The Mount Sinai Hospital residency program in Neurology is designed to provide residents with a broad knowledge base in neuroscience and the clinical abilities to recognize and treat the full spectrum of neurologic diseases. The program provides an extensive clinical and didactic grounding to enable trainees to handle and understand the growing body of neuro-therapeutics throughout their careers. The residency program also establishes a degree of maturity, responsibility, and empathy that is inherent in the modern practice of clinical neurology. This includes developing the resident’s skills across the full range of ACGME core competencies, including Professionalism, and Interpersonal and Communication Skills, as well as fostering an aptitude for adept Systems-Based Practice as it pertains to clinical neurology.
By graduation, the Mount Sinai-trained neurologist will be well-grounded in basic neuroscience, have had a broad clinical experience, and have developed as a seasoned clinician-scientist, poised to become a professional neurologist of the highest caliber.
PGY-2 year
The first year of the program (PGY-2) is designed to provide maximal clinical exposure under the guidance of senior residents, fellows, and attendings. Inpatient neurology care is divided into three services for patients admitted to a primary neurology team – general neurology, epilepsy, and stroke – and an inpatient consultative service. The general neurology floor and inpatient consult services are staffed by a senior resident and an attending neurologist. The epilepsy service is staffed by an epilepsy fellow and an attending neurologist. The stroke service is staffed by a senior resident, a stroke fellow, and an attending neurologist. Educational clinical conferences include a daily morning report of the prior day's new clinical consultations and admissions, staffed by a teaching attending, weekly Grand Rounds, Chief of Service rounds, a year-long noon conference series in neuroscience, and supplementary didactic conferences across neurologic subspecialties.
As residents matures professionally, their level of responsibility increases, both within each academic year and across the three years of the training program. As incoming PGY-2's, the level of each resident's patient responsibility is determined by the clinical skill level that they bring into the residency from their medical internships. During the first 20 weeks (5 months) of each academic year, PGY-4's are in-house 24 hours a day to supervise, educate, and observe the PGY-2 residents as they gain proficiency with neurological assessment and management. All admissions and discharges are discussed and reviewed with the senior resident on-call, 24 hours a day. Attending neurologists are available 24 hours a day to discuss any case, and all patients discharged from the emergency department must be discussed with an attending neurologist.
The PGY-2 residents are afforded greater independence and responsibility over the duration of the PGY-2 year at Mount Sinai as their clinical knowledge and skills increase. Over the year, each resident's knowledge and skills are assessed and developed by the faculty. Residents meet with the Program Director on a semi-annual basis to assure they are reaching appropriate neurological “developmental milestones.” During the second half of the PGY-2 year, the junior residents are encouraged to take a more active role in patient care during their inpatient service rotations at Mount Sinai. During the time that the PGY-2 residents spend at the Bronx VA (typically 4 to 6 weeks), they will have their first opportunity to truly run a consult service – under advisement from a supervising PGY-3.
PGY-3 year
In the second year of the program (PGY-3 year), residents have the opportunity to run a team as senior residents at Elmhurst Hospital on the inpatient service and the consult service, as well as in clinic and nightfloat rotations. A significant increase in autonomy is required for the PGY-3 resident to be able to lead a team at Elmhurst Hospital, although there is close clinical supervision by the experienced neurology faculty members at this site. PGY-3s also have a supervisory role during their rotations on the consult service at the Bronx VA where they guide and help educate the PGY-2 on the service.
The rotations through the inpatient and consultation services at Elmhurst Hospital Center, plus the Elmhurst Clinic and EHC Nightfloat blocks during the PGY-3 year, expose the resident to an extraordinary array neurological disorders. Further, the cultural milieu at Elmhurst is challenging in its complexity. Elmhurst, Queens, comprises one of the most culturally diverse populations in the United States, and the patients at Elmhurst Hospital Center come from across the globe, speaking a multitude of languages and dialects, and bringing with them their particular beliefs and customs. The neurology faculty members at Elmhurst Hospital have extensive experience communicating effectively with these patients and are vested in helping the neurology residents develop their own clinical and cultural competence.
There are also additional rotations exposing the residents to pediatric neurology, epilepsy and electrophysiology (EMG) training. Elective time can be spent in subspecialty rotations or research. A resident's clinical, leadership, and teaching skills continue to be strengthened during this PGY-3 year such that when they return to Mount Sinai as a PGY-4, they are prepared to effectively run the neurology services where the expectations for their role as supervisor and teacher will be much higher.
PGY-4 year
In the third (PGY-4) year of the program, the residents develop and expand their teaching and supervisory skills. Each rotates as the senior resident on the three clinical services – general neurology, stroke/critical care, and consultation services. Ample opportunity and incentive are provided for clinical and basic neuroscience research with a welcoming faculty. They also act as teaching residents for junior residents, non-neurology trained rotators – from psychiatry and internal medicine – and medical students during dedicated blocks of the year. With this expanding knowledge base and close supervision, residents develop an enhanced level of medical knowledge, professionalism, and patient care skills. At every clinical training site, either the attending neurologist on service or the patient's admitting neurologist is ultimately responsible for every patient. The senior neurology resident on the service collaborates with the attending on clinical decisions. The senior neurology resident is also responsible for the day-to-day functioning of the service, ensuring all patients receive the care decided upon during rounds, and for being available to the junior residents, patients, and hospital staff for any questions that arise. The PGY-4 year is where senior residents function as, and graduate having become, junior attendings. The program encourages research and presentations/publications, and will fund resident travel to any conference where he or she is presenting their work.