The first year of residency focuses mainly on training in internal medicine but also includes two months of neurology and one month of psychiatry (a board requirement). The PGY1 residents rotate through three hospitals: Baylor St. Luke's Medical Center, Ben Taub Hospital, and Michael E. DeBakey Veterans Affairs Medical Center.
Residents must develop competency in managing general medical conditions critical to caring for patients with neurological problems. The internal medicine months include two months on medicine subspecialty electives at Baylor St. Luke's (e.g., renal, hematology/oncology, infectious disease, or gastroenterology), one month in the Ben Taub Emergency Center, one month in the MEDVAMC Medical Intensive Care Unit, one month on the MEDVAMC cardiology, and three months on general medicine wards divided between Ben Taub and MEDVAMC.
Additionally, residents spend one month on Consult/Liaison Psychiatry at MEDVAMC, one month on the General Neurology/Stroke Service and one month in the Neurological Intensive Care Unit, both at Baylor St. Luke's and one month. There is no continuity clinic requirement during the intern year.
Interns work two weeks of night float at MEDVAMC and/or Ben Taub. There is no overnight call on MEDVAMC/Ben Taub wards. At Baylor St. Luke's, MEDVAMC MICU, and in the Ben Taub Emergency Center, interns have a few overnight shifts per month. Upper-level internal medicine residents are always available in-house during night calls. The two neurology months and the psychiatry month are free of overnight call.
The PGY2 year is designed to teach the fundamentals of caring for patients with diseases of the nervous system. Although the emphasis is deliberately on the care of hospitalized patients, residents are also afforded a number of opportunities to develop their skills in the evaluation and management of neurology outpatients both in their own continuity clinic as well as on a number of outpatient clinic rotations. Residents rotate in the NICU as well as on the general neurology/stroke service at Baylor St. Luke's Medical Center. At MD Anderson Cancer Center, residents rotate on the neuro-oncology consult service. At both the Ben Taub Hospital and Michael E. DeBakey Veterans Affairs Medical Center, residents assume primary care of patients admitted to the neurology inpatient services.
The wide diversity of patients seen in our hospitals exposes second-year residents to a myriad of neurologic disorders and provides a broad exposure to all aspects of neurology: acute neurological emergencies, common chronic diseases, neurological complications of medical diseases, as well as tertiary referral neurology. There are thousands of neurology admissions per year to our hospitals and thousands more consults, ensuring residents a diverse and unique clinical experience.
In addition to the inpatient, consult, and critical care training during the PGY2 year, 2-3 months are reserved for outpatient experiences. Outpatient experiences take place at the general neurology and subspecialty neurology clinics at Ben Taub and MEDVAMC. In addition to general neurology clinics, subspecialty clinics at Ben Taub and MEDVAMC include epilepsy, stroke, cognitive disorders, movement disorders, multiple sclerosis, and neuromuscular diseases.
Our program is designed so that call is front-loaded. Thus, PGY2 residents take overnight call at all hospitals except MD Anderson, which is home call. Baylor St. Luke's has a night float system, and PGY2s will have two weeks of night float in addition to some traditional call. PGY2s have approximately five overnight calls at Ben Taub and MEDVAMC during a four week block. PGY2 residents take primary responsibility for the care of the patients they admit.
The third year of neurology training is a time to gain broad exposure to subspecialty outpatient neurology and hone skills in consultation neurology. Residents serve as consultation chiefs at Ben Taub Hospital and Michael E. DeBakey Veterans Affairs Medical Center. They also serve as chiefs in Baylor St. Luke's Medical Center NICU, where they are primary responders to acute stroke calls during the work day and gain extensive experience in administering thrombolytic therapy. Outpatient experiences include Primary Brain and Spine Tumor Clinic at MD Anderson Cancer Center, movement disorders at the Parkinson’s Disease and Movement Disorders Clinic at Baylor Clinic, Child Neurology Clinic at Texas Children's Hospital, and outpatient clinics at Ben Taub and MEDVAMC. Residents are also introduced to the basics of neurophysiology with a one-month EMG rotation and one-month EEG/EMU rotation. Residents have an additional three months of electives to pursue additional subspecialty, neurodiagnostic or research rotations.
PGY3 residents also take on leadership and teaching roles in their capacity as consultation service and ICU chiefs. Along with their PGY4 colleagues, third-year residents also serve as back-up for the PGY2 residents on call at Ben Taub and MEDVAMC. This responsibility sharpens decision-making, teaching and leadership skills.
The PGY3 year is also important time for career planning, as most fellowship plans are finalized late in the PGY3 year or early in the PGY4 year. Residents are provided with strong support and career guidance in pursuit of fellowships, academic positions, and practice opportunities. The vast majority of Baylor neurology residents pursue fellowship training.
The final year of training is a time to consolidate the knowledge and skills gained over the previous three years of training and assume a more active leadership and management role. With the help of PGY3 residents, PGY4 residents supervise and assist junior residents. While on the wards, upper-level residents round with the junior residents, provide clinical support, and teach the junior residents and students.
PGY4 residents serve as the inpatient service chiefs at both the Ben Taub Hospital and Michael E. DeBakey Veterans Affairs Medical Center. They rotate in the Baylor Neuromuscular Diseases Clinic. They also complete their child neurology requirements with one month of child neurology consults and another month of pediatric neurocritical care consults. The remainder of the year is reserved for additional subspecialty experiences at the Baylor Clinic or any of our affiliated hospitals. Residents may also use elective time for research.
PGY3 and PGY4 Call
There is rarely overnight in-house call for senior residents. PGY3 and PGY4 residents have one week of night float each at Baylor St. Luke's Medical Center. PGY3 and PGY4 residents serve as supervisors for the care of the patients on their service, and therefore do take backup call from home on a regular basis when they are service chiefs. On some services, and especially early in the academic year, upper-level residents may come into the hospital to evaluate admissions as necessary for optimum patient care. On other services or times of year, upper-level residents or faculty may only need to provide over-the-phone backup. Elective months are usually free of backup call duties.