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 adult neurology consults, stroke, general neurology, and night float and NNICU. An additional 2-3 months is spent on the inpatient consult service at St. Louis Children’s Hospital. The remaining 2-3 months include adult outpatient sub-specialty clinics, EEG, electives and career development planning.
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 and outside hospital neurologists.
NICU service – The Neonatal Neurology consult service handles consults in the NICU and infants in the CICU.
12th Floor Neurology Ward Service – Two months during PGY4 year is 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, neuro rehab 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 assists our epileptologists in the care of the Epilepsy Monitoring Unit (EMU) Patients with the help of nurse practitioners and pediatric residents.
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. Patients are seen by the resident and then presented to the attending. Subspecialty clinics include epilepsy, movement disorders, cerebral palsy, headache, tuberous sclerosis, neurofibromatosis, neurorehabilitation, Rett syndrome, neuroimmunology, neonatal neurology, and neuromuscle.
PGY4 residents have 2 elective months for research/ career development/ required electives or subspecialty 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 the trainee for independent practice and supervision.
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, genetics, neuro-ophthalmology, neuro-otology, and additional EEG, EMG training. There is at least 6 months of elective time that may be used for clinical or basic research and electives.
During the neurology inpatient floor service and adult NeuroICU rotations the residents take in-house call every fourth night. During the nightfloat 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 calls.
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 calls from patient families for the division of pediatric neurology. One weeknight per week is usually covered by the adult neurology rotator. Weekend call is divided between Friday night and Saturday morning through midday Sunday. During weekend call the on-call resident covers all hospital services. They receive assistance from the adult neurology rotator one day each weekend and a PGY3 rotator the majority of the year.
During the PGY5 year the residents take at home call one Sunday per month. They provide additional call coverage when a PGY4 is on vacation/leave or on a dedicated career development week divided equally among the PGY5s (about 2 additional 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 4-8 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 two to three attending physicians. Generally, all patients admitted to the hospital 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 assistance of the nursing staff during their busy in-patient rotations.