The first year of neurology (PGY-2) at Stony Brook is divided into a variety of different rotations, and a typical day for each is listed below. All of your time is spent at Stony Brook University Medical Center or the Northport VA Medical Center.
General Neurology (~8 weeks):
All neurology admissions other than strokes or TIA’s are admitted to the general team, which consists of a PGY-4 neuro resident, a PGY-2 neuro resident, the attending, and medical students. Your day begins at 7:30AM with morning report where the overnight cases are presented. On most days a lecture follows, and by 9:00AM or 9:30AM you hit the floor and start seeing patients. Interdisciplinary discharge planning rounds with the social worker, case manager, therapists, and nursing occurs around 10:00AM. Attending rounds usually ends before 12PM. We typically have 4-10 patients on the general service at any given time. When rounds are finished, you have the rest of the day to complete your work. All notes, discharges, and dictations will be completed. Lumbar punctures will be performed if needed. Neuroradiologists are available to review films. There will be time to read up on the neurological diseases you encounter. Sign-out to night float occurs at 6PM.
Stroke Neurology (~7 weeks):
All strokes, hemorrhages, and TIA’s are admitted to the stroke team, which consists of a PGY-2 neuro resident, a stroke nurse practitioner or physician assistant, the attending, and medical students. Your day begins at 7:30AM with morning report where the overnight cases are presented. On most days a lecture follows, and by 9:30AM you hit the floor and start seeing patients. Rounds with the attending usually begin around 10AM, and we typically have 10-20 patients on the stroke service at any given time. We have a Step-down Unit where our most critical patients will be admitted. Patients may go there after the administration of tPA, if they require pressors or continuous drips, or if they just need close monitoring. Again you will have the afternoon to complete all of your work, and sign-out to night float occurs at 6PM.
Veterans Affairs (VA) Hospital (~7 weeks):
The VA hospital is in Northport, about 30 minutes West of Stony Brook University Hospital. The VA rotation consists of outpatient office-based care in the Veterans Affairs Hospital. The team consists of a first, second, and third year neurology resident as well as a rotator from psychiatry. However, the majority of the time is spent in the clinics. The day begins at 8AM with patients seen throughout the morning, and the afternoon visits usually end around 5:00. The second year resident attends clinic with the rest of the neurology team and will see consults before or after clinic. On an average day there are one to two new consults called. Residents at the VA can participate in Stony Brook lectures using teleconferencing.
Consults (~7 weeks):
The consult team consists of a first year neurology resident (PGY-2), second year neurology resident (PGY-3), two attendings (a general attending and a stroke attending), and several medical students. Your day begins at 7:30AM with morning report followed by one or two lectures. The senior consult resident (PGY-3) manages the consult team. All emergency room consults, Code BATs (acute stroke codes), potential admissions, as well as new consults from other inpatient teams and ICUs are seen by the consult team. All neurology follow-ups on other floors are also seen by the consult team. The PGY-3 resident will assign consults to the PGY-2 resident as well as medical students and occasional rotators from other departments. During the course of the day, you will see the consults from the night before with one of the attendings, follow up on established patients, and see new consults and present them to the attending. Your shift ends at 6PM with sign-out to night float. Sign-out on Fridays is at 5PM. The residents usually rate this rotation as one of the busiest rotations but also best learning experiences.
Ambulatory Rotation (~9 weeks):
Stony Brook Neurology is transitioning to a 5+1 System. For 2020-2021, only PGY-2 residents are participating in the 5+1 system. By 2021-2022, both PGY-2 and PGY-3 residents will be included, and by 2022-2023, all Neurology Residents will be part of the 5+1 system. In this system, for 5 weeks, residents will be on inpatient rotations (or VA) and on the 6th week, they will be on one whole week of Stony Brook outpatient (or VA). While on the ambulatory rotation, days start with morning lectures which will either be attended in person or virtually. After lecture, clinic begins at 9:00AM in our Stony Brook outpatient offices about 12 minutes away. When residents are in Stony Brook clinic (Mondays, Wednesdays, Thursdays), they will have a variety of faculty preceptors. Residents will either see their personal continuity patients or have the opportunity to participate in one of our attending-run specialty clinics such as ALS, sleep, or multiple sclerosis. On Monday & Tuesday afternoons, the ambulatory rotator heads over to the VA in Northport to see patients in the VA clinic. Every Wednesday morning lumbar punctures are scheduled, where residents will perform two to four LP’s. On Fridays residents have morning lectures and academic time, and in the afternoon you will have Stony Brook continuity clinic. The typical day ends at 5:00.
PGY2 Schedule on 5+1 system
|AM||Continuity Clinic||Elective*||LP||Continuity Clinic||Academic|
|PM||VA||VA||Continuity Clinic||Continuity Clinic||Continuity Clinic|
*Elective means that after lecture, residents have elective time (e.g. EEGs, specialty clinic), research time, or can schedule a personal appointment if needed.
Night float is Sunday through Thursday, and your shift starts at 6PM. You are responsible for all in-house consults (both pediatric and adult) and neurology admissions while on-call overnight. During the week, a senior resident will stay with you until 9PM to help out with consults, and then he or she is available all night from home as back-up, and can come in to the hospital if necessary. All cases are presented to an attending via telephone. By July 2022, when we have grown to our full complement of 6 residents per year, we will have a Senior Night Float Rotation in place. This means that a PGY-3 or PGY-4 resident will be in-house with you at all times. Your Night Float shift ends at 7:30AM with Morning report during which 1-2 cases from the night before are presented. Night float occurs in very manageable one to two week blocks with Fridays and Saturdays off.
Elective (2 weeks):
A variety of elective opportunities exist for residents throughout the training program. For PGY-2 residents, you are encouraged to do one week of EEG and one week of Neuroradiology.
For 2020-2021, PGY-3 and PGY-4 residents see their continuity clinic patients every Friday afternoon. Because we are transitioning to a 5+1 system, PGY-2 residents see their continuity clinic patients only during their Ambulatory rotation, and will see their own continuity patients on Monday mornings, Wednesday afternoons, all day Thursday, and Friday afternoons. As we continue to phase in the 5+1 system, all residents will end up seeing their own continuity clinic patients in this way, only during their ambulatory rotation weeks rather than every Friday afternoon. Our patient population is diverse and includes individuals with multiple neurologic ailments. In our newly renovated outpatient offices, the examination rooms are fully equipped with all that you will need for your exam, plus a computer for EMR, and all cases are presented to an attending who will then examine the patient with you. You will make your own management plan and the attending is available for guidance. The most important aspect of continuity clinic is that these patients truly become your own, and you will continue to follow them throughout your years at Stony Brook.
Weekend call is broken up into three different shifts. The Friday night person covers from 5PM Friday to 7AM Saturday. A senior resident stays with you until 9PM to help with consults, and is available as back-up from home the rest of the night. Saturday call starts at 7AM and goes until 7AM on Sunday. You and a senior resident round with the attendings and write notes on our own neurology inpatients, and then the junior resident covers consults for the rest of the shift. The senior resident stays most of the day and leaves on Saturday evening at 6PM, taking back-up call from home. There is a third resident in-house on Saturday who is a PGY-2 resident taking Short Call that makes the day run smoother for the rounding PGY-2 resident. The next team comes in at 7AM on Sunday, receives sign-out from the Saturday resident, and then the new team rounds with the attendings and writes notes on our inpatients. Both the junior resident and the senior resident cover consults until the night float resident comes in at 6PM on Sunday. Again, the senior resident is available from home as back-up, and an attending is available at all times. In a typical month, you will be on-call for three weekends and have one weekend off.