A Day in the Life of a PGY4

The third year of neurology (PGY-4) 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.

General Neurology (~13 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.  As the senior resident, you are responsible for overseeing the general service, and you supervise and teach the junior resident and medical students on service.  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.

Veterans Affairs (VA) Hospital (~13 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 third year neurology resident is responsible for taking care of patient phone messages as well as overseeing any lumbar punctures that are performed during clinic.  You are also responsible for setting up infusions for patients in the outpatient infusion center. Residents at the VA can participate in Stony Brook lectures using teleconferencing.   

Pediatric Neurology (4 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. 

Neurocritical Care 

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.  

Electives (~18 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.


As a third 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.

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.

Vacation 4 weeks