The third year of neurology (PGY-4) at Stony Brook is divided into three 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.
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 9AM you hit the floor and start seeing patients. As the senior resident, you are responsible to oversee the general service, and you provide guidance to and teach the junior on service. Discharge rounds with social work, the case manager, and nursing staff occurs at 9:30AM. Rounds with the attending will usually begin around 10AM, and we typically have four to ten patients on the general service at any given time. Rounds are usually completed in the early afternoon, and you have the rest of the day to complete all of your work. All discharges and dictations will be completed, lumbar punctures are performed if needed, neuroradiologists are available to review films, and all other tasks are finalized. Sign-out to night float occurs at 6PM.
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 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 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. 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.
Pediatric Neurology (4 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 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 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 go to resident continuity clinic in the morning and then Muscular Dystrophy Association (MDA) clinic at St. Charles in the afternoon.
Electives (~18 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.
There are also a few “selectives” 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.
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 required 2-week selective 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 NICU 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 five to seven 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 have continued to follow them throughout your three years at Stony Brook.
Call:
Call during the second and third years of the neurology residency is done from home. As a third 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. You will also typically have one Stony Brook weekend shift per month in which you report at 7AM on a either 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 third year of the neurology residency, you are not required to cover any of the VA home-call shifts.