Neurology Residency Program Structure

With a wide breadth and depth of outpatient experiences, our residents have opportunities to follow their own continuity patients for three years, as well as see clinic patients in multiple different subspecialties.

Starting in the first year of residency, residents maintain a longitudinal General Neurology clinic, working with the same attending every other week. The staffing is dynamic, with an increased level of supervision in the first year, and graded levels of autonomy in later years. Since residents work closely with this attending over three years, they often serve as not only a clinical teacher but also as an advisor and mentor. In the first year residents also rotate in a Pediatric Neurology clinic at Boston Children's Hospital every other week. Residents find this allows them to develop a greater level of comfort with childhood neurologic diseases, which often persist into adulthood. This clinic only operates every other week in the first year, and for the second year residents pick a second Adult Neurology clinic.

Subspecialty clinics occur during elective and subspecialty blocks. During the first year, residents participate in a Neurophysiology block, when they may rotate through clinics in the subspecialties of Epilepsy, Neuromuscular, and Sleep Neurology. There is also a Neurorehabilitation block during the first year, when residents spend time in the Cognitive Neurology clinic. During the second and third year Elective blocks, residents rotate through subspecialty clinics of their choosing. Popular clinics among residents include Neuro-ophthalmology, Neuroimmunology/MS, Movement disorders, Neuro-oncology, Headache, Autonomics, Epilepsy, Neuromuscular, Sleep, and Neuro-ID. Finally, there is an option to add a longitudinal Movement disorder clinic for 6 months during the PGY4 year, for residents with a particular interest in Movement disorders or outpatient Neurology.

The inpatient program is divided into ward and consult rotations during the first two years, which are supervised by Chief Residents in the third year of the program. The neurology inpatient wards at both Beth Israel Deaconess Medical Center and Children's Hospital are run on a full-time staff model, where the ward team includes the first-year residents under the supervision of a Chief Resident and a teaching attending. Residents take major responsibility for evaluation and management of all patients, with the support of the attending staff. Beth Israel Deaconess is a single hospital, but operates from two sets of buildings, East Campus and West Campus. The Neurology/Neurosurgery ward and Neurology/Neurosurgery ICU are located on West Campus, along with the Emergency Department; the East Campus houses most of our outpatient facilities, including the Neurology outpatient offices in the Shapiro Clinical Center. The Department of Neurology provides consultation services on both campuses.

• Learn more about our Global Neurology elective

*Rotation schedules are meant to be an approximation of an average schedule. Because of clinical need, unexpected absences, or other factors, individual schedules may vary somewhat from the typical pattern.

PGY2		PGY3		PGY4
Rotations	Weeks	Rotations	Weeks	Rotations	Weeks
General Ward	10	West Consult	10	General Wards Chief	8
Stroke Ward	10	East Consult	6	Stroke Wards Chief	8
Neuro ICU	8	Emergency Department	6	Emergency Department	8
Children's Ward	4	Night Float (first half)	4	Neuropathology	4
Neurorehabilitation	4	Children's Consult	4	Psychiatry	4
Neurophysiology	6	Neuro ICU	5	Elective	16
Neurosurgery	3	Stroke Consult		Vacation	4
Night Float (latter half)	4	Elective	9
		Vacation	4

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During the first year, residents primarily take responsibility for neurology ward inpatients and the Neuro ICU at Beth Israel Deaconess Medical Center and the neurology ward at Children's Hospital, only covering consultations on nights and weekends. At BIDMC, the inpatient neurology ward is divided into the Stroke Service and the General/Epilepsy Service. During the first year, residents rotate in the Neuro ICU with the multidisciplinary team caring for acutely ill Neurology and Neurosurgery patients. There is a rotation in Neurosurgery where residents divide time between OR, Neurosurgery clinics, and inpatient services. There are three blocks of Neurophysiology, when the residents learn the principles of electroencephalography and epilepsy; electromyography and neuromuscular disease; and sleep medicine. The Neurorehabilitation block also takes place in the first year, when residents spend time at a Rehabiliation hospital (Spaulding) under the supervision of neurologists with special training in rehabilitation medicine, and also spend time in the Cognitive Neurology clinic at Beth Israel Deaconess.

The BIDMC neurology rotations subscribe to the ACGME and AAMC policy limiting duration on call and work week. Night call on the neurology wards at BIDMC is covered from Sunday through Thursday by a dedicated night resident rotation, to ensure that ward residents get adequate sleep and time off. Night call on Friday and Saturday nights is covered by the resident on call that day, who is able to go home immediately after rounds the following morning and is off for the remainder of the weekend. Residents start their Night Float rotations at BIDMC during the latter half of the first year, which will continue into the second year. Night call at Children's Hospital during the first year is every fourth night. Electrophysiology, Neurorehabilitation, and Neuro ICU ordinarily have no night call.

During the second year, residents primarily rotate through consult services on both the East and West Campuses of Beth Israel Deaconess Medical Center and at Children's Hospital. In addition, there is a rotation in neurological intensive care medicine at Children's Hospital, and a rotation in the Beth Israel Deaconess Emergency Department, in which the resident will have the opportunity to participate in emergency evaluation of patients with neurological complaints. Residents also spend time in the Neuro ICU at Beth Israel Deaconess rounding with the Stroke/ICU attending and fellow on acutely ill patients admitted to the Neuro ICU.

Second year residents serve as Night Float residents in the first half of the year. The Emergency Department rotation has no overnight call, but includes some weekend days. The resident on the Children's Intensive Care rotation takes night call from home.

Third year residents rotate through Beth Israel Deaconess Medical Center as Clinical Chief Resident on either the Stroke Service or the General/Epilepsy Service. They are in charge of the neurology inpatient service, supervising both the ward and consult residents and the medical students rotating through the neurology service. Residents also take Neuropathology in the third year, during which they prepare cases for Neuropathology Conferences and teach their fellow residents high-yield topics. There is also a rotation on the Psychiatry inpatient ward service. The remainder of the third year includes outpatient clinic electives and elective time for a research or teaching projects. Electives range broadly in a wide variety of academic pursuits and can be chosen from the many opportunities available on the Harvard Longwood Campus, to allow availability for clinics and conferences. Only one month of rotation time away from campus is permitted in the third year. In addition, residents have the opportunity to spend one term as a teaching assistant in the Human Nervous System and Behavior course in Harvard Medical School. Two of the third year residents will be chosen as Administrative Chief Residents, and they will share the responsibility for preparing the night call, weekly conference, and Grand Rounds schedules.

In conjunction with the neurology department at Boston Children's Hospital (BCH), we are proud to be able to offer interested residents the opportunity to apply for an R25 Residents and Fellows Grant through the National Institutes of Neurological Disorders and Stroke (NINDS). The NINDS R25 is a program that is specifically designed to support the development of physician-scientists in neurology. During the PGY2 year, residents who are interested in applying for the R25 must identify a research mentor and design a brief research proposal. There is a great deal of faculty mentorship and support through this process. Prior to formal submission to the NINDS in September of the PGY3 year, this proposal undergoes a thorough evaluation (and revisions if necessary) by an assigned group of senior neurology researchers at BIDMC and BCH. Successful R25 applicants receive salary support for protected research time (80% of the work week) for a 24 month period beginning approximately January of the PGY4 year. Since the commencement of R25 funding for the BIDMC/BCH programs, 7 residents have been selected for R25 funding, with projects that span the spectrum from molecular biological research in mouse models of human disease to neuroimaging and electroencephalographic investigations of patients with illness.