Neurology Residency
Frequently Asked Questions
- How have the hospitals and the neurology residency approached the coronavirus pandemic?
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There have been widespread changes in the hospital and the residency to promote patient safety as well as safety of our residents and staff while maintaining our educational mission. There are dedicated COVID units and ICU. All inpatients and ER patients COVID tested. Everyone who enters the hospital is screened at the door. The number of visitors has been reduced to one per patient. We have a robust COVID hotline that we can call for any issue. There are numerous webinars, and town meetings which have been instituted to educate everyone. However all of the educational conferences have continued. We have reduced the number of people in the conference room to allow for proper social distancing and have made full use of web casts and virtual learning.
- What are the unique aspects of the neurology residency program?
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We have the second largest program in the country (12 residents per year) which helps to spread out the call schedule, allows flexibility with schedule changes, and has allowed many educational innovations within the program (for instance, our Leadership in Medical Education track, Research track, Quality Institute rotation, etc). Our PGY3 year is really unique. Half of the year is actually spent not on service. Instead, there are 2 months of dedicated EEG classes, 2 months of dedicated EMG classes, and 2 months of neuroscience classes and labs at the medical school where you help teach the 2nd year Case Western medical students. The other unique aspect of our residency is our call schedule. No one works more than 16 hours at a time which really helps resident wellness, work-life balance, as well as our education.
- What do most of the residents do after residency?
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Nearly all our residents go on to do fellowships. The most common fellowships over the last few years have been epilepsy, neuromuscular, stroke, and critical care. Movement disorders and headache fellowships are also pretty common. Less common are neuro-interventional, neuro-immunology, sleep, and genetics - we’ve had one or more residents go into each of these over the last few years.
- How do your residents do in obtaining fellowships?
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Our residents do extremely well in obtaining fellowships. Many decide to stay here at University Hospitals for fellowship because there are many great options for fellowship here. However, those who prefer to go to a different program also get the program’s full support. Fellowship matches have always been excellent for our residents, who end up in prestigious programs around the country. It is very common for our resident to get their top pick.
- How much time do residents spend at the main hospital and at the VA?
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Residents do about one-sixth of their inpatient rotations at the VA. In addition, about one-third of the outpatient clinics in which residents participate are at the VA.
- What criteria are used to select residents?
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We are really looking for diversity within our resident class. No one size fits all. We are looking for a combination of individuals who want to be clinicians, educators, and researchers. So our program looks at step scores, your evaluations from your medical school especially in neurology and internal medicine clerkships, letters of recommendation (especially from neurologists), any research that you have done, and extracurricular activities.
- Do you have subspecialty teams?
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Our inpatient service consists of (4) subspecialty teams including stroke, epilepsy, general neurology and neuro-ICU. These teams are staffed by board certified attendings across stroke, epilepsy, neuromuscular, neuro-critical care, movement disorders, and neuroimmunology subspecialties which provides residents with a well-rounded inpatient experience.
- Are your rotations based on months or blocks?
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Our rotations are based on 2 week blocks. So we have (13) 2-week blocks.
- How many people are on a team?
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The general neurology and stroke inpatient teams consist of a senior resident (PGY4), an assistant senior resident (PGY3) and 2 junior residents (PGY2) as well as a (PGY1) neurology resident. The stroke team often has a stroke fellow as well. The epilepsy team consists of an epilepsy fellow, senior resident (PGY4) and junior resident (PGY2). Our neurointensive care unit team consists of the fellow, a senior neurology resident (PGY3), 2 junior neurology residents (PGY2), an emergency medicine resident (PGY2), neurosurgery resident (PGY1), and usually a neurology (PGY1) resident.
The inpatient teams have primary patients assigned to the junior neurology residents as well as consult patients who are seen by the PGY3 neurology resident and psychiatry / neurosurgery rotators. The ICU team has primary patients assigned to the junior residents while the senior resident (PGY3) covers all the neurology primary patients. The PGY1 neurology residents spend 3 months during their internal medicine year rotating through our inpatient services -usually one month in general / stroke, one month in the neuro critical care unit, and one month in a neurology related elective.
Depending on the academic calendar, there can be up to 3 medical students (MS3, AI) on the each team.
- Can you tell me more about the ambulatory curriculum?
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Starting in the PGY-2 year, we do a half-day of continuity clinic every OTHER week. In this clinic, we see new and former patients and follow them over the 3 years. It is a general neurology clinic. Half of the residents are assigned to UH and the other half to the VA. However on the alternate weeks, we do a subspecialty continuity clinic. We do this for a year and then change to a different subspecialty clinic. We get to help choose which field we do our subspecialty clinic in. These can be in stroke, neuromuscular, movement, neuro-oncology, headache, sleep, cognitive, multiple sclerosis and immunology. By doing this we get to "test drive" three subspecialties with in our residency. In addition, there are dedicated ambulatory blocks where you are not on service, but instead have the opportunity to attend different subspecialty clinics of your choice. Residents also frequently choose to attend different clinics during their electives, as well.
- What are my options for elective time?
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We are fortunate to have a lot of elective options. Most popular ones include Movement disorder, Botox clinic, Neuromuscular, Neuro-cognitive, Neuro-radiology, and Neuro-ophthalmology. Research electives are also possible. However our program is very open to any special elective ideas that you have. For example, few of our residents did a helicopter/ EMS elective to work with EMS to bring the acute strokes to the main campus from peripheral hospitals.
- How does the neurology residency comply with duty hours?
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We have a night float system as well as a cap on call consults/admissions. In addition we have a unique call schedule which almost no other program has. We have a short call where residents work until 9:30 PM and a night service between 9:30 PM and 8 AM. With our call schedule, no resident works more than 16 hours. Everyone gets to sleep in their own bed every night. There is no 24+4 call which is so common in other programs.
- Are away rotations or international experiences available?
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Yes, some residents have arranged to have away rotations at other institutions if they have a specific interest. These must be arranged with the program director, however they can provide excellent opportunities for diverse experiences and training.
- Do you have a short call?
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We do! The day team signs out at 4pm. Short call then begins at 4pm, and goes until 9:30pm, at which time they sign out to the night float team.
- Is there a night float system?
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Every night of the year, our night float team gets sign out at 9:30pm, then hands the pagers back to the day team at 8am.
- How do days off work?
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Every resident gets four days off in four weeks duration which is mutually decided among the team members. Based your call schedule you can get a golden weekend (both Saturday and Sunday off), silver weekend (either Saturday or Sunday) or a black weekend (neither Saturday or Sunday).
- How do you handle vacation time?
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We have (2) 2-week blocks of vacation as well as 4 days off for a holiday of your choice.
- How do you educate house staff about patient safety and quality?
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Our Neurological Institute has a monthly quality-assurance meeting where patient safety events are discussed. Our PGY 3 residents are part of this committee. Policy and practice changes are shared with residents at the monthly resident meeting as well as by email. Additionally, we have a monthly Morbidity & Mortality conference where cases are discussed between residents and faculty. Lastly, our senior residents all do a 4-week rotation in the Quality Institute at UH where they learn about patient guidelines, risk management, quality improvement, and quality assurance
- What is the patient mix?
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As a tertiary care hospital, UH Cleveland Medical Center receives a full complement of pathologies from throughout Northeast Ohio, including the urban & suburban populations of Cleveland, Youngstown & Akron. Additionally, we see many patients from the rural areas of Appalachia and Ohio, including the Amish. At UH Cleveland Medical Center, one of the major strengths is that there is a true diversity of patients including along social, economic, racial ethnic and cultural lines. We take care of the local population, patients in the suburbs, some surrounding states, and some international. Our VA is the 4th largest in the country and is a regional hub for spinal cord injuries, so in addition to the typical allotment of veterans’ pathology, we also receive exposure to the care and management of chronic immobilizing neurologic conditions that also includes MS & ALS (we even have rotations on the SCI unit!).
- Do you have non-resident or hospitalist services?
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No. All neurology consults and admissions are seen by the general neurology, stroke, epilepsy, or neurocritical care team. All of these teams are staffed by a core of neurology residents. In addition, the general neurology team has several rotators from other specialties, and the neurocritical care team has a couple rotators as well as two nurse practitioners.
- Where will I live?
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Many of our residents live in beautiful and tranquil neighborhoods that surround UH such as Cleveland Heights, Shaker Heights & Little Italy. Please see the map of where our residents live. Housing is quite affordable in greater Cleveland. You can literally live 5 to 15 minutes away from work and have a very easy commute.
- Are meals provided?
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Yes. Meals are provided at noon conferences which are Tuesday to Friday. We also typically have sushi, humus and a charcuterie board at our 4PM Thursday conferences. Additionally, residents are provided with “On-Call” money that replenishes every six months, which can be used at the cafeteria and restaurants in the hospital.
- Are there house staff social events?
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Yes, there are many social events and group activities with other residents. The Cleveland Association of Residents and Fellows (ARF) plans and hosts social events and gatherings around Cleveland involving residents from all major Cleveland hospital systems. Additionally, there are internal activities involving both Internal Medicine and Neurology residents. One such example is Bronson’s Day, an annual tradition in which all Internal Medicine interns (including Neurology interns) are given the day off to attend a baseball game together.
- Can you tell me about your board pass rates?
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Yes, our board passage rate is excellent. Over the last 10 years, 95% of our graduates are board-certified. 87% passed on the first attempt.
- With all this food, I’m going to need to work out! Where do the residents go?
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The main gym is located on the campus of Case Western Reserve University within walking distance of the hospital. It has a full assortment of free weights, cardio rooms, basketball gyms & a swimming pool. All residents get free access. Additionally, there is the “Ortho Library” housed on the 11th floor of the main hospital that overlooks the city of Cleveland and Lake Erie which has free weights, a squat rack, an elliptical & a treadmill. Just enough to squeeze a workout while on call! There are also plenty of places outdoors to get exercise such as the Towpath Trail, an 87-mile bicycle path that connects Cleveland to Akron, or kayaking on the rivers & lakes that surround Cleveland.