Residency Structure and Training
Training by Year
Our program prides itself on early integration into the field of neurology – this allows interns the opportunity to immediately embark on their chosen career path, feel at home in our department, and have extra neurology elective experience to make well-informed decisions about eventual fellowships. Neurology interns spend 8 months on internal medicine inpatient rotations, as required by the ABPN, but the remainder of the year is spent on neurology rotations. Interns rotate on the inpatient General neurology service for 1 month, spend 1 month on either the General Neurology Clinic or Epilepsy service, and use the rest of the time on their choice of a wide selection of neurology electives. Although they do not yet have their own continuity clinic, they spend time with a PGY4 in clinic to gain familiarity with the longitudinal clinic process, become certified in lumbar punctures in a low-stress environment, and meet the patient population they will be caring for as residents. Vacation is taken during the neurology blocks. Neurology interns are also paired with faculty and peer mentors and encouraged to get an early start on research projects.
PGY-2 (Junior resident)
Junior residents have maximal exposure to inpatients, spending several months on the wards (Stroke, General, Consults, VA, and NICU), but also have multiple selective and elective months to continue their exploration subspecialty interests. Residents rotate early on Epilepsy 1 (if they have not already done so as an intern) to become comfortable reading EEGs. Residents with a strong interest in research may complete research rotation during their PGY2 year.
During this early period, residents learn to obtain reliable histories, complete a thorough and accurate neurological examination, and to manage common neurological problems. They become comfortable responding 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. Residents also acquire skills in neuroanatomy and neuroradiology to understand clinical localization and interpretation of CT and MRI scans.
PGY-3/PGY4 (Senior resident)
Senior residents lead the inpatient teams by supervising junior residents, rotators and medical students and gain additional experience in the evaluation and management of complex neurological disease. The ability to read an EEG is further refined during a second month on the Epilepsy service, and familiarity with EMG/nerve conduction studies is acquired on the Neuromuscular rotation. Residents spend 3 months over their final two years rotating on pediatric neurology and also complete their psychiatry rotation on one of the inpatient wards at the VA. The remainder of the time is spent on a wide variety of selectives and electives to ensure a broad education in neurology. Senior residents also spend one or more months on dedicated research electives to complete their longitudinal research project.
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.
PGY4 residents have the opportunity to spend 6 weeks in the fall as part of the UF Medical School Neuroscience course, during which they refine their knowledge of neuroanatomy and localization by teaching preclinical medical students.
Stroke: Two neurology residents (generally one junior and one senior resident) rotate on the vascular neurology service, led by a board-certified vascular neurologist. The team also includes fellows from our ACGME-accredited vascular neurology fellowship program, dedicated stroke ARNPs, off-service rotators from neurosurgery, anesthesia, and pediatric neurology, and medical students. The stroke team manages all vascular neurology inpatients (including stroke patients in the neuro-ICU), hospital stroke consults, and emergent stroke alerts. Residents become adept in acute stroke treatment decisions, inpatient stroke workup, and post-stroke recovery.
General Neurology: Neurology residents (PGY3 or 4 in the first half of the year, PGY2 in the second half of the year) rotate on the General neurology inpatient service with a board-certified neurology attending, PGY1 neurology interns, an inpatient ARNP, off-service rotators from neurosurgery, anesthesia, and pediatric neurology, and medical students. Residents manage patients admitted to the primary neurology service with a non-vascular diagnosis. Only a select group of attendings with particular strengths in inpatient neurology rotate on the service, ensuring an optimal educational experience for the residents.
Neurology Consult: Neurology residents (PGY2 in the first half of the year, PGY3 or 4 in the second half of the year) rotate on the Consult service with a board-certified neurology attending, off-service rotators from internal medicine, anesthesia, and pediatric neurology, and medical students. The team is responsible for all non-vascular ED and inpatient consults. This is a great opportunity for residents to learn how to approach new patients and expand their differential diagnosis.
Neurology Intensive Care Unit (NICU): Residents spend 2-4 weeks annually on the NICU service, under the guidance of neurology-trained intensivists on a team with critical care fellows, PAs, and anesthesia and neurosurgery residents. Residents rotate on 12-hour shifts during either daytime or night hours and learn to manage the critical care needs of neurological and neurosurgical patients under close supervision. This is one of our most popular rotations, even for those planning an outpatient career, due to the strength of the teaching from our neurointensivists.
VA General Neurology: Two neurology residents (generally one junior and one senior resident) rotate on the VA service, led by a board-certified neurology attending. The team also includes off-service rotators from psychiatry and medical students. The team manages consults and also sees consults.
Short call and night float: Two residents from the inpatient services (Stroke, General, Consults, or VA) remain in the hospital from 5-8 pm daily, allowing the others to sign out. During a given week, each resident will have 1-3 short calls. Short call residents manage the inpatient services (with the exception of the NICU) and see new consults and stroke alerts. The short call residents, in turn, sign out to two residents assigned to a separate night float rotation at 8 pm. Junior residents are always paired with a senior resident on night float for the first half of the year, to ensure in-house supervision and comfort level.
Junior and senior residents have continuity clinics at both Shands and the VA. Residents pick up the continuity clinic from a graduating resident, and also acquire patients on inpatient rotations. Continuity clinics are supervised by dedicated clinic attendings, ensuring continuity of care and optimal teaching. Interns do not have their own patient pool but rather attend clinic with a PGY4 while rotating on neurology.
Selective and Elective Rotations
Residents are required to spend one month on each selective rotation (noted with * below) over the course of the residency to ensure a well-rounded neurology education. The remainder of time may be spent on their choice of a wide variety of other electives, including:
- Epilepsy (including electroencephalography)*
- General Clinic*
- Intra-operative monitoring
- Movement disorders*
- Multiple sclerosis/neuroimmunology
- Neuromuscular disease (including electromyography/nerve conduction studies)*
- Neurosurgery/endovascular neurosurgery
- Sleep disorders
- Interventional pain (off-site outpatient clinic in Tallahassee, FL)
Residents may also create their own individualized elective based on interest, with approval from the program director. Off-site rotations may be set up, provided there is sufficient lead time to obtain a formal agreement with the other institution and for the resident to obtain a state-specific training license if the rotation is outside of the state of Florida.