The Neurology Residency Program

Thomas Scott, M.D., Program Director

Length of program: 3 years
Number of position(s): 6

The three-year Neurology Residency Program places a strong emphasis on traditional bedside teaching and the use of sophisticated technology in all aspects of the neurosciences, including basic neuro-sciences research. Applicants must have completed one year of graduate training beyond receipt of their medical degree. This year must include a minimum of eight months of internal medicine with no more than two months in neurology.

The case mix on the Neurology Service is remarkably protean and includes examples of common neurological disorders as well as unusual conditions. In each case, house staff officers are closely and personally supervised by senior attending physicians. This includes traditional history-taking and neurological examination and the interpretation of advanced investigations.

In addition to the emphasis on traditional, classical neurology, residents are regularly involved in diagnosing and treating patients in the hospital's internal medicine, neuro-oncology, neuro-ophthalmology, neuro-otology, neuropathology, neuropsychiatry and neurosurgery services. Residents from these services have the opportunity to rotate through neurology, allowing neurology residents to interact with those who take a different approach to neurological disorders.

Clinical Services

Comprehensive Epilepsy Service
In response to a need for comprehensive epilepsy services in Western Pennsylvania, Allegheny General Hospital's Department of Neurology established the first such program in Pittsburgh in 1988. More than 2000 patients are evaluated through the program annually. Patients are offered the coordinated services of neurology, neurosurgery, psychiatry, neuropsychiatry, social services and nursing for treatment of their epilepsy.

The comprehensive evaluation and treatment planning for the patients relies on a variety of diagnostic procedures, including continuous digital video-EEG monitoring, subdural grid electrocorticography, MRI, CT, PET, neuropsychological evaluation, intra-carotid procedures and full pathological and blood laboratory support.

Program services include a weekly outpatient epilepsy clinic staffed by epileptologists, neuropsychologists and neurology residents. Presurgical evaluation and treatment are offered in conjunction with the Department of Neurosurgery. The program also has a bi-weekly interdisciplinary refractory epilepsy conference for the comprehensive evaluation of patients being considered as candidates for epilepsy surgery.

As part of a commitment to improve patient care, health-care professionals in the Comprehensive Epilepsy Service are involved in several studies that may benefit people with epilepsy. Ongoing research projects include:

• Basic research investigating the mechanisms of post-stroke seizures and epilepsy
• Clinical testing of investigational anti-epileptic drugs in patients who do not respond to conventional anti-epileptic drugs
• Hormonal therapy in catamenial epilepsy

Neurology residents are expected to become proficient in interpreting digital EEGs, seizure patterns on video-EEG monitoring and caring for patients with a variety of seizure disorders. They also become proficient in selecting the appropriate medication for different seizure types and making decisions as to when surgical intervention is appropriate.

Comprehensive Stroke Service
Through its multidisciplinary approach to prevention, assessment, diagnosis, therapeutic intervention and research, the Comprehensive Stroke Service provides hundreds of patients each year with an integrated, thorough level of care.

The Stroke Profile Prevention Program offers complete outpatient evaluations of high-risk candidates using neurovascular imaging and laboratory tests. Neurodiagnostic capabilities within the Department of Radiology include MRI, transcranial and carotid duplex analysis. Through the program, patients who have experienced strokes will undergo periodic evaluations to assess the efficacy of their medical or surgical treatment.

A Brain Attack Program has existed for more than two years, treating more than 500 patients in 2002. Developed by the Department of Neurology in conjunction with the Department of Neurosurgery, the Brain Attack Program is designed to provide interventional therapy for stroke. Therapy consists of clinical trials of neuroprotective agents and thrombolytic agents administered intravenously and intra-arterially.

Neurology residents become proficient in diagnosing and treating stroke as well as learning modern therapies for stroke prevention. All residents are trained in the National Institutes of Health Stroke Scale for participation in clinical trials for neuroprotective medication and thrombolytic therapy.

Spasticity and Movement Disorder Center
Allegheny General Hospital's Spasticity and Movement Disorder Center is designed to provide thorough, coordinated care to patients with increased muscle tone and abnormal body movements resulting from any number of medical conditions, including:

• Parkinson's disease
• Tremor
• Spasticity
• Stroke
• Brain injury
• Multiple sclerosis
• Dystonia
• Cerebral palsy
• Huntington's disease
• Neuralgia

To take full advantage of these new therapies, Allegheny General Hospital and its staff neurologists, have created a multidisciplinary approach to evaluating and treating patients whose lives have been disrupted by increased muscle tone or abnormal body movements. The Center's goal is to reduce both the abnormal muscle tone and the amount and frequency of irregular body movements to improve a patient's ability to function and, therefore, help regain a more independent lifestyle.

Allegheny General's specialists in the fields of neurology, neurosurgery, anesthesiology, pain management and physical medicine participate in the Center, which is designed to provide comprehensive care that is also personalized to meet each person's needs. These specialists use the most recent advances in diagnosis and treatment, with advancing new surgical procedures when medication alone is not adequate.

Allegheny General Hospital has been designated one of 20 centers nationwide for excellence in the diagnosis and treatment of Parkinson's disease and other movement disorders.

Multiple Sclerosis (MS)
Allegheny General Hospital's Department of Neurology is a member of the Consortium of Multiple Sclerosis Centers, a national group of recognized leaders in developing new treatments for MS. The department participates in multi-center drug trials involving novel therapies for MS. These have included the most recent immune modulating therapies.

Residents learn the variety of manifestations of multiple sclerosis and medications available for symptomatic therapy and prevention of recurrent attacks.

Curriculum

Teaching rounds are conducted daily. Residents in the Department of Neurology see patients each week in the subspecialty and general neurology clinics as well as in a private practice setting.

Neurology residents in the department's teaching program are involved in supervising and training medical students and are encouraged to participate in the department's research activities.

In the second week of June each year, neurology residents are expected to present the clinical or laboratory research in which they have been involved. Residents are encouraged to present their work at national and international meetings, through platform or poster presentations, with the supervision of a faculty member.

The department also provides a clinical neurosciences research training track, which includes a lecture series on topics ranging from research design and basic statistics to ethics and the preparation of manuscripts for editorial review. PGY-3 residents also are encouraged to complete either a three-month (part-time) or one-month (full-time) rotation in clinical neurosciences research. Full computer databasing, statistical support and individual mentorship on research projects are provided.

The conference schedule includes a neuroscience conference, weekly basic neuroscience lectures, case reviews, a monthly Journal Club and lectures in neuro-ophthalmology, neuroradiology, electroencephalography and neuro-pathology. Morning report takes place each Monday and Thursday morning.

Clinical Rotations

PGY-2	Ten months	Adult Inpatient and Adult Neurology Consults
	Two months	Electives*
PGY-3	Three months	Electives*
	One month	Pediatrics
	One month	Psychiatry
	Two months	Adult Inpatient and Adult Neurology Consults
	Three months	Outpatient Office/Specialty Clinics
	One month	Pediatrics
	One month	Neurorehabilitation
PGY-4	Six months	Chief resident, Inpatient Service
	Four months	Electives*
	Two months	Pediatrics

* Clinical electives are available in Electrodiagnostic Laboratory, neuro-ophthalmology, neuro-otology, neuro-pathology, neuroradiology, neurosurgery, psychiatry, behavioral neurology, outpatient offices and subspecialty (epilepsy, stroke, multiple sclerosis and movement disorder) clinics.

A two-month outside rotation in child neurology is scheduled in PGY-3 and PGY-4. During these rotations, residents become proficient in evaluating and treating diseases of the neonate, child and adolescent and obtain extensive inpatient and outpatient experiences.



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