Neurology Inpatient Services

Two inpatient neurology teams, one a General Neurology Service (seizures/status epilepticus, Multiple Sclerosis, AIDP, CNS cancers, Myasthenia Gravis, autoimmune encephalitis, etc) and one a Stroke Service. Each team consists of a neurology faculty member, senior resident, junior resident, psych intern, and a nurse practitioner. Residents lead the care of the patient, overseen by the attending faculty member.   Members of the neurology inpatient teams work with the Neuroscience Intensive Care Unit (NSICU) team to co-manage critically ill neurological patients, and residents on the inpatient teams are also part of the pool of doctors responding to and managing acute stroke alerts, as well.

Neurology Consultation Services

The consult team, consisting of a neurology faculty member, senior resident, junior resident, nurse practitioner, and sometimes other rotating residents (medicine, neurosurgery, PM&R, etc). The team handles consults from other inpatient services and the Department of Emergency Medicine, with residents on the consult service also being in the pool to respond to acute stroke alerts. This is one of the most active consultation services at the hospital, with a wide breadth and depth of neurological conditions.

Neuroscience Intensive Care Unit (NSICU)

Residents rotate through the NSICU during PGY-1, PGY-3, and PGY-4 under the supervision of NSICU intensivist faculty. On this rotation, residents learn to diagnose and manage critically ill patients with acute neurological conditions, including strokes, status epilepticus, myasthenic crisis, and encephalitis; patients are co-managed with the neurology inpatient team. Residents have hands-on opportunities to perform and become certified in a number of procedures, such as line placements.

Epilepsy and Electroencephalogram (EEG)

Residents learn to perform and interpret routine and long-term EEG monitoring, for both adult and pediatric patients. In addition to reading EEGs, residents will also see epilepsy patients in clinic and receive instruction on the medical and surgical management of epilepsy syndromes. Neurology residents complete a minimum of two months of EEG training during their time in the program.

Neuromuscular and Electromyography (EMG)

During a minimum of two months of EMG training, residents receive hands-on education in the diagnosis of neuromuscular conditions and their management. Residents gradually obtain more responsibility in performing nerve conduction studies and EMG, and after four weeks of training, they will be able to independently perform their own EMG procedures while under supervision.   

In addition to performing EMGs, residents will also see patients in neuromuscular clinics, including the multidisciplinary amyotrophic lateral sclerosis (ALS) clinic. 

Central Virginia VA Healthcare System

The neurology services available at the Richmond-area Veterans Affairs hospital are integral to the Department of Neurology and its residency program. The rotations involve managing the inpatient service, consultations and EEG interpretation, plus they engage in neurology outpatient general and subspecialty clinics.

Day Float

The Day float resident is a PGY-2 who works with the consult team from 12PM-8PM Monday through Thursday, and 7AM-5PM on Saturday and Sunday; the Day Float has Friday off. This resident sees new consults in conjunction with the consult team, is in the pool for responding to acute stroke alerts, and also assists the inpatient team with procedures (LPs, etc) and education of residents and medical students.

Night Float

The night float rotation is two weeks long, consisting of in-house overnight call from Sunday to Friday nights from 8PM-9AM, with Saturday night off. One junior and one senior neurology resident are on night float together and they see emergency consults (including acute stroke alerts), as well as cover the inpatient neurology services.

All consults are staffed via phone overnight with a neurology faculty member. Night float residents present any admissions to the day team in the morning and go home by 9 a.m.

Outpatient Neurology

Our program is unique in that as part of our core curriculum, we provide residents with ample time in several dedicated outpatient subspecialty rotations, starting early in their training and continuing throughout their residency.  

Part of this outpatient experience consists of an Ambulatory Care Center rotation, where residents can explore a variety of outpatient neurology subspecialty clinics of their choosing over the course of the two-week block.   

Throughout their three years of training, residents also maintain a half-day per week of their own continuity clinic.

Pediatric Neurology

Residents manage inpatient and emergency room consults and advise the inpatient pediatric team. During this rotation, residents gain broad experience in the management and treatment of pediatric neurological disorders including epilepsy, developmental abnormalities and metabolic disorders. They are directly overseen by faculty specializing in pediatric neurology.

Psychiatry

PGY-4 residents will spend 4 weeks as members of the psychiatry consult-liaison services at VCU Medical Center. This rotation exposes residents to the diagnosis and management of acute and chronic psychiatric conditions including delirium, depression, anxiety, psychosis, personality disorders and suicidality, plus the intersection of psychiatric conditions and a variety of medical conditions. 

Scholarly Activity

All residents will participate in scholarly activity during their residency. All PGY-3’s present a case at the yearly Night of the Cases dinner (with the highest rated resident receiving a free trip to present their case at the annual Virginia Neurological Society meeting at the Omni Homestead resort). All PGY-4’s present at the departmental Grand Rounds. In addition, residents are encouraged to participate in a research project during their residency, under the guidance of a faculty research mentor of their choosing. Previous research projects have included basic and translational research, clinical research, outcomes and health utilization, education, health care disparities and clinical case presentations with literature review. Residents will also receive training from their research mentors in topics of study design, funding and implementation.

Electives

In addition to the required outpatient rotations detailed above, additional elective time is provided during the 3 years of residency. Potential electives include (but are not limited to): 

• Neuro-radiology
• Neuro-Ophthalmology
• Neuro-pathology
• Neurosurgery 
• Headache/chemo-denervation
• Movement disorders 
• Epilepsy
• Neuro-cognitive/Dementia
• Sleep 
• Neuromuscular
• Neuro-Oncology
• Global Health Neurology
• Tele-neurology
• TBI
• Pain Medicine
• Speech and Language Pathology 

Residents may also use elective time to become more adept at electrodiagnostic tests like EMG, EEG, or to further pursue scholarly projects.