The second year of neurology (PGY-3) at Stony Brook is divided into four main rotations (plus electives), and a typical day for each is listed below. All of your time is spent at Stony Brook University Medical Center unless otherwise noted.
Consults (~13 weeks):
The consult team consists of the second year (PGY-3) neurology resident, two attendings (a general attending and a stroke attending), and occasionally a first year (PGY-2) neurology resident and several medical students. The typical day begins at 7:30AM with morning report where the overnight consults are presented. All emergency room consults (and potential admissions) as well as new consults from other services are managed by this team. All neurology follow-ups on other floors are also seen by the consult service. The second year resident is responsible for managing the consult team, as well as running all Code BAT’s (our acute stroke code). 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 appropriate attending. On average, you will receive six to nine new consults and will follow up on four to six previously seen patients every day. Your shift ends at 6PM with sign-out to night float. Sign-out on Fridays are at 5PM when the junior and senior resident on call return from continuity clinic.
Veterans Affairs (VA) Hospital (~13 weeks):
The VA rotation consists of outpatient office-based care in the Veterans Affairs Hospital in Northport, NY. 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, which are held Monday through Thursday. The day begins at 8AM with patients seen throughout the morning, and the afternoon visits usually end between 4:00 and 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. Every Tuesday, all residents report to Stony Brook for morning lectures and then the VA residents proceed to Northport for afternoon clinic. On Friday, all residents again report to Stony Brook for morning lectures which are followed by our Stony Brook continuity clinic in the afternoon. Also on Friday, the VA second year resident will have Stony Brook continuity clinic in the morning to make up for the continuity clinics they miss during their consult weeks.
Pediatric Neurology (8 weeks):
The pediatric neurology team consists of an attending, a pediatric neurology fellow, a neurology resident, and possibly a medical student. You are required to do twelve total weeks of pediatric neurology during your residency, with eight weeks during the PGY-3 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 emergency room peds-neuro consults. You will round on all patients seen, and your day ends at 6PM with sign out to night float. On Fridays you will report to resident continuity clinic as usual, except for the first and third Fridays of the month when you will go to resident continuity clinic in the morning and Muscular Dystrophy Association (MDA) clinic at St. Charles in the afternoon.
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. These are distributed among the psychiatry resident, the neurology resident, and—if they are currently rotating—a family medicine resident or medical students. Throughout the day you will round and see consults with the attending, and your work is typically completed at 5PM. You will continue to attend neurology continuity clinic on Friday afternoons while rotating through psychiatry.
Electives (~10 weeks):
There are many elective opportunities available at Stony Brook during the second and third years of neurology including neuro-ophthalmology, neuro-radiology, interventional neurology, neurosurgery, pain, and sleep at our outpatient sleep center in Smithtown, NY (ten minutes away). You can also choose to do additional weeks of our consult service or stroke service. Some “away” electives that residents have rotated through in the past include movement disorders and headache in Manhattan.
There are also a few “selectives” that are required to be completed during either the second or third year of the neurology residency including:
Movement Disorders (2 weeks): This rotation can be scheduled with our movement disorder specialist at Stony Brook in our out patient clinic. Here you will have an opportunity to see patients with movement disorders including Parkinson’s disease, tremors, chorea, dystonia, tics, parkinsonism, etc. Your typical day begins at 9AM and ends at 5PM. As usual, you report to resident continuity clinic on Fridays.
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.
EEG (4 weeks): This rotation takes place in the neurology epilepsy unit within Stony Brook University Hospital. You will work closely with the neurophysiology fellow and attending 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 four-bed epilepsy monitoring unit.
Neurology ICU (2 weeks): This is a required 2-week selective that is performed at Winthrop Hospital in Mineola, NY, which is about 35 miles west of Stony Brook. Stony Brook University Hospital is currently working on starting its own neuro ICU, but until that time, we will complete our ICU training at Winthrop. The unit is covered by physician assistants with supervision by a neuro critical care attending, and there are no other residents in the NICU. The day begins around 8:30AM, at which time you will follow up on the overnight admissions until rounds begin. Depending upon the volume, attending rounds can go through the early afternoon. After rounds, there may be a conference or a new patient in the emergency room to be evaluated or admitted. Occasionally there are quick attending rounds later in the afternoon, and by 4-5PM your work is complete. You do not report to resident continuity clinic on Fridays during your Winthrop rotation.
Neuroradiology (2 weeks): This rotation takes place in Stony Brook University Hospital, and you sit with one of the neuroradiologists on staff. You will get to see a large variety of adult and pediatric neurologic imaging.
Continuity Clinic:
Every Friday afternoon, all residents (except those on an away elective more than one hour away) attend our continuity clinic where you will typically see four to six patients. Our patient population is diverse and includes individuals with multiple neurologic ailments. The examination rooms are fully equipped with all that you will need for your exam, 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, 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 out patient 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.