Neurology Residency Program
Policies and Procedures
Appointment and Selection
Promotion
Dismissal and Grievance
Evaluation, Supervision and Duty Hours
Moonlighting
Appointment and Selection
The Neurology Program will select residents after screening applications,
inviting qualified candidates for interviews and evaluation by faculty and
current residents. The rank order list will be prepared by the Program
Director after consultation with the faculty and chief resident.
Promotion
A resident will be promoted when, in the opinion of the faculty, the
resident has performed acceptably and demonstrated mastery of the knowledge
and skills at the current level and has no non-academic performance matters
which warrant attention by the Program Director.
Dismissal and Grievance
Dismissal
The Program Director has broad latitude to act for the good of the program,
in the interest of patients and as a resident advocate.
The Program Director and other faculty as needed may counsel a resident who
fails to perform satisfactorily. A period of probation and performance goals
may be established by the Program Director and approved by the faculty. A
resident who fails to meet the established goals during the period of
probation may be dismissed. This information will be communicated with the
resident and documented in the file.
A resident may be dismissed when the Program Director finds academic
deficiencies or non-academic performance difficulties which cast grave
doubts upon the resident's potential capacities as a neurologist.
A resident will be afforded appropriate due process when the circumstances
warrant it.
Grievance
The resident's chief resident, faculty advisor and residency director are
available to advise/assist the house officer with any grievance they may
have.
The Department follows institutional policies, which require multilevel
hearings, due
process, timely notice and accurate records if disciplinary action is
required. Residents appeal any disciplinary decision through the Residency
Director. When the appeal is before the departmental RRC, the house officer
may chose to speak directly to the committee and/or have their chief
resident, faculty advisor, or residency director present their appeal. The
response will be promptly discussed with the resident.
After a departmental decision has been made, the House Officer may appeal
decisions to Dean of the School of Medicine within 10 working days after
being notified of the Chairperson's final decision and the reason the House
Officer is asking that the decision be reversed or modified.
The House Officer may or may not remain on duty during the appeals procedure
depending on the nature of the issue involved and the departmental RRC's
decision. The Department, upon becoming aware that an appeal is being made,
will advise Hospital Administration, through the appropriate Assistant
Hospital Director, of such appeal.
Evaluation, Supervision and Duty Hours
Faculty evaluation
Each spring every resident completes an evaluation of the residency program.
Program area evaluations are reviewed at the following faculty meeting. The
chairman reviews faculty evaluations individually with faculty members.
Resident Evaluation
Each resident is evaluated by the responsible "on service" faculty member at
the end of each month of rotation. The resident is asked to review
evaluation and record his comments. The Residency Director reviews these
results individually with the resident at least every 3 months or
immediately, if either the faculty member or resident notes any problems.
Monthly assessments are filed in each resident's evaluation folder and may
be reviewed by the resident at any time.
The Departmental Residency Review Committee (RRC) consists of the Clinical
Faculty. This committee meets monthly to review the course of the training
program, resident performance records, and mediates problems as they are
identified.
Residents choose faculty advisors during their first year and they meet
throughout their residency. Faculty help residents chose elective, organize
and supervise research or other scholarly activities, and advise them
professional concerns such as choosing career paths.
When resident performance warrants further intervention, a formal conference
between the resident, her/his advisor and/or the program director is held.
If serious problems are present, a status of "probation" is established
after the situation is reviewed by the departmental RRC. The resident is
informed of this action and a written copy of specific goals to be achieved
by the resident are reviewed with him, signed, and filed. Probationary
status is permitted only for a limited time; outlined goals must be met
within the agreed upon time period, to have this status removed.
Supervision and Duty Hours
General Notes
The MCG Neurology residency will adhere to ACGME guidelines concerning
attending physician supervision of residents and resident duty hours. This
includes adhering to the maximum of an 80-hour average workweek and the
24-hour in-house call provisions of the ACGME. There will be a minimum of 10
hours between work periods. Senior residents (PGY-3 and PGY-4) do not have
in-house call and therefore will not fall under the 24 hour on call statute.
Senior residents who moonlight outside their MCG residency duties must
adhere to the 80-hour maximum average workweek (see Section V.)
Monday through Friday each workday will officially start with Morning Report
at 7:30am.
Residents are given a total of 3 weeks or 21 working days of vacation each
year. In general, vacation and time off for professional meetings should be
taken during Subspecialty rotations and electives. Time of during a general
rotation is discouraged but if time off is required during a general
rotation (neurology ward, neurology consults, or neurology practice site),
it is the responsibility of the resident to obtain approval from the chief
resident, then supervising attending, then residency director. This must be
done 2 months in advance for vacations and at least 30 days in advance for
other absences. No more than 7 days vacation may be taken out of the
Pediatric Neurology rotation during the 3 years. Notification to the
clinics, ward service, consult service, paging operator, etc. is the
responsibility of the resident.
Night Call Responsibilities
(5:00pm - 8:00 am) and weekends are covered by a junior resident (First
Call) and a senior resident (Second Call). Coverage includes wards,
consults, and ER's for both MCG and the VAMC.
Calls from the neurology ward go first to the junior resident. If there is
any question, the senior resident, and if necessary, the attending should be
called.
Calls from the Epilepsy Service go to the junior resident on call. These
include patients in the unit as well as post op patients. If there is any
question, the Epilepsy Attending should be called. Patients in the Epilepsy
Monitoring Unit are there for monitoring of their seizures. If further
problems arise the attending should be called.
Calls from the MCG E.R. and from other MCG services (consults) go to the
junior resident. The call resident should evaluate the patient and call the
2nd call resident to review the case. If there is any question, the
attending should be called. If the consulting service asks for the neurology
the attending should be called.
Calls from outside E.R.'s and from referring physicians should go to the
neurology attending. The attending may call the junior resident or senior
resident to see the patient or deal with the situation, but the attending is
responsible and should be kept informed.
In the event that there are neurology patients in the intensive care units
of the VA Medical Center or the MCG Hospital, the first call person will be
expected to remain in house at MCG or VA. There is a designated neurology
call room on the 9th floor of MCG.
The first call person is expected to present all patients seen in consult or
seen in the MCG E.R. or VA-Life Support Unit to the second call resident.
The first call person is urged to check out any ward service problems with
the second call resident if he/she feels uncomfortable with the problem.
First call residents are not authorized to defer E.R. patients to the
neurology clinics. Appropriate clinic referral is the responsibility of the
second call resident, who is also responsible for notifying the clinic nurse
and practice site attending of the patient's scheduled appointment as early
as possible.
It is essential that the on call resident contact the ward team and the
consult service early the next morning, on weekends as well as weekdays, for
any admissions or medical follow up.
Meal money provided to the 1st call residents if they stay in house for
call. The money is transferred at the end of each month.
Residents are responsible for handling calls between 8:00 am- 5:00 pm from
their continuity clinic patients.
MCG and VA Ward Resident
Basic Responsibilities
The neurology ward resident is responsible for the care of all patients on
the neurology ward. The ward resident can assign an appropriate number of
patients to be followed by the associate, but the neurology resident should
have detailed knowledge of every patient's case. The associate should not be
primarily responsible for more than 2 of the ward patients.
The neurology ward resident should perform a primary admission neurological
examination on all patients on the ward service. If the initial history and
physical examination is done by another resident while on call, the
neurology ward resident should perform a neurological exam on the patient
the next day and document it in the chart.
The ward resident is responsible for making sure that the plan of action for
all ward patients is carried out. This includes writing orders, following up
laboratory data, writing consultation requests, and reviewing radiographic
studies. Some of these duties can be delegated to the associate and/or
students, but these must be supervised and reviewed by the neurology ward
resident.
The neurology ward resident is responsible for daily progress notes on all
patients on the neurology ward. The neurology resident should write the
progress notes on his/her patients and should ensure that the associate
writes daily progress notes on his/her patients. The student's notes should
be
reviewed and cosigned by either the ward resident or the associate who is
following that patient. However, student notes do not substitute for the
notes written by a physician.
Discharge summaries and letters to referring physicians are to be dictated
by the ward resident. Outpatient follow-up should be in the resident's
continuity clinic or with the appropriate attending, which ever is deemed
appropriate by the ward attending. A copy of the discharge summary should be
sent to the referring physician.
Discussion of the patient's case with the family members or referring
physicians may be done by either the ward resident, the associate, or the
attending, but it is the resident's responsibility with the attending
physician to ensure that the family and referring physicians are kept
updated.
The ward resident should obtain the assistance of the consult resident,
chief resident, or the ward attending in the event of an emergency with any
patient.
The ward resident and associate will handle all calls concerning the
inpatients on their service between 8:00 am - 5:00 pm.
The ward resident is responsible for checking out patients to the first call
(and when indicated, 2nd call) resident.
The VA ward resident must attend neurology clinic on Tuesday and Wednesday
mornings.
Work rounds should be made Monday - Friday by the neurology ward resident,
the neurology consult resident, the associate, and those students on wards
and consult service from 8:00 to 8:15 am, after morning report. The consult
resident is not required to round with the ward attending, but he/she should
have frequent communication with the ward attending.
Attending rounds should be made daily, These rounds should include the
neurology attending, the neurology ward resident, the rotator when not
assigned to clinic, and the students. Rounds should be held between 8:00 am
and 6:00 pm unless there are extenuating circumstances. Rounds should be
completed by 6:00 pm.
Both the MCG and VAMC neurology ward residents are required to attend their
resident continuity clinic. The VAMC ward resident will attend VAMC general
neurology clinics.
MCG and VAMC Consult Resident
Basic Responsibilities
The neurology consult resident is responsible for the care of all inpatient
consults seen by the neurology service. The consult team is responsible for
seeing consults from 8:00 am - 5:00 pm Monday - Friday. Consults must be
seen the same day they are called in. The consult resident should check out
inpatients consults with the on-call service when appropriate. All inpatient
consults will be seen and examined by the neurology consult resident and
presented to the consult attending in a timely fashion.
The neurology consult resident is responsible for seeing all neurology
consultations in the emergency room before a disposition is made. These
patients should be presented to the consult attending either verbally, or
the attending should see the patient personally. If a patient is to be
admitted either the consult or ward attending will also evaluate the
patient. The resident should notify the ward resident of admissions. If the
consult resident admits a patient is his responsibility to write admission
orders and the admission H & P.
Between 8:00 am and 5:00 pm, calls from outside ER's and physicians should
be directed to the consult attending, when requested.
The neurology consult resident must communicate effectively with the
referring service, ensuring that our recommendations are known by the
referring service. The consult resident should follow-up on any studies that
we recommend.
The neurology consult resident should arrange for neurology outpatient
follow-up for consult patients when it is necessary.
The neurology consult resident may assist the attending in handling phone
referrals and transfers from outside physicians and hospitals and directing
them appropriately.
The neurology consult resident is also responsible for supervision of the
associates and students who are on the consult service.
Consult rounds are to be arranged between the consult resident and attending
and should be finished by 6:00 pm.
The MCG and VAMC neurology consult residents are required to attend their
resident continuity clinic. The VAMC consult resident will be required to
attend the VAMC general neurology clinics.
MCG Practice Site Resident
Basic Responsibilities
The MCG practice site resident is responsible for seeing patients in the
neurology clinics as determined by the practice site schedule. The MCG
practice site resident will present all patients to the appropriate
attending.
The MCG practice site resident is responsible for following up laboratory
and x-ray studies ordered on patients in the general neurology clinics per
directions of attending. In addition, the resident is responsible for
conveying the results of the evaluations to the referring physician. This is
done by dictating a letter to the referring physician and by phone calls
when appropriate.
When a patient is admitted from the practice site, the practice site
resident is responsible for an admission history and physical admission
orders, and for informing the ward team.
EEG/Epilepsy Resident
Under the direction of the attending physician, the Epilepsy/EEG resident is
responsible for the care of all patients on the in-patient Epilepsy Service.
The Epilepsy/EEG resident is also responsible for seizure management of post
operative patients following epilepsy surgery.
Under the direction of the attending physician, the Epilepsy/EEG resident
attends the epilepsy clinics each week.
Under the direction of the attending physician, the Epilepsy/EEG resident is
responsible for reading the EEG's in the EEG/ EP Lab on a daily basis. The
resident should review the EEG's prior to the reading session with the
attending. The attending reading session is held each morning immediately
after Epilepsy Service rounds.
Each of the Epilepsy/EEG attending will provide a series of teaching
sessions to cover epilepsy and EEG during the rotation. This may include a
review of textbooks, review of articles, or other assignments.
EMG/Neuromuscular
Under the direction of the attending physician the EMG/Neuromuscular
resident will be responsible for the initial evaluation of patients referred
to the EMG laboratory for testing. This will include proper documentation
and generation of the results of all testing. EMG (needle examinations) will
be done under the direct supervision of the attending physician. The EMG/Neuromuscular
resident will also follow patients admitted to the inpatient neurology
service with primary neuromuscular problems and assist the ward resident
with daily evaluation and management. The EMG resident will attend the
weekly Muscular Dystrophy Association Clinic.
Pediatric Neurology
Under the direction of the attending physician the Pediatric Neurology
resident will be responsible for the care of patients admitted to the
pediatric neurology service, consultation requests to pediatric neurology
and will attend all pediatric neurology outpatient clinics. The pediatric
neurology resident will also return patient phone calls as directed by the
pediatric neurology attending.
V Moonlighting
Moonlighting outside the Neurology residency is allowed during the PGY-3 and
PGY B4 years. Moonlighting must be approved by the residency program
director and by the department chairmen. Moonlighting must not interfere
with residency responsibilities and moonlighting hours must comply with
policies concerning residency duty hours.