Program Description

INTERNSHIP YEAR PGY-1

For residents entering the four-year training program after medical school, the first year of residency training includes an internship year with a strong emphasis in internal medicine. The internship rotations satisfy the requirements of the American Board of Psychiatry and Neurology, and include 7 months of internal medicine (including one month of palliative care), 1 month of emergency medicine, 1 month of psychiatry, 1 month of neurosurgery, 1 month of stroke, and 1 month of neurology. The neurology residency program director works closely with the internal medicine program director to coordinate the internship year.

FIRST-YEAR NEUROLOGY PGY-2

The first year of neurology training is well supervised and emphasizes experience on the inpatient neurology wards at University Hospital and the Portland VA Medical Center. The inpatient neurology service at the University Hospital includes a stroke service in addition to a general neurology service. Medical students and interns from psychiatry, internal medicine and neurosurgery rotate through the neurology inpatient services and work closely with first year neurology residents. Neurology faculty make daily attending rounds and directly supervise neurology residents on the inpatient ward services at the University and the VAMC. Rotations are 1 month in length, with a total of 3 months on the University inpatient neurology service, 3 months on the inpatient stroke service, 3 months on the VA inpatient neurology service, 1 month of neuroradiology, and 2 months of neurocritical care.

First year residents attend one half-day neurology continuity clinic per week at the University Hospital and one half-day clinic per week at VAMC throughout the first year. Residents will continue to follow many of their patients in the outpatient clinics during their second and third years.

SECOND AND THIRD YEAR NEUROLOGY PGY-3 AND PGY-4

During the second and third years of neurology training, residents rotate on the neurology consultation services at the University and Portland VA Medical Center hospitals and select a variety of elective rotations. The neurology consultation services provide consultation to the University and VA emergency rooms and to the inpatient medical and surgical services at both hospitals. Neurology residents round daily with the consult attending and supervise the consult team, which may include medical students, internal medicine residents, and psychiatry residents. The neurology resident on the consult service may also supervise the first year neurology resident on the inpatient neurology ward. Consult rotations are 1 month in length, and a total of 3–4 months per year is spent on consult services during the second and third years. In addition, second year residents spend one month as a senior resident on the neuro-critical care service.
Residents in their second and third years spend the remaining months on elective rotations, generally scheduled as 1–2 month blocks (see Elective Rotations).

Second and third year neurology residents continue to attend a minimum of one half-day neurology clinic per week at the University hospital and one half-day neurology clinic per week at the VAMC. Many of the patients are followed longitudinally throughout the 3 years of residency. Additional subspecialty outpatient clinic experiences are included during elective blocks.

RESEARCH & SCHOLARSHIP

Scholarship in its many forms is strongly encouraged in the OHSU Neurology Residency Program.  All residents are expected to complete a scholarly project during the course of the residency. This could take the form of a traditional research project leading to a peer reviewed journal article, but is flexible to meet the needs of each resident and could alternatively take the form of a case series report, a web based teaching module, or development of clinical pathways or quality improvement methods. The department provides a generous book/travel fund (currently $1500 per year for each resident during PGY-3 and PGY-4 years).  In addition, the department pays the major costs of travel and expenses for any resident who presents a paper or poster as first author at a national meeting.

The OHSU Department of Neurology is highly engaged in Clinical and Basic Science research, and is committed to training the next generation of neurology researchers.

To further this aim, the OHSU Neurology Residency program offers a flexible research track during residency. Qualified candidates with dedication to an academic research career may apply during their PGY-2 year to enter this program, which blocks 3-6 months across the end of PGY-3 and beginning of PGY-4 years to permit dedicated research experiences. The research block is meant to provide the foundation for applications for mentored research grants such as a K23 or VA Career Development award. The research block is in lieu of other residency elective time. Residents continue continuity clinic and night call (currently about every 10th night) during the research block, but are otherwise free of clinical responsibilities while on the research block.

Residents interested in clinical research can concurrently apply to participate in the OHSU Human Investigators Program, which provides comprehensive training in clinical research study design, statistical analysis, grant writing, and manuscript writing and presentation.

Residents interested in laboratory-based basic science can prepare themselves to submit a K08 or similar application during the PGY-4 year. More information is available upon request.

MENTORING

Each incoming neurology resident is paired with a neurology faculty preceptor who meets with the resident quarterly throughout the 3–4 years of residency. These meetings provide an opportunity to discuss elective selection, career plans, research project guidance, feedback on attending evaluations, and feedback on the training program. In addition, the neurology residency program director and associate program director, Drs. Dan Gibbs and Ed Kim, meet monthly with the residents to discuss training issues and to develop new programs and policies. Informal discussions between the program director or other faculty members and the residents regarding the residency training are encouraged.

OUTPATIENT CLINICS

Residents rotate through a variety of general and subspecialty neurology outpatient clinics at University hospital throughout the 3 years. First year neurology residents spend one half-day per week in a general neurology clinic. Second and third year neurology residents spend one half-day per week in a subspecialty neurology clinic at University hospital. The six subspecialty clinics included are Aging and Dementia clinic, Epilepsy clinic, Movement Disorders clinic, Multiple Sclerosis and Neuroimmunology clinic, Neuromuscular clinic, and Stroke clinic. Residents evaluate new patients appropriate to the subspecialty clinic and also continue to follow patients seen in previous clinic rotations. Neurology faculty attendings are present at all clinics to staff patients with residents. Faculty are also seeing patients in the same subspecialty clinics and will involve the residents in team conferences and teaching exercises over the course of the clinic.

Residents rotate through the VAMC general neurology continuity of care clinics for one half-day per week throughout the 3 years. Patients with a wide variety of common and uncommon neurological disorders are seen in these clinics. Several neurology faculty are present at every clinic to provide staffing for new and follow-up patients. Residents may rotate through additional faculty subspecialty neurology clinics at the VAMC while on elective rotations. These subspecialty clinics include Stroke clinic, Dementia clinic, and Seizure clinic.

ELECTIVE ROTATIONS

A total of 12 months of elective time is provided to neurology residents during the second and third years, with 6 months of electives per year. Elective time is flexible to accommodate the differing career paths of individual residents. Elective blocks are 1–2 months in length. A total of three months of pediatric neurology, one month of psychiatry, and two months of basic science (e.g. neuroradiology, neuropathology, or basic science didactic elective) are required for Neurology board certification.

Popular structured electives, which most residents take for 2–4 months, are:

Neuromuscular elective, which includes neuromuscular outpatient clinics and training in electromyography and nerve conduction studies. 

Epilepsy elective, which includes epilepsy outpatient clinics, reading of electroencephalograms (EEG), reading of evoked potential studies, and EEG/CCTV seizure monitoring unit experience.

Additional electives available

• International elective
• EEG 
• Neuroophthalmology
• Neuro-critical care
• Movement Disorders 
• Multiple Sclerosis 
• Stroke
• Sleep disorders
• Neuro-otology
• Pain Management
• Neuro-oncology

Residents may use elective time to attend additional outpatient clinics in neurology or other related specialties or to participate in other consultation services, such as psychiatry or neurosurgery. Residents may also use elective time to participate in research projects.

TEACHING CONFERENCES

A variety of clinical and teaching conferences for residents and faculty are scheduled each week. These occur at the beginning of the working day or in a noon lunch format to allow all residents to attend.
Neuroscience Grand Rounds are held weekly in the University Hospital South Lecture Hall at OHSU and are attended jointly by faculty and residents from the Department of Neurology and the Division of Neurosurgery. Community neurologists and neurosurgeons also attend Neuroscience Grand Rounds regularly. Topics are clinically relevant, and invited guest speakers are common.
A Neuroradiology and neuro-oncology conference is held weekly to review neuroimaging studies of inpatients at the University and VAMC hospitals and to review neuro-oncology clinical cases, and provide a didactic instruction. Relevant teaching cases and films are included in this conference. Neuroradiology teaching rounds are built into the daily neurology work rounds schedule, and pertinent imaging studies are reviewed in “real time” with a neuroradiology faculty.

A Neuropathology conference is held weekly, which includes clinical case presentations and review of biopsy or autopsy material.
Morning report is held weekly with the residents. This conference is faculty run, and inpatients and consultations seen by the residents during the on call hours are reviewed with the Department Chairman or another faculty attending.

A weekly clinical Thursday noon conference attended by faculty, residents, and students’ reviews clinical topics, with an outpatient emphasis.  Both faculty and residents may present case discussions at the noon conference. A monthly Morbidity and Mortality conference is held to review patient care issues for the University and VAMC neurology inpatient services.

A weekly clinical Neuroscience Lecture Series designed specifically for the residents, runs throughout the 3 years of residency.  Faculty speakers from the University and from OHSU’s allied research centers present units on neuroanatomy, neurophysiology, neuropharmacology, molecular biology, and neuropathology in a series of 60-minute lectures.  Handouts and references are provided. This lecture series provides a valuable supplement to self study in the basic neuroscience material necessary for Neurology board certification.

A monthly journal club for residents facilitated by faculty members. This includes a comprehensive evidence based medicine course taught by the program director. In addition, there are several subspecialty neurology journal clubs and conference in which faculty participate. Residents are encouraged to attend subspecialty journal clubs of interest to them.

A weekly epilepsy case conference is held in the resident conference room.

Resident Core Conferences

• Morning Report: Discussion of Clinical Cases with Department Chairman
• Neuroradiology/Neuro-oncology: Weekly Case based noon conference for residents
• Neurology Grand Rounds: Weekly Conference with Clinical and Research based topics
• Clinical Neurology Conference: Weekly noon conference presented by residents (1/3) and faculty (2/3) on a rotating series of clinical topics.
• Morbidity and Mortality: Once per month includes discussion of morbidity and mortality cases
• Clinical Neurosciences: Weekly Faculty taught series over 3 years covering major topic blocks including: neuroanatomy, basic neurophysiology, neuropharmacology, neuropathology, and emergency neurology
• Neurology “Tool Box” series: Annual series of important topics to get new residents up to speed on the most critical skill sets.
• Friday Resident Conference: Includes monthly evidence based medicine course taught by program director, monthly meetings with program director and associate program director, journal club, and additional clinical topics
• Difficult Case Conference: Monthly discussion of challenging clinical cases with resident and faculty participation

Additional Conferences for Residents (optional and/or rotation specific)

• History of Neurology: Optional quarterly discussion of the specialty’s major historical milestones, led by the Chairman
• Neuro-critical care lecture series
• Neuropathology (Brain Cutting)
• Neuromuscular and Muscle Biopsy Conference
• Epilepsy Case Conference and Epilepsy Surgery Conference
• Movement Disorders video case review
• Aging and Alzheimer’s Case review conference
• Neuro-oncology Tumor Board
• “Synapse”: Monthly Departmental gathering to discuss ongoing research projects of interest in the Department