Clinical Excellence

AHR

This 20 bed ICU serves both BWH neurology and neurosurgical patients. The neurology ICU team, which is named after the current BWH vice-chair Allan H. Ropper, consists of one junior resident (PGY2/NM1), one senior resident (PGY3/NM2), nurse practitioners, a critical care fellow, and an ICU attending. The NM1 and NM2 care for neurology patients within the ICU, many of whom present with large strokes requiring catheter-based or surgical intervention, large intracerebral hemorrhages, GBS with respiratory failure, or status epilepticus. This rotation consists of two weeks of days (with one 24-hour call) followed by two weeks of nightfloat.

CMF

The MGH CMF Service is a ward service that primarily admits stroke and vascular cases. It is named after the eminent MGH neurologist, C. Miller Fisher. The service is comprised of junior neurology residents, PM&R rotating residents, an NP, a senior resident and an attending. Call is every fourth night. As with all of our services, there is a senior resident on call overnight in house with junior residents at all times.

DMD/SKF

The BWH DMD Service is a ward service named after the eminent BWH neurologists, David M. Dawson and Steven K. Feske. The service is comprised of four junior residents, physician assistants, two senior residents, and two attendings. This is a busy service that cares for patients with a wide variety of neurological diseases (stroke, neuro-oncology, epilepsy, neuro-ID). Call is every fourth night. As with all of our services, there is a senior resident on call overnight in house with junior residents at all times. We have nocturnal physician assistants that take overnight call with our junior residents to share in the responsibility of caring for our inpatients, maximizing the balance between clinical service and education for our residents.

EBB

This rotation, named after the late BWH epileptologist Ed Bromfield, consists of caring for patients admitted to the BWH long-term epilepsy monitoring unit, alongside a PA and the epilepsy fellows. Since patient volume is generally light, significant portions of the rotation are spent learning to read EEGs one-on-one with epilepsy attendings and fellows. Residents cover the MGH ED on Friday nights.

MED

The MGH neurology service provides dedicated consultation to the emergency department at all times. While on this busy service, the junior resident takes neurology consults from the MGH ED. This rotation, although hectic and busy, is a favorite of the residents because of the opportunity to see a fantastic array of various neurologic illnesses as a first responder. The range of cases is enormous, from benign headaches to intractable seizures, and goes through a myriad of chief complaints including confusion, back pain, numbness, headache, weakness, blurred vision, slurred speech, tingling, and 'dizziness'. A significant proportion of consults are for acute strokes and hemorrhages, which are triaged with the stroke/critical care team. The ED has both CT/CTA and MRI scanners for neurology patients, and you work closely with neurosurgery, neuroradiology, neurointerventional, stroke/critical care, and a wide variety of subspecialty attendings. Shifts are either 7am-7pm or 7pm-7am. NM2 residents support the NM1 during a “twilight” shift from 2pm – 10pm.

Our first-year residents now have nine weeks of outpatient clinic in their first year, which are interspersed about every five weeks between inpatient rotations. These clinics will be at BWH, MGH, and the VA hospital and provide exposure to both common neurologic complaints and subspecialty neurology, including opportunities to rotate in the Multiple Sclerosis clinic, ALS clinic, Movement Disorder clinic, and Memory Disorder clinic. Some of these outpatient blocks are completely customizable, so that residents can explore particular subspecialties that interest them the most. There are occasional cross-coverage requirements during this block including weekend neuro ICU coverage at MGH.

RDA

The MGH RDA Service is a ward service named after Raymond D. Adams (an eminent MGH neurologist known for Victor and Adams' Principles of Neurology). This team is comprised of junior neurology residents, rotating pediatric neurology residents, an NP, a senior resident and an attending. The RDA service admits a wide variety of neurological cases, but mainly focuses on non-vascular neurological diseases. Cases often include epilepsy, demyelinating disease, neuroinfectious diseases, and movement disorders but a significant proportion includes unusual mystery diagnoses (neurological 'zebras'). Many New England Journal neurology CPC cases come from this service. This service operates on a rotating day/twilight/night schedule. As with all of our services, there is a senior resident with the juniors (in-house) at all times.

BCH

Pediatrics/Children’s Hospital: Residents spend one month rotating through pediatric neurology at Boston Children’s Hospital. This experience can include exposure to epilepsy and general neurology inpatient services as well as ED consults. There are occasional overnight call responsibilities on this rotation.

Residents have 10 weeks of elective for self-directed study, research, or sub-specialty clinical activity. Many residents take these opportunities for longitudinal research projects, international neurology training, or clinical training in areas of particular interest. There are no call responsibilities during elective blocks in order to maximize the educational, research, and academic goals of the elective experience; however, there are occasional cross-coverage requirements as the in-house overnight senior resident at MGH.

Residents on Jeopardy serve as back-up sick call for the residency. This is considered a clinical rotation and residents may be asked to cover any of the NM1 or NM2 rotations that may require coverage. During days not on service, Jeopardy time may be used for independent study or research.

MAS Senior

The MAS service is the BWH consult service named for Martin A. Samuels, the former Chair of the BWH Neurology Department. This service consists of three NM2 residents, rotating internal medicine and psychiatry residents, medical students, an NM3 senior resident and an attending. The NM3 coordinates all consults and assigns inpatient consults to the NM2s and rotating residents. A dedicated NM2 sees all consults in the BWH Emergency Department. There are three NM2 residents on this rotation at any given time, with one resident on from 7am-7pm, one resident overnight 7pm-7am, and one resident in the ED from 11am-7pm. At night, the overnight NM2 resident is the in-house senior resident for BWH and oversees new consults and the junior residents on the ward services.

With the attending neurologist, the NM2 consult senior resident is responsible for evaluating all non-stroke/ICU consultations from inpatient services at MGH. Often, the consult team includes medical students and rotating internal medicine residents, who are all under the supervision of the NM2 resident. On Saturdays, the MGH consult senior covers inpatient consults and the MGH ED.

The NM2 stroke consult senior takes all stroke/ICU consults at MGH. This senior resident is responsible for supervising the stroke consult team, which may also include rotating medical students and medicine residents. On Friday nights, the MGH stroke senior covers the MGH ICU with the neurocritical care fellow or serves as the in-house MGH overnight senior resident.

ONC

Residents rotate on the MGH inpatient neuro-oncology service and work closely with the neuro-oncology fellows, nurse practitioners, and attendings to provide care to this patient population. Each week, the resident attends outpatient neuro-oncology clinics at MGH or the Dana-Farber Institute. There is no overnight call responsibility on this rotation.

NM2 residents gain outpatient subspecialty experience across multiple clinics including behavioral neurology, epilepsy, movement disorders, MS, neuromuscular, neuro-otology, neuro-oncology, and neuro-ophthalmology. There are no scheduled weekend duties on this block, but residents on this rotation serve as Jeopardy on the weekends.

This block provides an in-depth focus on neurophysiology and epilepsy management taught through hands-on tutorials in EEG interpretation at the Jamaica Plain VA Hospital. Residents will be exposed to a breadth of complex epilepsy cases in the VA Epilepsy clinic and take part in the weekly epilepsy didactic conference series. There is one night of call as the in-house MGH overnight senior resident during this block.