The second year of neurology (PGY-3) at Stony Brook is divided into a variety of different rotations (+ electives), 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.
Consults (~10 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. On average each day, you will receive 6-10 new consults (including Code BATs), plus will follow up on 4-6 patients on the inpatient floors and ICUs. In contrast to the PGY-2 experience on the consult team, the PGY-3 consult rotation is a more advanced rotation that includes more independence, as well as supervision and teaching of junior residents and medical students. Your shift ends at 6PM with sign-out to night float. Sign-out on Fridays are at 5PM. The residents usually rate this rotation as one of the busiest rotations but also best learning experiences.
Veterans Affairs (VA) Hospital (~11 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. The second year neurology resident is responsible for any consults requested by the emergency room or by other services for their inpatients. 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.
Pediatric Neurology (8 weeks):
The pediatric neurology team consists of an attending, a pediatric neurology resident, an adult neurology resident, medical students, and sometimes a general pediatrics resident. You are required to do twelve total weeks of pediatric neurology during your residency, with eight weeks during the PGY-3 year, and four weeks during the PGY-4 year. After AM report, you pre-round on the patients being followed by the peds-neurology team, and then you are responsible for the inpatient and pediatric emergency room peds-neuro consults. Over the course of this rotation there is also significant exposure to pediatric and neonatal EEGs. You will round on all patients seen, and your day ends at 6PM with sign out to night float.
Psychiatry (4 weeks):
During this rotation, you are a member of one of the in-house psychiatry consult teams. There are two teams, each with their own attending, and the teams alternate seeing consults called into the psychiatry department. You will still attend neurology morning report at 7:30AM and go to all neurology lectures, and then you will pre-round on your psychiatry patients that you saw the day prior. At 9:30AM you meet in the psychiatry department conference room where the attending and residents go over the consults from overnight and new consults that still need to be completed. Throughout the day you will round and see consults with the attending, and your work is typically completed at 5PM.
Neurocritical Care (~8 weeks)
All Neurology residents spend time in the Neurocritical Care Unit (NCCU). The Unit is run by a Neurocritical Care Attending. The day starts in the NCCU at 7:00PM. You pre-round on your patients prior to attending rounds. Attending rounds start at 9:00PM and are interprofessional, including nurses, residents, medical students, nurse practitioners/physician assistants, and allied professionals. Afternoon rounds take place around 4:00PM, and signout is at 6:30PM. Residents do not cover the NCCU on nights or weekends. The NCCU includes multi-disciplinary patients, and there is collaboration with the Neurosurgery, Stroke, and Epilepsy teams. Residents gain experience with different procedures and concepts, including ventilator management, management of elevated ICP, management of EVDs, how to perform and interpret TCDs, and continuous vEEG monitoring.
Elective (~8 weeks):
There are many elective opportunities available at Stony Brook during the second and third years of neurology including Neuro-ophthalmology, Neuroradiology, Pain management, Movement Disorders, Sleep Disorders, and more). You can also choose to do additional weeks of our consult service or stroke service.
There are also a few “required” electives that are required to be completed during either the second or third year of the neurology residency including:
EMG (4 weeks): This rotation takes place in the outpatient Stony Brook neurology clinic, and you will have the opportunity to observe and/or perform EMG’s with the neurophysiology fellow and attending.
Epilepsy/EEG (4 weeks): This rotation takes place in the Epilepsy Monitoring Unit within Stony Brook University Hospital. You will work closely with the neurophysiology fellow, epilepsy fellow, Epilepsy NPs, and attendings who read all of the routine and video EEG studies performed throughout the hospital. You will also examine and follow the patients admitted to our inpatient Epilepsy Monitoring Unit.
Neuroradiology (2 weeks): This rotation takes place in Stony Brook University Hospital, and films are reviewed with one of the attending neuroradiologists. You will get to see a large variety of adult and pediatric neurologic imaging.
Continuity Clinic:
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 week. More details about that in the “A Day in the Life of a PGY2” section. Until all three years of Neurology residents transition to the 5+1 system, senior residents will continue to see their own continuity patients on Friday afternoons only. Every Friday afternoon, the senior residents attend our continuity clinic where they will typically see 4-6 patients. 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 three years at Stony Brook.
Call:
As a second year resident, you will have two to three Stony Brook weekday call shifts per month which begin at 6PM after your regularly scheduled workday is over. You will stay with the night float resident in-house until approximately 9PM in order to help out with any new consults. From 9PM until morning report the next day, you will be available as back-up from home if the junior resident requires any assistance. The senior resident on call is also responsible for answering any outpatient calls. You will also typically have one Stony Brook weekend shift per month in which you report at 7AM on either a Saturday or a Sunday. You will work with the junior resident and round with an attending on our neurology inpatients. Once all of your work is finished and all consults are caught up on, you will then be able to leave at 6PM to take the rest of your shift as back-up from home.
During the second year of neurology, call for the VA hospital is also from home. We have no in-house neurology coverage at the VA overnight, and weekday home-call is split amongst the first and second year neurology residents, as well as the psychiatry rotator. You will typically have two to three VA weekday home-calls per month. Weekend VA coverage is provided exclusively by the second year neurology residents, and you will typically cover two weekend days each month. You will occasionally be called in to the VA while on home-call.
Night Float:
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. On these nights, the PGY-3 or PGY-4 Senior Night Float Resident works alongside the PGY-2 Junior Night Float Resident. In addition to sharing consults and patient care, the Senior Night Float Resident will supervise and teach the PGY-2 resident. Additional responsibilities include answering any outpatient calls. Night float is Sunday through Thursday, and your shift starts at 6PM. You and the PGY-2 are together responsible for all in-house consults (both pediatric and adult) and neurology admissions while on-call overnight. All cases are presented to an attending via telephone. 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.