Our rotations are divided into two-to-four-week blocks covering core rotations and electives. We currently have approximately thirteen blocks of elective time during the PGY2-4 years. OHSU neurology is a flexible program offering our residents unique possibilities tailored to meet their education and career goals.
For residents entering our categorical 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 both ACGME and the American Board of Psychiatry and Neurology, and include seven months of internal medicine (including palliative care) and one month of emergency medicine. In addition, interns complete two months of neurology and one month each of stroke, neurosurgery, cardiology, and infectious disease. The neurology residency program director works closely with the internal medicine program director to coordinate the internship year.
At the end of the year, interns emerge with a broad base of knowledge ready to manage medically ill patients. Our residents find this to be a rewarding year where strong bonds are created with other residents and faculty throughout the hospital.
An example schedule:
During the first year of neurology training, the resident develops an understanding of core neurology diseases, localization, and the neurological examination through largely an inpatient setting.
Residents focus on inpatient neurology at the University Hospital and the Portland VA medical center (PVAMC). Ward services at the University Hospital include the general neurology service, stroke service, and the epilepsy monitoring unit. In addition, residents rotate through the neuroscience intensive care unit. At the PVAMC, residents work on the general neurology ward and epilepsy monitoring unit. 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 2–4 weeks in length, with a total of 2–3 months on the University inpatient neurology service, 2–3 months on the inpatient stroke service, 2–3 months on the VA inpatient neurology service, two months of neurocritical care, and 1.5–2 months of elective time (including epilepsy/epilepsy monitoring unit).
Residents also begin their continuity care clinics at the University Hospital and PVAMC through half-day clinics each week. Many of the patients are followed longitudinally throughout the three years of residency.
The second and third years of neurology training serve to expand on skills obtained during the first year and incorporate subspecialty training through consultation services and elective rotations.
The consult senior provides consultations to either the University Hospital or the PVAMC. 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 also supervises the first-year neurology resident on the inpatient neurology ward. Consult rotations are two weeks in length, and a total of three months per year are spent on consult services during the second and third years.
Beyond the consultation services, residents continue to round out their education with a variety of rotations. Senior residents spend one month as a senior resident on the neurocritical care service. Per the American Board of Psychiatry and Neurology, residents also fulfill their three months of pediatric neurology and one month of psychiatry requirements during these years. Residents in their second and third years spend the remaining months on elective rotations, generally scheduled as two-to four-week blocks (see Elective Rotations for selections). These may include subspecialty outpatient clinic experiences or inpatient electives.
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 PVAMC.
Overnight coverage of our clinical services is provided by a night float system. Each academic year, the overnight coverage schedule is distributed evenly across the PGY2-4 resident classes. On average, every resident is scheduled for two separate 2-week blocks of night float per year.
Monday through Saturday overnights are covered by the night float resident. The only overnight coverage not provided by the night float resident is one 12 hour overnight shift on Sunday overnights. This weekly Sunday overnight shift is also distributed across the PGY2-4 resident classes.
A total of 1.5–2 months of elective time are provided to neurology residents during the first year. A total of 8–9 months of elective time are provided during the second and third years, with approximately 3–4 months of electives in the PGY3 year and 4–5 months of electives in the PGY4 year. Elective time is flexible to accommodate the choices and differing career paths of individual residents. Most elective blocks are 2–4 weeks in length.
In addition to elective time, a total of three months of pediatric neurology and one month of psychiatry are completed during PGY3-4 years, as required for Neurology board certification.
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. Residents are also required to take two consecutive months of neuromuscular elective, which includes neuromuscular outpatient clinics and training in electromyography and nerve conduction studies.
Electives and rotations:
- Epilepsy monitoring unit
- Global Neurology: Saipan
- Global Neurology: Botswana
- Movement disorders
- Neuroimmunology/ Multiple sclerosis
- Neurocritical care
- Neurointerventional radiology
- Palliative care
- Sleep and polysomnography
- VA Subspecialty and Teleneurology Clinic
- Future Rotation: Community Practice (Bend, OR)
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 for each resident. 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 flexible use of elective time for research. The research blocks are meant to provide uninterrupted time for the resident to build a research foundation as well as to collect preliminary data toward future research projects in fellowship. A goal of this preliminary research is to support future 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 may have intermittent weekend shifts 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.
Each incoming neurology resident is paired with a neurology faculty adviser who meets with the resident quarterly throughout the four 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 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.
Residents rotate through a variety of general and subspecialty neurology outpatient clinics at University Hospital throughout the three 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 three 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. These subspecialty clinics include Stroke clinic, Dementia clinic, MS clinic, Movement Disorders clinic, and Epilepsy clinic.
We offer excellent conferences aimed at teaching our residents pearls of neurology as well as educating them on the future of neurology. As such, these are driven by resident needs. In the past and through the present day, residents have been able to shape the didactic content to fit their needs.
Resident core conferences
PGY2 Bootcamp: This is a two-week didactic conference and workshop training camp designed to teach junior residents the basics of clinical neurology at the start of the PGY2 year. Our junior residents get to meet many of our core faculty as they learn about key clinical subjects in neurology. Some of the training activities include: Interactive Case Discussions, Mock Stroke Code, Mock Status Epilepticus Code, and a range of orientations to the clinic and outpatient settings. The foundation of the didactic lecture series is our ‘Tool Box’ series of lectures designed to cover what every new clinical neurologist needs to know (with a dedicated focus on emergency neurology). It is also a unique opportunity for our new PGY2 residents to learn and bond together over a two-week period without assigned clinical duties.
Wednesday Grand Rounds: Weekly lectures on pertinent contemporary topics in neurology, typically given by OHSU or invited neurology and neuroscience faculty
Thursday Noon Conference: Weekly conference presented by residents and faculty on a rotating series of subspecialty topics, includes discussion of morbidity and mortality cases once a month
Thursday Afternoon Resident Education Conference: In order to improve resident attendance and to minimize interruptions from cross-coverage, we consolidated our resident didactic conferences to an uninterrupted block from 1:15 to 4:45 P.M. every Thursday afternoon. Activities on Thursday include the following:
- Thursday ‘Noon’ Report: This is our former ‘morning report’ discussion of clinical cases with our Department Chair. It is a weekly activity and actually occurs at 1:15 P.M.
- Thursday Neuroradiology Conference: This is a conference organized twice per month for our residents to review images and build skills in interpreting neuroradiologic images with the guidance of our neuroradiology faculty.
- Thursday Board Review Conference: Over the course of each academic year, we a review a curriculum of 20+ topics in preparation for future neurology board examinations.
Rotating Neuroscience Education Series: This is an ongoing faculty-taught series covering major topics in neuroscience and neuroradiology, recently including Neuropsychiatry, Movement Disorders, Neuromuscular Disorders, Neuropathology, Neuro-Ophthalmology, Sleep Neurology, Aging and Alzheimers, Vascular Neurology, Neurophysiology, Neurogenetics and Molecular Biology, Epilepsy and EEG, Headache, and Emergency Neurology.
Additional conferences for residents (optional and/or rotation specific)
- Neurocritical care lecture series
- Neuropathology (Brain Cutting)
- Epilepsy Case Conference and Epilepsy Surgery Conference
- Movement Disorders video case review
- Aging and Alzheimer’s case review conference
- Neuro-oncology Tumor Board
- Multiple Sclerosis and Neuroimmunology weekly education conference
- “Synapse”: Monthly Departmental gathering to discuss ongoing research projects of interest in the Department