week throughout their training. The residents have increasing autonomy for patient management as they increase in seniority.
HO-II's must check out all patients with the supervising attending. Senior residents check out all new patients, but only check out follow-up patient management issues if they have a question. In general the senior residents simply inform the supervising attending of their management plan for their return patients.
Residents also rotate through the faculty’s specialty clinics. This includes clinics in multiple sclerosis, headache, epilepsy, movement disorders, neuromuscular disease, sleep, neurosurgery, and general neurology.
Residents can also work in other clinics outside of our department, such as pain management and neuro-oncology, during their elective months. Additionally, each resident spends at least 3 months learning NCV/EMG and at least 4 months reading EEGs. Finally, each resident does 3 months of pediatric neurology, and the majority of the time on this rotation is spent in the pediatric neurology clinic.
The neurology inpatient consultation service is the responsibility of the 3rd and 4th year residents. There is always an HO-III and HO-IV resident on the service. The HO-IV is responsible for managing the team. The consult residents see all old consults and round with the attending on all new consults.
As part of developing independent patient care responsibility, the residents are encouraged to make initial workup, management and treatment recommendations prior to rounding with the attending. When rounding on consult follow-ups, the residents are also encouraged to make recommendations prior to the attending rounding. All management, workup and treatment plans recommended by the residents, however, are communicated to the attending physician, usually during formal rounding on new patients.
The HO-IV resident on consults is the initial resource for the HO-III resident when patient recommendations are made. Additionally, to further prepare the residents for independent patient care, the HO-IV resident on consults is on-call from home Monday throughThursday until midnight each night to "staff" inpatient consults seen by other residents. This provides the HO-IV resident experience in initial management decision making in an acute patient care setting.
If the HO-IV resident is unsure of the appropriate management for an inpatient consult, then there is always a neurology attending on-call to provide advice. All patients "staffed" over the phone by the HO-IV will be seen by the consult attending the next day for formal attending staffing.
All residents throughout their training will have periodic on-call duties. During the HO-II year each resident has between 4 and 7 calls per month, and they cover all adult neurology issues. The majority of these call nights are in-house, but there is some home call. During the HO-III and HO-IV years, the residents have between 1 and 4 calls per month, with all of the calls being home-call. The majority of the calls during the HO-III and HO-IV years are for pediatrics only.
When residents see a patient in the ED they are responsible for triaging the problem as either a general neurology or a stroke-related issue and then contacting the appropriate attending for disposition. All residents are expected to have formulated a differential diagnosis and plan of management prior to contacting the attending.
The mechanism for taking call throughout the residency training and not limiting call to specific rotations is designed to ensure exposure to emergency neurology and acutely ill patients throughout the training program. Residents on-call will take patient calls after hours. The resident has primary responsibility for management and disposition of these calls. If the resident is unsure of correct disposition, then there is always an upper level resident or attending who can provide assistance.
Teaching is an integral part of the residency training program and is crucial to developing the residents' knowledge base. The ward residents are the primary teachers for the medicine interns and the 3rd year medical students. The senior residents provide teaching and assistance for the junior residents and help to supervise procedures as needed.
Senior residents participate in the recurring lecture series for the 3rd year medical students and are encouraged to participate in teaching opportunities for the 1st and 2nd year students as well. All residents are required to prepare case presentations for Grand Rounds during their HO-II year and to give formal Grand Rounds presentations during their HO-III and HO-IV years. The residents also participate in the noon didactic lectures periodically, particularly during EMG and pediatrics conferences.
Teaching sessions for the residents occur several times during a normal week. Three mornings of the week we have morning report, where an interesting case is presented by a resident. Attendings are present and help work through the differential diagnosis, workup, and treatment of the patient.
One morning per week we have grand rounds, during which there is a presentation from a faculty member from another institution or another department at Wake Forest. It is typical to have a didactic teaching session during the lunch hour. These sessions are directed towards the residents and cover a wide variety of topics. Finally, there are different sessions on Fridays, such as morbidity and mortality conference, oral boards preparation, and journal club.
Residents are encouraged to participate in research throughout their residency training. This can take the form of helping to recruit patients for clinical trials, case reports or other projects undertaken with faculty guidance.
Residents are encouraged to present their research at national meetings. All residents are given a travel stipend to support educational travel to national meetings. Residents are also encouraged to fully develop manuscripts and submit them for publication.
Promotion and Graduation
Residents are promoted and graduated by consensus of the faculty after demonstrating satisfactory performance in all of their clinical rotations and basic competencies in procedures and professionalism. Specific criteria for promotion are itemized in the Criteria for Promotion document.