Structure & Curriculum

Structure
Outpatient Neurology
Inpatient Neurology
Emergency Neurology
Consultation Services
Neuropathology
MGH Child Neurology Service
Electives
Special Programs

Structure
The program is jointly governed by Drs. Anne Young (MGH) and Martin Samuels (BWH) as co-directors of the program and clinical department.

Dr. Steven Feske (BWH) acts as administrative director. Dr. Walter Koroshetz (MGH) serves as Chair of the residency committee.

There are four chiefs each year – third year neurology residents who are responsible for scheduling, educational programs, lectures and administration of the program. The chiefs play an active role in initiatives to advance and improve the program. Although there is a great deal of informal communication between the residents and faculty concerning the nature and future of the program the chiefs often act as a more formal bridge between the house-staff, faculty and administration.

The program also has a permanent residency committee which meets periodically throughout the year to make changes to the curriculum and other aspects of the program.

There are resident committees that guide the social activities, curriculum, and information technology for the residents. Residents have also been involved in hospital wide committees for graduate education, ethics and optimal care and other topics.

Curriculum

Goals and Philosophy:
The goal of the training program is to furnish the trainee with experience in clinical and academic neurology, progressively greater independence and autonomy come with greater experience. To achieve these aims there is a different emphasis in each of the three years. During the first year of neurology the majority of the trainee’s time and energy is spent in managing patients who present to the emergency room or are admitted to the hospital with neurological disease. In the second year, residents obtain more exposure to outpatient subspecialty neurology, to neuropathology, child neurology, and have elective time to pursue their own interests. In the third year, supervision of inpatient services occupies about one-third the time, while elective and consultation rotations help to further expose the trainees to a large volume of complex patient care issues.

In general, the rotations alternate in each year between the two main hospital complexes, which are separated by about three (3) miles. A shuttle bus offers convenient travel between MGH and BWH. One of the VA hospitals requires an automobile and is about 30 minutes away. Video Teleconferencing between the BWH and MGH is used for coordinating teaching (such as noon conferences) and patient care services.

Pediatric neurology trainees from the Children's Hospital program rotate on the adult services during their first year. Residents from the Neurosurgery, Internal Medicine, Psychiatry, and Rehabilitative Medicine also spend time on the neurology services.

The MGH/BWH Neurology program maintains close contact with the Harvard Neuroscience Program and the Harvard Neurology Program under Dr. Clifford Saper at the Beth Israel Hospital. Residents may take electives at the Beth Israel program and vice versa, during second and third years. Many residents take elective or fellowship training in the Neuroscience programs at Harvard and MIT.

Drs. Young and Samuels are the co-chairs of the department. Each maintains direction of the workings of the individual institutions on a day-to-day basis. There are 5 attendings per month on service at MGH, and three at the BWH.

Comprehensive libraries are available at all the participating institutions and closed circuit TV is used for many conferences.

Curriculum Structure

First year curriculum (varies slightly):

Second Year:

Third Year:

Outpatient Neurology

Proficiency in outpatient neurology is considered an extremely important educational objective. The MGH/BWH program offers a rich and varied outpatient experience as follows:

1. Beginning in the first year, residents will develop their own weekly practice derived from patients with a wide variety of pathology who are initially cared for during their inpatient and emergency ward visits. In both the MGH and BWH outpatient units residents are advised and supervised by staff neurologists.

2. The Jamaica Plain and Brockton VA hospitals furnish a resource of efficiently managed outpatient neurology. By design most clinics are not specialized, and trainees under staff supervision function as the principal physician for patients with common and uncommon illnesses. Many residents choose longitudinal clinics at the VA (for the second and third years) and gather their own list of primary patients. All clinics are staff supervised. In many instances, medical students participate. The VA also provides Partners Neurology residents with rotations in clinical neurophysiology.

3. In the second and third years, residents can elect to join a specific subspecialty unit for monthly sessions over a year. In addition they attend longitudinal clinics at 2 sites from among the BWH, MGH, or VA at which large numbers of patients are seen over extended periods and the resident serves as either the principal care giver or consultant.

4. Pediatric neurology training, totaling 3 months for adult trainees, involves inpatient consultation rotations at both Boston Children’s Hospital and the MGH Hospital for Children as well as a supervised outpatient pediatric neurology experience at the MGH.

5. Subspecialty blocks of outpatient time are included in the second and third years, in which trainees attend specialized units with staff members practicing tertiary care neurology (see below). These units involve teams of clinical investigators and clinician/neuroscientists concentrating on: Alzheimer's disease, movement disorders, multiple sclerosis, neuromuscular disease, metabolic and hereditary disease, stroke, neurovisual disorders, neurovestibular disorders, behavioral neurology, pain, epilepsy and sleep disorders.

Inpatient Neurology

Inpatient Services, MGH

C.M. Fisher Service: There are usually 23 patients on this service including the neurology patients in our 18 bed neurointensive care unit. Patients are admitted from the emergency ward, from the stroke, epilepsy, neuro-visual, neurobehavioral and spinal cord services and from outside hospitals by referral. There is a bias toward vascular and intensive care neurology on the CMF service. Four first-year neurology residents share responsibilities for patient care. Under the direct supervision of a senior resident and senior staff neurologist, they diagnose and treat a wealth of acute neurologic conditions. One of the four neurology residents is assigned primarily to the Neurointensive Care unit which is staffed by a team of fellows and staff neurointensivists.

The third-year resident on the CMF service has the primary responsibility with the Staff physician for evaluating, managing and arranging follow-up for patients on the service and for instructing and supervising the first-year residents and medical students on neurology. Morning teaching rounds are made by a senior staff physician and neuroradiology rounds are conducted weekly. Call is every fourth night.

R.D. Adams Service: There are usually 20 patients on the RDA service including a 4 bed epilepsy monitoring unit. One or two first-year neurology residents, a rotating psychiatry resident, and a physiatry resident, supervised by a senior resident coordinate the diagnosis and management of patients admitted from the emergency ward or from the neuro-oncology, neuroimmunology, neuromuscular, pain, movement disorder or neurodegenerative disorder subspecialty groups. The third year resident has the primary responsibility for the management of the team and patients along with the assigned staff physician. Morning teaching rounds are made by a senior staff physician and neuroradiology and neuro-oncology rounds are conducted weekly. Call is every fourth night.

Inpatient Service, BWH

D. M. Dawson Service and BWH ICU Services:
Current census at BWH averages 25 with about 700 admissions per year. It includes a two-bed epilepsy-monitoring unit. In addition, there is a twenty-bed neurology/neurosurgery ICU. An attending and a third year resident supervises four first-year residents who care for an extremely varied and complex group of floor patients. A separate team consisting of an attending, a stroke fellow, a second year resident, and a first year resident cares for patients admitted to the neurological ICU. Call is arranged in a q5/q3 long call / short call system.

Emergency Neurology

At both the MGH and BWH the emergency department is staffed continuously by a neurologist. The Emergency Departments are managed by full time Emergency Physicians and Emergency Medicine residents from the joint training program. The ED neurology residents have a unique opportunity to evaluate large numbers of acute neurological and neurosurgical patients with a variety of diagnoses. Rapid diagnostic testing is available to help the neurologist arrive at a management plan. Patients discharged from the ED are seen by the residents in followup in the Neurology Ambulatory Care Unit. The ED is a major source of inpatient admissions at both hospitals and a referral center for neurologic emergencies in the region. A member of the staff is on call for emergency cases and consults with the neurology residents. A senior resident sees admissions from the ED and is available to ED resident. The Acute Stroke Staff also see patients presenting with acute stroke with the ED resident. Teaching on ED cases occurs at morning report at both the MGH and BWH.

Consultation Services

During the second and third years, residents experience a variety of consultation rotations, under faculty guidance. At the BWH a second year neurology resident sees consults throughout the hospital and Dana Farber Cancer Center and is assisted by a second year medical resident and medical students. At the MGH a third year resident carries out consultations on patients with a diagnosis other than stroke. A second year neurology resident is assigned to the Stroke/ICU consult team which sees stroke consults in the hospital, all the ICU consults, and supervises acute stroke management on the hospital floors.

One resident rotates at the VA, performs inpatient consultations at the West Roxbury VA, and attends 3 or 4 clinics per week.

Neuropathology

Two residents at a time work on the neuropathology services of the MGH and the BWH, which are developing a combined program. Dr. Tessa Hedley-Whyte is responsible for the MGH laboratories, while at the BWH Drs. William Schoene and Umberto De Girolami lead the service. Residents are provided with a general introduction to neuropathology and postmortem examinations. They carry out gross and microscopic examinations of nervous tissue and report their findings after detailed, supervised study. A clinicopathologic brain-cutting conference takes place each week. Additional time in neuropathology can be worked out on an elective basis.

MGH Child Neurology Service

The MGH Child Neurology service, directed by Dr. Verne S. Caviness, Jr., is comprised of 12 Staff Attendings, who supervise the Partners Neurology resident training in Child Neurology at MGH. The service admits and consults on the MGH Pediatric service (including the PICU and NICU), and staffs multiple outpatient general (Drs. Verne Caviness, Jr., Elizabeth Dooling, and Kalpathy Krishnamoorthy) and subspecialty Child Neurology clinics including: Dystonia (Dr. Katherine Sims), Epilepsy (Dr. David Holtzman), Learning Disabilities (Drs. Peter Rosenberger and Margaret Bauman), Neurofibromatosis (Dr. Mia MacCollin), Neurogenetics (Drs. MacCollin and Sims), NICU follow-up (Dr. Krishnamoorthy), Pediatric Neuromuscular (Dr. Ann Neumeyer), Pediatric Pain (Dr. Robin Jones), Pervasive Developmental Delay (Dr. Ed Hart), Substances of Abuse Exposure follow-up (Dr. Barry Kosofsky), and Tuberous Sclerosis (Dr. MacCollin). Many of the staff, and their basic research associates, study mechanisms underlying normal and disease-induced abnormalities of brain development.

Two third year adult neurology residents are assigned to the Child Neurology Service. They work alongside Partners Child Neurology trainees on the inpatient and emergency consult service at the Mass General Hospital for Children. One or two Child neurology trainees are recruited each year and they work on the adult neurology service for their first neurology year. They then supervise the Child Neurology Service in their second and third years. The child Neurology service admits and consults on the MGH Pediatric Service including the pediatric and neonatal intensive care units.

For more information about this program please refer to the Child Neurology website.

Electives

A variety of research possibilities can be pursued during the elective time. The scientific efforts of faculty members at the two institutions, combined with the laboratory endeavors of scientists at Harvard, MIT, BU and MIT Neuroscience programs provides a spectacular environment for the academic neurologist. Residents are encouraged to seek advanced training, or to set up projects, under the mentorship of these investigators.

Many residents choose to spend their elective time in the broad range of clinical subspecialties that make up Partners Neurology. Please see the clinical facilities page for a listing of neurology subspecialty programs. Clinical neurophysiology training is popular, under Dr. Anthony Amato at BWH or Dr. Didier Cros at MGH. EEG exposure likewise can be arranged at either institution. Clinical electives can be sculpted to fit the needs and desires of the resident.

Eleven or more second and third year residents on rotations without other nighttime duties will together share the night and weekend supervision of the first year trainees and perform emergency neurologic consultations at the MGH and BWH.