University Hospital Inpatient Stroke Service
The stroke service team consists of senior and junior neurology residents, a stroke neurology attending, medical students, and stroke fellow when available. The primary responsibilities of the team include taking care of stroke patients on a specialized stroke unit, acutely responding to stroke codes, and following up with stroke-specific consults. Junior neurology residents are the first responders to stroke codes with additional assistance from the senior resident and stroke fellow when available. A stroke neurology fellow or attending is available to staff stroke codes in-person or over the phone. Over time, residents will become comfortable independently running stroke codes and making an initial acute treatment plan with supervision from stroke fellows and attendings as needed. The stroke service provides continuity, not only from a patient perspective, but also to the residents and students taking care of stroke patients from the time of the initial stroke code through the hospital course.
University Hospital Inpatient Service
The general neurology team consists of senior and junior neurology residents, an attending, medical students, and a nurse practitioner. The team takes care of all non-stroke neurology inpatients, including those admitted with acute illnesses and those admitted for EEG monitoring or chemotherapy for CNS neoplasms. Approximately 1,300 patients are hospitalized each year between the two Neurology inpatient services, and residents assume the major responsibility for patient care under the supervision of Neurology faculty.
Junior Night Float
The Junior Night Float resident’s day starts at 4:30 p.m. every weekday. They take new consults until the Senior Night Float resident arrives at 8 p.m., and then helps cover floor patients until 3 a.m.
Senior Night Float
The Senior Night Float sees consultations at night starting at 8 p.m. He or she also supervises the Junior Night Float, helps out with cross-cover if needed, and presents any admissions to the team in the morning.
Neuro ICU Service
Residents rotate through the neurological intensive care unit for two weeks during their intern year, and one month during their PGY2 or PGY3 year. Residents learn to admit, diagnose and treat those neurological patients whose acuity level requires intensive care.
Neurology Outpatient Services
Our program differs from many other programs in that the Neurology Clinic is a major training site. Our clinic has successfully integrated the efforts of residents and faculty to provide not only a high standard of care but also a quality learning experience. Each resident works full time in the various University Hospital Clinics for approximately six months during the residency.
Residents do focused outpatient rotations in each of the following:
- Multiple sclerosis
- Headache and neuropathic pain
- Neuromuscular disease
- Movement disorders
- Cognitive disorders
- Sports Neurology
- Sleep Disorders
In addition, residents maintain the equivalent of a weekly half-day Continuity Clinic throughout their residency.
The Neurology Service at the VA Ann Arbor Healthcare System is an integral part of the Neurology Program. Three neurology residents are assigned to the VA every month. All three spend the morning in the VA Outpatient clinic. In the afternoons, two of the residents will see consultations at the VA medical center (approximately 250 per year) or care for any inpatients on the neurology service (approximately 60 per year). The senior resident at the VA also helps with EEG interpretation. Active involvement by full-time faculty ensures a quality learning experience. The third resident at the VA joins the Psychiatry Consultation service in the afternoons to learn principles of psychopathology, psychiatric diagnosis and therapy, and the indications for and complications of drugs used in psychiatry.
Residents spend an average of one month per year on the Pediatric Neurology rotation. The consultation service evaluates approximately 1,200 children per year in Mott Children's Hospital at the University of Michigan Health System. Four mornings per week are spent in clinic where residents see only new patients. Residents also do inpatient and emergency room consults and advise the inpatient pediatric team. During this rotation, the resident gains a wide experience in the management of children with seizure disorders, developmental abnormalities, metabolic disorders affecting the nervous system and other neurological problems.
The six-week EEG rotation takes place during the latter half of the first year or the first half of the second year of residency training. During this rotation, the resident learns to perform and interpret both outpatient electroencephalograms and long term EEG monitoring. There is also opportunity to learn more about intraoperative monitoring and surgical treatments for epilepsy.
Electromyography (EMG) / Neuromuscular
The EMG rotation is at least two months long, although many residents choose to do an additional month immediately afterwards. Residents receive didactic and hands-on training in electrodiagnosis of disorders affecting the peripheral nervous system. Over the course of the rotation, the resident becomes increasingly independent and may perform more than 100 EMG studies under supervision. Residents also participate in the clinical evaluation and treatment of patients with neuromuscular diseases and in the examination of nerve and muscle biopsies.
The University of Michigan also is the home of EMG Whiz, a popular Web-based EMG training simulator for residents and fellows.
Residents work on teams throughout the year to develop and implement longitudinal quality improvement projects. The QI blocks allow senior residents the opportunity to have dedicated time to plan a project, collect and analyze data surrounding a quality issue, and work to make a meaningful change in the way the system works.
In addition to the outpatient selectives detailed above, an average of five months of elective time are provided during the three years of residency. Many residents choose to work on clinical or basic research during this time. Other popular electives include neuroradiology, neuro-ophthalmology, sports neurology, neuropathology, neurosurgery, neurological education, neuroimmunology, genetics, stroke, sleep, movement disorders and epilepsy. Residents may also use elective time to become more adept at electrodiagnostic tests like EMG, EEG, evoked potentials and intraoperative monitoring. Residents may also choose to do electives in international health care.
Every resident gets two two-week vacations per year. Vacation is scheduled in "blocks," so it is not taken during other rotations.
The call schedule varies from rotation to rotation.
The night float residents (senior and junior) share the overnight in-house call at the University Hospital five-six nights a week.
All residents on the VA Medical Center rotation take home call an average of every third night. Residents will need to come in to see any emergency consultations. On average, this is about once every two to three calls.
All residents on Pediatric Neurology take home call an average of every third night. This tends to entail answering phone calls from patients' parents after hours, and is especially busy in the early evenings. Rarely, residents will need to come in to see an emergency consultation.
Residents who are not on any of the aforementioned rotations split the overnight call the one night a week that is not covered by night float. This averages out to 2.5 calls night/year.