Best One-hospital neurology programs

[Jonath00]

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What do you think are the best one-hospital Neurology programs (in terms of overall training, resident satisfaction, etc)? Thank you.

 

[neurologist]

What do you think are the best one-hospital Neurology programs (in terms of overall training, call volume, resident satisfaction, etc)? Thank you.

Mayo.

 

[GopherBrain]

Why one hospital? I'm biased, but I just don't think any one hospital could possibly provide the variety of patients that the multi-hospital places can.

 

[Onco]

Mayo.

Rhode Island Hospital - Brown

 

[typhoonegator]

Rhode Island Hospital - Brown

Seriously? Maybe things have changed...

I agree with GopherBrain on this one; a multi-hospital system adds breadth and depth you could never get with a one-hospital model. As painful as it is to learn the culture at multiple hospitals, you are most certainly better off for it. At least, that has been my experience. Could you elucidate a bit on why one hospital is so important?

 

[neurologist]

Why one hospital? I'm biased, but I just don't think any one hospital could possibly provide the variety of patients that the multi-hospital places can.

I'm biased too, but in a different way. More hospitals just means that you will become more of a "hospital neurologist." However, the vast majority of neurology takes place in the outpatient setting, not the hospital. Lots of the multi-hospital programs give you at best, what, 1/2 day a week of "continuity clinic"? And the other 5 days you are mostly running around doing ward scut to dispo patients.

IMHO, a really good neuro residency would maximize outpatient clinic opportunities, maybe with a system of alternating month-on-hospital and month-of-full-time-clinic rotations. Too many of them are "3 months of ward neuro at each of our 4 hospitals," for all three years of residency, with minimal outpatient contact. Of course, the entire reason for this is to provide cheap labor to the hospitals, but that's a whole different rant . . . 😀

Anyway, there's nothing wrong with a one-hospital system as long as that one hospital draws a heterogenous population from a fairly large area.

 

[Nerdoscience]

Not to diss Mayo, because it's really a super-top notch program, but there are definitely weaknesses to being in a small town next to a larger metropolitan area, and being almost entirely a referral center. For instance, you're not going to see as many acute strokes. As much as they say you see enough of the "bread and butter" stuff, you won't see nearly as much as others. This is more important to some subspecialties than others.

Many programs have you at one adult hospital, one Children's hospital, and one VA. I don't feel that this really counts as a multi-hospital program in many ways, even though it would be technically.

 

[neurologist]

Not to diss Mayo, because it's really a super-top notch program, but there are definitely weaknesses to being in a small town next to a larger metropolitan area, and being almost entirely a referral center. For instance, you're not going to see as many acute strokes. As much as they say you see enough of the "bread and butter" stuff, you won't see nearly as much as others. This is more important to some subspecialties than others.

Have you been to Mayo? There is plenty of bread and butter stuff, because Mayo is the only game in town, and the vast majority of it's patients are actually local, or at least no more distant than in any other big-hospital-in-a-small-city-covering-a-big-geographic-area place (Dartmouth, Rochester NY, UVA, etc come to mind -- think those are "weak" programs, too?). If you think they don't see enough acute strokes, maybe you should go hang out with the resident covering the stroke service some night.

(And besides (WARNING: highly biased rant coming . . . 😀 ) how many acute strokes do you need to see? After the first hundred or so they all become just variations on the same theme; sure, there are some neat neuroanatomic peculiarities every once in a while, but the acute treatement is not highly variable).

Anyway, whether it's one hospital or seventeen, I think a more balanced in/outpatient curriculum is more important than one emphasizing heavy inpatient case load.

 

[kcumbDO]

mayo is awesome, i hope i have the priveledge of doing my prelim and neuro there, i ranked them number 1 and praying for good results on match day.

 

[Mollaret]

And besides (WARNING: highly biased rant coming . . . 😀 ) how many acute strokes do you need to see? After the first hundred or so they all become just variations on the same theme; sure, there are some neat neuroanatomic peculiarities every once in a while, but the acute treatement is not highly variable).

I realize that you are biased, but this argument is ridiculous. After you are in practice for a while, you will realize that vascular neurology has become highly specialized. There is nothing routine about the care of stroke patients. Quick aside:

C. Miller Fisher, M.D. was once told by a neurology resident at MGH that they could wait to see a patient later on rounds becuase they had "just a routine stroke." Dr. Fisher responded immediately, "That's very exciting...I've never seen a routine stroke before...let's go see the patient right now."

However, Mayo is an excellent program where a resident should expect to see both the "horses" and the "zebras", and learn to tell the difference between them.

 

[R-Me-Doc]

.

 

[Jonath00]

I realize that you are biased, but this argument is ridiculous. After you are in practice for a while, you will realize that vascular neurology has become highly specialized. There is nothing routine about the care of stroke patients. Quick aside:

C. Miller Fisher, M.D. was once told by a neurology resident at MGH that they could wait to see a patient later on rounds becuase they had "just a routine stroke." Dr. Fisher responded immediately, "That's very exciting...I've never seen a routine stroke before...let's go see the patient right now."

Neurologist is thinking in terms of a trainee not a stroke attending. 😉