During the PGY2 year of residency, you will have maximal exposure to in-patients, spending several months on the wards (VA Junior; Shands Junior; and Stroke). There are also several half-month blocks of nightfloat. Furthermore, you will gain experience in epilepsy, both on the Epilepsy Monitoring Unit (EMU) and in epilepsy clinic as part of the Epilepsy I rotation. You will also spend several weeks in outpatient neurology clinics, gaining exposure to general neurology clinic and then one or more subspecialty clinics. PGY2 residents who have a strong and clear interest in a specific clinical or research area may request specific subspecialty clinics or research rotations at the beginning of the year.
You will be paired with a Senior resident when you are on the wards. It is expected during the first year of neurology training you will learn to obtain complete and reliable histories, do a thorough and accurate neurological examination, and learn how to manage common neurological problems, including stroke, seizure disorders, headache, and disorders of similar prevalence. In addition, it is expected that you will learn how to respond to neurological emergencies, such as status epilepticus, acute stroke, respiratory compromise in neuromuscular disorders, acute encephalopathy, meningitis and encephalitis, spinal cord compression, raised intracranial pressure and space-occupying lesions. During the first months of training, you will be given the opportunity to learn how to read electroencephalograms (EEG). You are expected to acquire sufficient knowledge of neuroanatomy and neuroradiology to understand clinical localization and to develop skills in reading CT and MR scans. You should also read about basic neurophysiology, neurochemistry, and neuropharmacology
At the end of the PGY2 year of training, you will be allowed to proceed to the next level of training provided you have demonstrated progress in your daily care of patients to the satisfaction of the faculty, and you have obtained a satisfactory rating on all 6 ACGME competencies. To insure that you acquire the clinical and basic information outlined above, you are expected in your first and all subsequent years of training to develop a self-study program and to effectively use the resources of the library and internet. You are expected to develop effective communication skills by observing faculty and senior residents, to insure that your patients are appropriately counseled and informed. You will develop an understanding of ethical, socioeconomic, medicolegal and cost-containment issues through supervised experience in patient care, quarterly departmental conferences on these subjects, and resident lecture series including these topics. Each resident must complete a structured clinical assessment and evaluation in several clinical areas and satisfy the requirements in these areas as set up the Residency Clinical Competency Committee.
Second Year (PGY-3)
During the PGY3 year of residency, you are considered a senior resident. You will have ongoing exposure to in-patients, again spending several months on the wards (VA Senior ; Shands Senior and Stroke Senior) and several weeks on nightfloat. As a senior resident, your role will change and you will take on the responsibility of leading the respective inpatient teams. You will gain additional experience in the evaluation and management of complex neurological disease. You will be expected to lead the medical student and rotating resident teaching as well as supervise and guide junior residents. You will gain more experience in epilepsy by spending a second month seeing EMU and epilepsy clinic patients. You will complete one month of pediatric training in which you will see a combination of EMU admissions, inpatient consults, and outpatient clinics. You will complete 2-4 weeks of your psychiatry requirement in which you will work on one of the inpatient psychiatry wards at the VA. You will also spend several weeks in outpatient neurology clinics, gaining exposure to general neurology, movement disorders, behavioral neurology, and neuromuscular disease. Elective experiences are available in Neuroradiology, Sleep Medicine, Neuro-ophthalmology, Rehabilitation, Palliative Care, Neurosurgery, Neuro-oncology, and Research. During the first half of the PGY3 year, most residents start to think seriously about their fellowship and career plans and may tailor their clinic and elective experiences to help them decide. During the second half of the PGY3 year, residents who have decided to pursue subspecialty fellowship will apply and go on interviews.
Third Year (PGY-4)
During your final year of residency, your inpatient duties will be less than during PGY2 and PGY 3 years but you will spend approximately 4-6 weeks as the senior resident on each of the inpatient services as well as several weeks on nightfloat. You will also complete your 2 remaining months of pediatric neurology. If you do not complete your psychiatry requirement during PGY3, you will do so during PGY4. You will spend one month on neuropathology. As part of the UF Neuroscience course, you will spend a month teaching neuroscience to first year Medical Students, which provides an ideal time to solidify your previously acquired knowledge of neuroanatomy and localization. You will spend the remainder of the year in outpatient neurology clinics or on elective rotations. You will further your understanding of general neurology, epilepsy, movement disorders, behavioral neurology, and neuromuscular disease. You can choose to gain further exposure to Neuroradiology, Sleep Medicine, Neuro-ophthalmology, Rehabilitation, Palliative Care, Neurosurgery, Neuro-oncology, and Research. Most residents choose to use this time to solidify their outpatient knowledge and gain exposure to subspecialties not encountered in the inpatient setting but some residents may choose to gain more exposure to their chosen subspecialty area.
Residents are required to participate in clinical or laboratory research during a portion of their three years of residency. This can be done in your spare time during other rotations, but some residents will want to reserve one or more months during which to work on specific research projects. If three or more months are required, the resident will have to demonstrate sufficient progress in learning clinical neurology to allow for this expenditure of time in research. In the third year, residents will be required to present a summary of their research to the faculty and co-residents. One graduating resident is awarded for the Best Research Presentation each year (see Awards section later in the document).
Graduation from the program will depend upon the resident having demonstrating consistently competent care in all areas. The graduating 3rd year resident should demonstrate the ability to practice independent, competent, compassionate neurology. Each resident must satisfactorily complete a structured clinical assessment and evaluation in 5 clinical areas (Emergency/Critical Care, Neurodegenerative Disorders, Episodic Disorders, Neuromuscular and Pediatric Neurology).
All residents (PGY-2, 3 and 4) participate in a continuity clinic one half-day per week, which alternates at Shands and at the VA. First-year residents will pick up patients from the continuity clinic of a former third-year resident. All inpatients requiring outpatient follow-up are followed by the discharging resident in their own continuity clinic. Continuity clinics are supervised by attending neurologists.
Currently there are 5 faculty members in this group within the Department. In addition there are pediatric neurology faculty with epilepsy as their subspecialty. Their activity includes both busy outpatient and inpatient services including long term monitoring, an active epilepsy surgery service and consultative services fir inpatients with status and other types of cerebral disorders in the ICU setting. Apart from the rotation listed below, residents will be constantly exposed to the epilepsy faculty during their inpatient rotations, enlisting their expertise and evaluating long term EEG tracings in several of their inpatients. Active research in the area is pursued by several of the faculty.
Each PGY-2 resident, during the first six months of residency, will spend one month on the Epilepsy/EEG service. Residents will learn the techniques and interpretation of EEG. They will care for patients on the epilepsy monitoring unit and gain experience in video-EEG, in reviewing and interpreting 24-hour EEG monitoring of critically ill patients, and in learning the evaluation and management of patients with epilepsy in the outpatient and inpatient settings.
Each senior resident will spend one month on the Epilepsy/EEG service. While this rotation is similar to the Epilepsy I Rotation residents had early in their PGY2 year, it greatly increases the amount of responsibility they have for more independent, less directly supervised, practice of Epilepsy subspecialty neurology.
The resident is assigned to the psychiatry ward at the Veterans Administration Hospital and participates in rounds and conferences.
The resident works with neuropathology faculty and neuropathology fellows in reviewing current pathological material (surgical and post-mortem) and attends neuropathological conferences and brain-cutting. There are 3 [pathologists who work in the area including those with expertise in tumor pathology and neuromuscular pathology. In addition to learning basic neuropathology, this rotation provides residents with the opportunity to review and consolidate their knowledge of the pathogenesis of neurological diseases.
Outpatient Clinic Subspecialties Rotation
This group deals with a variety of outpatient neurology consults including patients with headache, spinal cord disease, MS and many other issues. The general neurology clinic rotation provides an opportunity to see patients with important and interesting disorders who do not qualify for admission to the hospital. Residents will work up new patients and see return patients with general neurologic complaints during each half-day clinic, under the supervision of one or more neurology attendings. Residents will discuss each case with the attending. For the more challenging patients, residents should research the patients’ problems after the clinic visit, and discuss their assessment with an attending.
This division interacts closely with a Pediatric neuromuscular specialist and the Powell Gene Therapy center in the care and study of various neuromuscular diseases. Residents will learn the clinical approach to patients with neuromuscular problems, review EMG and biopsy results and other results with a view to correct diagnosis, and learn the basics of pharmacological and non-pharmacological therapy as it applies to neuromuscular disease. Neuromuscular faculty have subspecialty clinics every day of the week in addition to weekly Muscular Dystrophy clinics that see both pediatric and adult patients. In addition the EMG lab studies patients every day of the week with over 1200 studies per year at Shands in addition to EMG lab at the VA. Residents will also learn the basics of nerve conduction and EMG, and the anatomy underlying these studies. Strong basic science groups support the clinical effort and residents can have a chance to interact with some of these labs with a view to enhance their interests and understanding and pursue research in a variety of diseases such as muscular dystrophies, ALS, and Charcot Marie Tooth disease.
UF Neurology has been known for long for its innovative discoveries of brain behavior relationships and this strong investigative initiative still motivates this group. Residents evaluate patients with neurobehavioral disorders in the Memory and Cognitive Disorders Clinics, Traumatic Brain Injury Clinic, and on rare occasion in consultation on the wards. They are supervised by attending faculty from neurology. Patients with the full spectrum of dementing diseases, traumatic brain injury, encephalopathies, plus patients with focal neurobehavioral syndromes such as aphasia, alexia, agnosia, or apraxia, are discussed in detail. Research opportunities abound.
Residents interact with different faculty members who have special interests in Parkinson’s disease, tremor, dystonias, chorea, atypical Parkinsonisms, myoclonus, Tourette syndrome and ataxias. There are specialty clinics for each type of movement disorder, and clinics occur at a unique patient-centric facility which includes neurology, neurosurgery, psychiatry, neuropsychology, physical therapy, occupational therapy, and speech therapy. During this selective residents will learn how to identify the different types of hypo- and hyper-kinetic movement disorders. Residents will be familiar with the most common movement disorders (such as Parkinson’s disease, Essential Tremor and dystonia) and also have the opportunity to see rare movement disorders (such as neuroacanthocytosis, Lubag disease, spinocerebellar ataxias, dystonia-myoclonus syndrome, etc). Residents will also learn the rudiments basics of surgical treatment of movement disorders and will participate in the microelectrode intra-operative mapping and programming for DBS patients. Many basic science labs interact with the Movement Disorder group including cell biology labs, research MRI labs and motor physiology labs.
Three months are spent on the pediatric neurology service. During this time, residents will maintain their continuity clinics (1/2 day per week), but will be excused from all other obligations on the adult service to devote themselves to pediatric neurology. They will admit and follow patients on the child neurology service, attend pediatric neurology clinics (general pediatric neurology, epilepsy, developmental/behavioral), and attend pediatric neurology conferences.
Residents may elect to do additional elective rotation blocks in Epilepsy/EEG, General Clinic, Neuromuscular Clinic, Behavioral Clinic, or Movement Disorders.
When on the Neurology service, residents are expected to review all images obtained on their patients and review them with the service attending. All current imaging studies are available for review on an excellent web-based system. During the neuroradiology elective, residents will have access to extensive teaching files, attend neuroradiology conferences, and read studies with attending neuroradiologists.
Residents will attend neuro-opthalmology clinics and conferences with an attending neuro-ophthalmologist.
Residents may rotate for one month on the Neurosurgery service, where they may participate in neurointensive care, neurosurgery outpatient clinics, neurosurgery consultations, and in-patient management. They may observe neurosurgical operative procedures.
Residents may rotate for one month with a neuro-oncologist to learn about the diagnosis, prognosis, treatment, and management of patients with neoplasms of the nervous system. This experience has both outpatient and inpatient consultation experiences. Residents on this rotation will also attend weekly Tumor Board Tuesdays at 4 pm.
Residents who wish to have protected time to complete a research project may spend additional elective time in research. Such activity is strongly encouraged and will begin with a presentation to selected faculty of the project proposed with the help of a mentor based on literature review. On approval of the project, the resident can work on the experiments with periodic progress reports to the mentor and presentation to the entire Department towards the end of their residency. Serious mentoring towards a grant oriented academic career will be available to selected candidates.