Neurology Residency Training Program

Welcome to the Neurological Institute of New York at Columbia University Medical Center and New York Presbyterian Hospital! This brief summary provides information about our Neurology Residency Training Program Synopsis.

The Neurology Residency Program at Columbia is one of the premier neurology training programs in the country. Established in 1948, the program has a long-standing tradition of academic excellence and prestige.

The basic goals of the Neurology Residency Training Program are: to provide the highest caliber of training and mentorship for residents in neurology, and to produce graduates who are exceptional neurologists, clinical investigators, neuroscientists, educators and leaders.

How to Apply

I. Program size and NRMP codes

The program offers positions for ten neurology residents per year (beginning July 2007), including combined 4-year Medicine/Neurology positions.

The program in Pediatric Neurology enrolls 2 residents per year

Neurology Advanced (categorical) program:	1495180A0	[3 years]
Medicine Preliminary program:	1495140P0	[1 year]
Medicine Preliminary – Neurology:	1495140P1	[4-year program]

II. Hospital Centers

1. Columbia University Medical Center [Columbia-Presbyterian Medical Center]
2. Harlem Hospital Center

III. Core Curriculum in Adult Neurology

There are six major clinical components of the residency program – ward-based neurology, consultation service, ambulatory care, intensive care unit neurology, pediatric neurology, and subspecialty neurology training. Each educational experience has objectives that are framed by the six core competencies of graduate medical education: patient care, medical knowledge, practice-based learning, interpersonal/communication skills, professionalism and systems-based practice. The neurology residency at Columbia provides a state-of-the art training that emphasizes clinical skills, advanced neuroimaging and therapeutics, subspecialty depth, research opportunities and resident scholarship.

Throughout their training, Columbia neurology residents participate with increasing independence in all aspects of patient care, and have experiences in adult and pediatric inpatient neurology, the neurological intensive care unit, stroke unit, epilepsy monitoring unit, consultation services, emergency room, ambulatory care, and all major subspecialties of neurology. The large and diverse patient volume provides our trainees with an unsurpassed depth of experience. Because the hospital serves a large urban population, residents have exposure to both common neurological problems encountered in our local community, as well as to patients referred for tertiary and quaternary care of rare and complex neurological disorders.

The collegial environment at Columbia and its subspecialty organization foster excellence in all areas of neurology. There are abundant opportunities for learning, from bedside and clinical rounds to formal conferences and seminars. Clinical teaching occurs against a background of exceptionally strong neuroscience, as understanding the underlying neurobiology of neurological disorders is an essential element in the training and development of future neurologists. Faculty members are readily accessible and offer many opportunities for personal interactions between trainees and renowned experts in neuroscience and nearly all subspecialty areas of neurology.

IV. Block diagram

The first year of training provides an intense exposure to basic clinical neurology [including clinical neuroanatomy], the neurological emergencies, neurocritical care and stroke.

During the second year, residents gain exposure to the subspecialties of epilepsy and neuromuscular disease, become team leaders on the consultation and ward services, participate to an increasing extent in medical education, and develop their research projects.

The third year of training provides an opportunity to gain expertise in all of the neurology subspecialties, accomplish research, consolidate a large body of neurological knowledge in preparation for board certification, and to plan the next career step, whether fellowship training, research or clinical practice.

The block diagram of the neurology curriculum is provided below:

Rotation [mos.]	PGY-2	PGY-3	PGY-4
Ward - CUMC	4	1	1
Ward - Harlem	-	1	-
Consult - CUMC	1/2	2	1
Consult - Harlem	1	2	1
Ambulatory block	1	-	-
NICU	1 1/2	1	-
Night float	1	-	-
Pediatric neurology	1	1 1/2	1/2
EEG & EMG	-	2	-
Psychiatry	-	-	1
Elective	1	1/2	6 1/2 (or research)
Vacation	1	1	1
Total	12	12	12

Electives:

The Department of Neurology offers subspecialty electives within all the major subspecialities of neurology, including aging and dementia, epilepsy/EEG, neuromuscular/EMG, neuro-oncology, neuroimmunology/multiple sclerosis, neuro-ophthalmology, neuro-otology, movement disorders, pediatric neurology, neuropathology, neuroethics, as well as research and call-free/clinic-free travel electives

V. Recent innovations in the Residency Program

In the last two years, several important changes in the neurology program occurred, all of which have had a major impact on the educational experience at Columbia.

1. Program expansion

In order to (i) expand the educational curriculum, with an emphasis on increasing ambulatory and subspecialty exposure, and (ii) to establish a true flexible research pathway for neuroscientists, the residency program was expanded from 8 to 10 adult neurology residents per year, effective July 2007.

For residents, the program expansion has significantly reduced in service demands on the individual resident, within ACGME guidelines, and created the opportunity increased exposure to the ambulatory setting and subspecialty clinical neurology. For residents seeking a career in clinical research or neuroscience, the curriculum change allows sustained academic activity over consecutive months, a pre-requisite for effective research and the preparation of successful career grant applications.

2. Neurological Intensive Care Unit

The new, state-of-the-art 18-bed combined Neurological-Neurosurgical intensive care unit opened in 2006, and has transformed the neurology service at Columbia. The facility, under the direction of Dr. Stephan Mayer, is equipped with the most sophisticated medical technology, including its own CT and MRI scanners, and provides advanced care to the most complicated and urgent neurological cases, often transferred from outside hospitals. The NICU has its own active fellowship program, carries out cutting edge clinical research, and plays an essential role in the education of Columbia neurologists.

3. Hospitalist Service

Beginning in 2006, an-inpatient hospitalist service, headed by Dr. Laura Lennihan, was developed to provide care for patients transferred from the NICU. These individuals often present a complex array of acute neurological problems, medical illness, and unique rehabilitation requirements. To meet the needs of this population, the hospitalist service provides a multidisciplinary approach that is not dependent on the residency program. Nonetheless, in its emphasis on neurorehabilitation and system-based medicine, the service carries out a potentially important educational function in the training of neurologists.

4. Clinical and Research Mentorship

All first year (PGY-2) neurology residents are paired with a faculty neurologist who serves as a clinical mentor. The clinical mentorship program, administered by Dr. Melodie Winawer, enables residents to establish regular and long-term contact with a faculty adviser who is available to review clinical skills, provide opportunities to see patients in the office, or simply offer encouragement and support during the early months of residency.

The research mentorship program is a more formal arrangement between the residency program and the Department that begins during the second year of neurology training, and is administered by Dr. Mitchell Elkind. Every PGY-3 and PGY-4 resident is matched with a faculty research mentor who will supervise and guide the resident through a research project. The goal of the program is to provide each resident with training and experience in clinical research. Research projects are presented as posters or platforms at Resident Research Day in June. Residents are further encouraged to submit their final projects for presentation at meetings and publication.

Individuals with career research ambitions are paired with Columbia clinician-researchers to plan their fellowship and grant application process during the second and third years of the residency. The electives are a valuable means of exploring the subspecialties of neurology, and it is possible for senior residents to begin taking advantage of Columbia’s many academic resources, including the School of Public Health, to develop the next stage of their careers.

In addition to clinical research mentorship, the neurology training program offers research tracks funded through the NIH for clinician-scientists, with the eventual goal of establishing a career as an independent laboratory investigator.

5. Psychiatry Training

Beginning in 2006, the ACGME and American Board of Psychiatry and Neurology (ABPN) require that all neurology residents participate in a one-month psychiatry training experience. The New York State Psychiatric Institute and Columbia’s Department of Psychiatry have collaborated with the Neurology Residency Program to provide a four-week clinical experience to our neurology program, divided between the psychiatric emergency room and the in-patient psychiatry consult liaison service. Residents are supervised by staff psychiatrists as they evaluate and treat the common psychiatry emergencies. The didactic curriculum includes lectures and case conferences on the evaluation of suicidality, assessment of the agitated patient, informed consent and capacity, voluntary versus involuntary commitment, confidentiality, substance abuse, intoxication and withdrawal, sociopathy, and the medical psychiatric patient

6. Neuroethics at Columbia

With the increasing emphasis on ethics in medicine, the residency program in neurology, together with Columbia Center for Bioethics [http://www.bioethicscolumbia.org/], has pioneered a curriculum in neuroethics. The curriculum includes quarterly ethics conferences, led by a faculty preceptor, to explore and discuss topics of importance to practicing and academic neurologists, including terminal issues, medical futility, informed consent and health proxy.

VI. Salary & Benefits

Salary, benefits, malpractice and academic policies are determined by the Accreditation Council of Graduate Medical Education (ACGME), and vary by region.

The 2007-2008 salary scale for all Columbia University residents is:

A complete benefits package is provided to all residents, comprising medical coverage, dental coverage, disability insurance, and life insurance. An additional bi-annual resident allowance of $1500. for housing is available through the Graduate Medical Education (GME) Department.

VII. Academic allowances

Academic allowances have remained stable for some years, and are not expected to change in the coming year. These allowances are summarized:

In addition, all residents are provided with American Academy of Neurology membership, a benefit that includes a subscription to the journal Neurology.

VIII. Call schedule

The frequency and duration of overnight call in the hospital is closely regulated and monitored by the ACGME. In addition, New York State imposes careful restrictions on residents’ call schedules.

Currently, neurology residents take call one night in four when on active service during the first year. Residents are required to leave the hospital by 11:00 am following a night on call, and many procedures have been put in place to facilitate a timely departure, including: a time cap for late admissions, a night float system to handle cross-coverage care, an early (7:00 am) start time for morning rounds, extensive involvement of our nurse practitioners and careful oversight of the sign-out process. Residents do not attend clinic after taking call, and residents’ longitudinal clinics are scheduled to account for night call duty.

Additional resident schedule requirements for New York State are:

• no more than 80 work hours per week
• minimum 10 hours between shifts
• each shift is no longer than 24 hours + 3 hours of information transfer (27 total)
• at least 24 hours of consecutive free time each week, averaged over 1 month

The average number of admissions to the Neurology Service at CUMC is 6 per 24-hour cycle; and at Harlem Hospital, the average is one admission per day. The consultation services at both hospitals have extensive and continuous supervision and from the attending staff. At CUMC, the Stroke Service, Neurocritical care service and Epilepsy Service all aid the consultation service in the prompt evaluation and treatment of neurological emergencies.

IX. Ambulatory clinics

i. During the PGY-2 year, residents begin a weekly continuity clinic in general neurology lasting the duration of their residency. The clinics are staffed by members of the general neurology division, under the direction of Dr. Peter Kim.

ii. During the PGY-3 and PGY-4 years, residents spend 6-month blocks in subspecialty clinics (movement disorders, epilepsy, neuromuscular, neuro-oncology, pain/headache, multiple sclerosis), while maintaining their continuity clinic.

In other words, residents have two afternoons in clinic each week: a general neurology clinic and a subspecialty clinic. Residents do not participate in clinic after they have been on call, so their patients are re-scheduled for the following week.

In addition to their own longitudinal clinics, residents have abundant opportunity to experience the clinical practice of neurology within every subspecialty setting. A highlight of the first year (PGY-2) of neurology training is the ambulatory neurology rotation, coordinated by Dr. Kirk Roberts, and situated in the office of the General Neurology Group on NI-2. On this one-month rotation early in training, first year neurology residents rotate through general and subspecialty ambulatory settings, and evaluate their own patients under the supervision of attending neurologists.

X. Resident Evaluations

The evaluation of resident performance is multi-dimensional, and includes observation and feedback from attending staff, nurse practitioners, peers, and medical students. The Department uses E*Value, a web-based evaluation system, to evaluate and document resident performance.

Current PGY-2 residents, and subsequent classes, are asked to build a neurology portfolio containing their clinical and scholarly accomplishments, especially with regard to the core competencies of graduate medical education. The portfolio includes, but is not limited to, documentation of cases, procedures, systems-based practice, teaching activities, committee participation and presentations at conferences, including Morbidity & Mortality conference, Journal Club, and Research Day. Much of this information will eventually be needed for licensure and board certification in the future. Resident evaluation also takes into account in-service examination scores, performance on the simulated oral board exam, academic output and publications.

All residents meet individually with the Residency Program Director, Dr. Blair Ford, and the Chairman of Neurology, Dr. Timothy Pedley, on a semi-annual basis to review performance and portfolio.

XI. Summary

The Neurology Training Program at Columbia offers a rich and challenging educational experience that combines clinical excellence, sub-specialty depth, unparalleled exposure to the entire range of neurological disease, exciting research and scholarship opportunities, dedicated mentorship, and collegiality. Graduates of the program are poised to develop successful careers of their choice, whether in research, neuroscience, education or clinical practice. The opportunity to work and live as a resident in one of the world’s great cities, a vibrant metropolis full of culture and excitement, is an essential part of the experience at Columbia.

Ms. Christy Cesta Education Administrator [212] 305-1338 ccesta@neuro.columbia.edu

Dr. Blair Ford Residency Program Director [212] 305-5548 bford@neuro.columbia.edu

Resident Research