Six months of the PGY3 year are spent on the inpatient adult neurology services at Barnes-Jewish Hospital. The residents share rotation schedules and inpatient responsibilities with the PGY2 adult neurology residents for that year. Rotations include the consults, acute stroke team (including exposure to telemedicine), stroke ward service, general neurology ward service, night float consults, and time in the neurological/neurosurgical ICU (one of the largest in the country). An additional 2-3 months are spent on the inpatient consult and inpatient neurology ward services at St. Louis Children’s Hospital. The remaining 2-3 months include adult outpatient sub-specialty clinics, EEG, EMG, electives and career development.
Five months of the PGY4 year are divided between the inpatient consulting service and the Neonatal ICU consulting service at St. Louis Children’s Hospital.
Consult service – The neurology consult service handles consults from the PICU, CICU, Emergency Department, and hospital floors. Residents covering the consult service also take calls from community pediatricians, outside hospital critical care physicians, emergency medicine doctors, and neurologists.
NICU service – The Neonatal Neurology consult service handles consults in the NICU (one of the largest in the country) and infants in the CICU.
12th Floor Neurology Ward Service – Several months during PGY4 year are spent as the supervising fellow of the 12th floor neurosciences service of St. Louis Children’s Hospital. This floor is largely dedicated to the care of general neurology, neurosurgery, neurorehabilitation and epilepsy monitoring patients. The pediatric neurology resident supervises the floor team of pediatric residents in the care of neurology patients. The 12th floor fellow also assists our epileptologists in the care of the Epilepsy Monitoring Unit (EMU) patients with the help of nurse practitioners.
Outpatient: Three months of PGY4 are spent on the outpatient clinic rotation at St. Louis Children’s Hospital. The resident rotates through the various faculty sub-specialty clinics including epilepsy, movement disorders, cerebral palsy, headache, tuberous sclerosis, neurofibromatosis, neurorehabilitation, Rett syndrome, neuroimmunology, neonatal neurology, and neuromuscle.
PGY4 residents have 2 months for research, career development, required electives or subspecialty electives of residents’ interest.
Each PGY5 spends 2 months of service time as the 12th Floor Neurology fellow or consulting fellow, as described above. This supervising and teaching role prepares trainees for independent practice and supervision.
The PGY5 year contains at least 6 months of elective time that may be used for basic science or clinical research and resident-designed electives both within neurology or interfacing subspecialties. Our residents have applied for and participated in the national R25 research mentorship and funding program. Recently, our residents have designed their own electives in global health, neurogenetics, neurocritical care, neuroimmunology, neuro-oncology, stroke, psychiatry, and ethics.
The remainder of the PGY5 year is spent completing requirements in adult neurology specialty clinics, as well as opportunities in neuroradiology, neuropathology, neuro-oncology, sleep medicine, neuro-ophthalmology, neuro-otology, and additional training in EEG, EMG, etc.
During the neurology inpatient ward services and adult neurological/neurosurgical ICU rotations, the residents take in-house call every fourth night. During the night float rotation, the resident works 6 nights of 12 hour shifts 7 pm-7 am with one night off per week. During outpatient and pediatric consult months there is no call, but residents may be on jeopardy for sick call.
During the PGY4 year, the residents take at home call. The on-call resident takes all neurology calls from St. Louis Children’s Hospital and all telephone consult calls from outside hospitals. The resident also takes parent phone calls for neurology patients.
During the PGY5 year, the residents take at home call one Sunday per month with 2-3 occasional other calls per year.
The pediatric neurology continuity clinic begins during the resident’s PGY3 year. Residents spend one half-day each week in clinic and typically see 3-7 patients per clinic. Patients are assigned to a specific resident’s schedule and follow-up with that resident during their entire three years of training. The clinic is typically staffed by three attending physicians. Generally, all inpatients who do not have a neurologist at the time of admission are followed in clinic by the resident that cared for them during their hospitalization if they need on-going care. Residents handle all outpatient calls on their own patients during office hours. PGY4 residents receive nursing staff assistance during their busy in-patient rotations.