Residency Information > Curriculum

Curriculum

During training residents will spend time at the following institutions:

Thomas Jefferson University Hospital (TJUH) a 600+ bed hospital in central Philadelphia with 140-160 neurology inpatient neurology admissions/month; 14 bed Neurosensory intensive care Unit (Gibbon Building), 10 bed Neuro-intensive care Unit (JHN), 18 bed Intermediate Neuro Care Unit, 11 bed Stroke Unit with cardiac monitoring, 8 bed video EEG unit, Headache Unit. Continuity Clinic will be scheduled one time per week for the full three years of the residency.

Jefferson Hospital for Neurosciences (JHN)- a hospital also located in central Philadelphia 2 blocks from Thomas Jefferson University Hospital dedicated to neurological, neurosurgical, and opthalmogical patient care and research.  This facility supports a 10 bed Neuro-intensive care Unit and 20 bed Intermediate Neuro-Intensive Care Unit on which neurology residents have patient care responsibilities.  The Neurology departmental offices and outpatient clinic are located on the 2nd floor. 

A.I. duPont Hospital for Children a pediatric hospital located in Wilmington, Delaware with active inpatient and consultative service, including video EEG monitoring, and active outpatient subspecialty clinics including epilepsy, neuromuscular, and headache. Additional outpatient sites include duPont at Jefferson, duPont at Einstein, duPont at Virtua (Voorhees, NJ), duPont at Bryn Mawr, and duPont at English Creek (Atlantic City).

CORE CURRICULUM:

Additional available electives:

Research, additional months of EEG, EMG, or specialty clinics such as Neuro-ophthalmology, Movement, or Sleep.  Residents may also design elective rotations to match their areas of interest pending department approval.

Vacation: Residents will be provided 4 weeks of vacation yearly.


Continuity Clinic
During the three years of residency, the resident will maintain a half day outpatient clinic once a week.  This will provide the resident with an opportunity to experience his or her own “practice.”  Patients seen by the resident will follow him or her through the three years of residency.  This experience will help the resident gain skills and understanding about managing patients in an outpatient setting and provide for continuity of care over time.  A faculty preceptor will be assigned to provide supervision and teaching throughout the year.

PGY 2 Core Curriculum Rotations:

University Service (Ward)
Residents will care for generally emergent admissions from the emergency department and transfers from other institutions.  They will learn directly from a senior resident and daily attending rounds for all patients in a team approach.  Residents will learn to diagnose and treat common neurological diseases in addition to an extensive amount of neurological pathology.  Some of the diseases residents will become comfortable managing include neurological infections, neuro-immunology, peripheral neuropathies, and neuro-oncology.  Residents will develop and enhance their skills in diagnostic acumen and integrate knowledge of anatomy, physiology, and pathology with the clinical situation, review the current literature to provide the most up-to-date treatment, and enact a plan of care under guidance by their team members.

NICU- Gibbon Service
The resident rotation in the NICU in the Gibbon Building will care for all neurological and neurosurgical patients in the ICU.  The resident will round daily with the intensive care attending and be responsible for management of all intensive care and emergency situations that occur while the patient is in the ICU.  Diseases likely to be encountered include neuromuscular respiratory failure, increased intracranial pressure, hemodynamic instability, coma and encephalopathy, post-operative neurosurgical management, status epilepticus, traumatic brain injury, spinal cord injury, sepsis, Guillain-Barre syndrome, and medical complications of neurological diseases.  The resident will learn skills and procedures that may be life saving in case of neurological emergencies.

Stroke Service
The stroke service requires immediate availability to evaluate and diagnose patients with vascular disease.  Residents will develop skills of acute management, use of anticoagulants, antithrombotic agents, and lipid management.  Knowledge of coagulation abnormalities and secondary prevention of stroke will be emphasized.  Residents will round daily with a stroke attending and apply their knowledge of anatomy, physiology, and pathology to localize patients’ lesion(s) and apply acute management of patients with vascular disease.  The resident will also develop extensive proficiency in imaging modalities as the team will evaluate all neurological imaging on all patients.

Epilepsy Service
Admissions to the eight bed Epilepsy Monitoring Unit are generally elective admissions to objectively clarify patient's seizures for maximizing potential anti-epileptic management, assist in diagnosis and management of non-epileptic seizures, or provide surgical management for refractory seizures.  The resident will round daily with an epilepsy attending and epilepsy fellow, review their patient's video EEG from the previous day utilizing external lead placement or depth electrodes, and learn to effectively manage anticonvulsant medications.  The resident will also attend a weekly multidisciplinary meeting including neurosurgery, neurology, neuroradiology and neuropsychology to evaluate refractory epilepsy patients for neurosurgical management.  If interested, the resident will also have the opportunity to observe electrocorticography and neurosurgical management in the operating room.

Headache Service at Methodist Hospital
Patients with intractable headaches or drug toxicity are scheduled admissions from the outpatient center.  These patients are referred from throughout the region.  The resident will round daily with an Headache attending and develop and implement a comprehensive plan to determine if the headache is primary or secondary.  Treatments for primary headache include DHE, neuroleptics, anti-epileptic drugs, steroids, NSAIDs, nerve blocks, and lidocaine.  Residents will be exposed to patients with pseudotumor cerebri, intracranial hypotension, vasculitis, sinus thrombosis, as well as primary headaches such as episodic migraine, transformed migraine, cluster headache, hemiplegic migraine, an hemicrania continua.  The resident will meet weekly with the headache team including psychiatry, psychology, pharmacy and nursing to maximize a plan of care.  Additionally, residents will work in the outpatient setting to gain exposure to outpatient headache disorders and learn additional skills such as injecting botox for headache and nerve blocks.

Multispeciality Out-patient Clinic
Residents will participate in the out-patient clinics of the various Neurology faculty as well with the faculty of the Neurosurgery Department.  The resident will see patients representative of each of the Neurology subspecialities represented at Jefferson.  These include patients with various cerebrovascular syndromes, movement disorder patients including Tourette's syndrome, Parkinson's disease, and dystonia, neuromuscular disease including patients with inclusion body myositis, peripheral neuropathy, and myasthenia gravis, epilepsy patients with acquired and idiopathic epilepsy syndromes, a variety of headache disorders, and neuro-oncology patients with primary CNS neoplasms. 

Neuroradiology
Residents will participate in the review of CT, MRI, MRA, MRV, CTA, and perfusion CTs to gain understanding of the physics, anatomic, and pathologic knowledge and cognitive skills required to interpret studies in a tertiary care neuroradiology practice.  Additional opportunities include observation of cerebral angiography, WADA testing, and myelography.   

PGY 3 & 4 Core Curriculum Rotations:

Ambulatory Clinic
PGY 3 resident will have two months of general outpatient clinic.  Residents will encounter a wide assortment of common and rare neurological diseases typically managed in the outpatient setting. The resident will also have the opportunity to see patients in the specialty clinics of their supervising attending.

As a PGY 4 resident, he or she will be expected to utilize two of their electives to supplement their outpatient experience.  During this time, the resident will be able to attend several specialty clinics and create their own schedule to enhance their knowledge and skills in particular neurological fields.

Stroke/Emergency Room Consultation Service
As a senior resident, responsibilities are extended to include evaluation of all emergency room consultations for neurological illnesses including stroke consultations within the hospital.  The resident will be exposed to a wide assortment of neurological problems from common neurological diseases to complex problems through direct walk-ins, second opinions, and transfers from other institutions to obtain care in a well-known, clinically oriented, tertiary care facility.  With attending supervision, the resident will evaluate the patient, determine an appropriate differential diagnosis, develop a treatment plan, and communicate necessary diagnostic and treatment measures to the emergency room staff.  The resident will also provide initial triage of patients for possible admissions to the appropriate neurological services if warranted.  Additionally, the resident will carry the Acute Stroke Code pager and will be the first line for in-house acute stroke management and, with attending guidance, administer antithrombolytics for acute infarctions, thrombotic agents to reduce intracerebral bleeds, or recognize and incorporate neurosurgical consultation for additional acute interventions.  

Inpatient Consultation Service
As a senior resident, responsibilities are extended to include evaluation of all neurological diseases (except stroke) in the inpatient setting including all medical and surgical specialties.  A wide assortment of pathology will be seen, building upon the previous year’s education.  Among other diseases encountered by residents such as peripheral neuropathies, seizure management, spinal cord lesions, vasculitis, auto-immune diseases, and paraneoplastic syndromes, the resident will also be exposed to a vast array of neurological manifestations of systemic illnesses. Residents will continue to develop their history and physical examination skills, formulation of diagnostic and therapeutic plans, and continued follow-up evaluations as appropriate under supervision of neurology attending physicians.  Residents will round daily with an attending, providing ample time for direct teaching.  

Pediatric Neurology
Residents will rotate a total of 3 months at A.I. duPont Hospital for Children during the second and third years.   During this time, residents will serve either on the inpatient consultation service and attend outpatient specialty clinics.  The resident will be exposed to genetic, congenital, postnatal, and developmental neurologic diseases.  The resident will round with an attending daily and help direct care of pediatric neurological patient illnesses.  The resident will also have the opportunity to spend time in outpatient general and specialty clinics such as neuromuscular and mitochondrial diseases, headache, epilepsy, auto-immune, and developmental delay.

NICU- Jefferson Hospital for Neurosciences
The resident will expand and enhance their intensive care training beyond the NICU- Gibbon Service to manage more complicated patient issues such as subarachnoid hemorrhages, aneurysm coils or clippings, intracranial to extracranial bypass operations, and cavernous sinus fistulas.  In addition to the critical care issues outlined above, the resident will become more comfortable with Swan management, advanced ventilation management, hypothermia protocols, and many cutting edge treatments and technology available within this unit.  Jefferson neurosurgery and endovascular neuroradiology program treats the highest volume of patients with aneurysms, brain AVMs, and angioplasty and stenting occlusive carotids and intracranial disease in the nation. Residents will become leaders in the in the academic field of stroke and neurocritical care and will develop the necessary insight into the disease process, pathology, pathophysiology and management of critical neurological patients either inpatient or working with patients in the outpatient settings who have undergone such experiences.

Senior Floor Resident
PGY 4 residents will spend two months in graduated responsibilities, working in a leadership role overseeing all in-house residents and medical students.  The resident will also directly supervise the junior resident on the ward service, serving as the team leader and provide additional reading materials to enhance the education of the team members and provide the most up-to-date patient care.  Didactic lectures for both resident and students will be organized by the resident.  This resident will also triage all general neurology transfers from other institutions as well as make initial determinations of emergency room admissions.  This rotation will allow the resident to function as an attending in both clinical and academic roles.  Attending oversight and guidance will continue to be provided.  

Psychiatry
Residents will rotate in a specialized psychiatric unit for the required ACGME rotation at Jefferson Hospital for Neurosciences.  The resident will take care of geriatric patients suffering from various cognitive, behavioral, and movement disorders.  Residents will also have the opportunity to gain exposure to ECT for depression.  During this month, the resident will also work to develop a stronger appreciation for acute and chronic pharmacologic effects.  Residents may also choose to spend their months in other available psychiatric services including the inpatient psychiatric unit at Gibbon Hospital or inpatient consultation services.

Neuropathology
Residents will review slides on a one to one basis with a neuropathology attending on a daily basis and will attend weekly neuropathology conferences and weekly brain cutting sessions.

Neuro-ophthalmology
Residents will have the opportunity to work at Wills Eye Hospital, one of the top ophthalmology centers in the United States, within the Neuro-opththalmology division.  Among other skills, residents will gain proficiency in checking vision, acuity, peripheral fields, and fundoscopic examination.  Residents will help to manage patients with ocular manifestations of various conditions, such as autoimmune diseases, optic neuropathy, myasthenia gravis, and the ocular disorders that may occur with brain tumors, AIDS and stroke.